Analyzing County Health Budgets
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The document provides guidance on how to analyze county health budgets by examining allocation of funds to programs and economic categories, comparing budgets to actual expenditures, and calculating per capita spending. It finds that while county spending on health is increasing, personnel costs still account for the majority of recurrent budgets and development budgets have low absorption rates. The document recommends improving prioritization of expenditures, addressing disparities, establishing efficient supply planning, and rationalizing staffing levels.
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Analyzing County Health Budgets
- 1. Afya Pwani LAMU COUNTY How to analyze county health budgets Allocation and Expenditure Tom Oneko Senior Health Finance Advisor Afya Pwani January 15, 2018
- 2. Conducting Budget analysis • A close look at the actions the government is implementing, or plans to implement, to identify the funds allocated to these actions in the budget. • What should health advocates look for in budget? – How much will the government invest to achieve the expected results? – Are the proposed goals logical in relation to the estimated funds? – Which agency will be responsible for implementation?
- 3. Budget analysis Approach • For each represented county, list out the following Budget FY16/17 -17/18; – County government budget allocation to health – County health allocation to; • Recurrent • Development – County health budget allocation to programmes (PBB) – County health Recurrent budget allocation to economic categories – County health Development budget allocation to economic categories – County per capita health allocation 3
- 4. Recurrent Allocations • Personnel emoluments • Operation and Maintenance/Use of Goods and Services • Medical drugs • Non-pharmaceuticals • X-ray & Lab supplies • Training expenses • Not Specified/ break down not given • Other Recurrent
- 5. Development • Purchase/Upgrading / Construction of Buildings • Refurbishment of Buildings • Purchase of medical and dental equipment • Equipment (Non Medical) • other e.g Capital Transfers To Government Agencies; Other Development) • Purchase of Furniture and Fittings • Other Development ( not elsewhere classified)
- 6. National government allocation to health 6 20.3 26.1 28.5 29.0 30.7 15.9 21.3 30.6 31.3 31.0 36.2 47.4 59.1 60.3 61.7 3.4% 4.0% 3.9% 3.7% 3.1% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 2013/14 2014/15 2015/16 2016/17 2017/18 KshBillions Financial Year MoH Recurrent MoH Development MoH (recurrent +Development) MoH budget/expend. as a % of total GoK
- 7. Government allocation to health 7 3.4 4 3.9 3.7 3.1 13.5 21.5 23.4 25.2 27 7.8 5.5 7.5 7.7 7.6 7.7 0 5 10 15 20 25 30 FY 2012/13 (Before Devolution) FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 FY 2017/18 PercentofTotalGovern,entBudget MoH County Health Combined (National and County)
- 8. Percent of Total Budget allocated to Health
- 9. County gov’t budget allocation to health 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 0% 5% 10% 15% 20% 25% 30% 35% 40% Wajir Mandera Bomet Turkana Samburu TanaRiver Nairobi Narok Bungoma Nyandarua Kilifi Isiolo Marsabit Migori Kitui Mombasa UasinGishu Nandi Kisumu Busia Vihiga Siaya TaitaTaveta Garissa Lamu TharakaNithi Nyamira Kirinyanga HomaBay WestPokot Kakamega Kwale Embu Makueni Transnzoia Meru Kajiado Kisii Kiambu Kericho Nyeri Machakos Nakuru Baringo Murang'a Laikipia Elgeyo/Marakwet %ofCountybudgetallocatedtohealth Counties % 2015/16 % 2017/18 2015/16 Average (23.4%) 2016/17 Average (25.2%) 2017/18 Average (28%) % 2016/17
- 10. Efficiency: Recurrent Allocations as a Percentage of Health Allocations by County, FYs 2015/16 and 2017/18 - 0.20 0.40 0.60 0.80 1.00 1.20 KAKAMEGA MARSABIT MANDERA NAROK MURANG'A LAIKIPIA TRANSNZOIA KWALE WESTPOKOT MOMBASA KIAMBU NYANDARUA KISII NYAMIRA VIHIGA TURKANA ELGEYOMARAKWET ISIOLO SIAYA LAMU SAMBURU NAIROBI MAKUENI GARISSA MACHAKOS KILIFI TAITATAVETA KAJIADO NYERI HOMABAY KITUI EMBU NAKURU MERU MIGORI KERICHO UASINGISHU KIRINYAGA TANARIVER BARINGO NANDI BUNGOMA WAJIR KISUMU BUSIA THARAKANITHI BOMET FY 2015/16 FY 2016/17 FY 2017/18 Average 2015/16 Average 2016/17 Average 2017/18
- 11. 70% 73% 71% 71.9% 59.1% 13% 9% 13% 13.3% 9.4% 8% 10% 10% 6.6% 4.8% 2% 5% 5% 2.7% 1.5% 1.0%7% 3% 2% 4.5% 6.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FY 2014/15 FY 2015/16 FY 2016/17 FY 2017/18 Lamu 17/18 %Recurentbudgetal;location Others (Grants, Transfers, Unclassified) Training expenses Non-pharmaceuticals Medical drugs Operations and Maintenance Personnel Emoluments County Health Recurrent Budget Allocations (%) by Economic Category for FY 2014/15 to 2017/18
- 12. County Health Services Development Budget Allocations (%) by Economic Categories, FYs 2014/15 – 2017/18 45% 47% 54% 43.0% 13% 3% 5% 3% 5.1% 0% 5% 16% 8% 11.9% 4% 4% 0% 3% 5.2% 0% 2% 9% 3% 15.8% 0% 9% 16% 15% 0.6% 0% 32% 8% 14% 18.3% 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FY 2014/15 FY 2015/16 FY 2016/17 FY 2017/18 Lamu 2016/17 Not classifed elsewhere Transfers/grants to other programmes Non-medical equipment Vehicles and ambulances Medical equipment Rehabilitation Construction
- 13. Health Allocation and Actual Expenditure FINANCIAL YEAR Budget Allocation Exchequer Issues Actual Expenditure Recurrent Development Recurrent Development Recurrent Development FY 2014/15 381.71 185.55 377.04 125.97 319.67 78.7 FY 2015/16 522.49 366.56 497.39 235.03 448.54 149.79 FY 2016/17 607.56 422.91 562.4 332.73 313.89 175.67
- 14. Absorption Rate 84% 42% 85% 62% 86% 41% 90% 64% 52% 42% 56% 53% 0% 50% 100% 150% 200% 250% Recurrent Development Recurrent Development Budget Allocation Exchequer Issues FY 2014/15 FY 2015/16 FY 2016/17
- 15. Per Capita FY 2017/18, Lamu , KES 6,009.68 0 1000 2000 3000 4000 5000 6000 7000 - 1 2 3 4 5 6 7 Bomet Baringo Bungoma NairobiCity Uasin-Gishu Nyandarua Turkana Migori Nandi Siaya Homa-Bay Kilifi Narok Trans-Nzoia Kakamega Vihiga Meru Kitui Kisii Kericho Busia Kisumu WestPokot Kajiado Kirinyaga Nakuru Kiambu Nyamira Mombasa Makueni Samburu Kwale Mandera Nyeri Murang'a Machakos Tharaka-Nithi Elgeyo-Marakwet Wajir Embu Taita-Taveta Tana-River Laikipia Garissa Marsabit Lamu Isiolo KShs,Thousands Per Capita FY 2015/16 (Ksh) Average 2015/16 Per Capita FY 2016/17 Average 2016/17 Average 2017/18 Per Capita FY 2017/18 Health Budget Per Capita
- 16. Question 1. From the graphs presented can we determine as a government whether the allocated financial resources are sufficient to fulfill their promises and commitments? 2. Where can we address shortfalls and improve on?
- 17. Recommendations • To improve prioritization of expenditure i.e. target resource to programs with greatest impact to the population. • To empower citizens to understand why certain policy decisions are made. • Address disparity on commodity budgeting allocation. • Establish efficient supply plan to assist in monthly forecasting and quantification. • HRH- Consider conducting staff rationalization and establish whether there is value for money in relation to service delivery and number of staffing cadre.