By Lenah Bosibori
Despite Kenya’s push towards universal health coverage, challenges in healthcare remain due to poor data management and lack of accountability in financial and non-financial information flows in the expenditure of money allocated across the country.
According to a study by IDinsight released in Nairobi on Wednesday, there is a significant gap in how lower devolved healthcare levels in Kenya account for funds received from the national treasury, making it difficult to demonstrate how these funds contribute to outcomes like reducing child mortality, Maternal Mortality and Neonatal Mortality.
Speaking to Africa Science News, Dr. Frida Njogu Ndongwe, IDinsight’s Regional Director for East and Southern Africa, highlighted that many health financing decisions are primarily guided by financial data, with insufficient focus on the quality of service given and improved healthcare facilities.
“A lot of our health financing decisions are based largely on financial data but we are not looking at health outcomes and health service utilization, ” said Dr Ndongwe. “These two need to speak to each other so that we are not only monitoring how the money released was spent but also seeing the quality of services delivered and improvement of the health facilities.”
In recent years, Kenya has implemented various health programs, such as Linda Mama, aimed at improving maternal healthcare. However, studies reveal that approximately 5,000 women and girls still die annually from pregnancy and childbirth complications.
Dr Ndongwe further notes that there is a need to align financial health outcome data. “Budgeting decisions are currently driven by financial data, but we are missing insights into whether service quality is improving,” she says.
According to data cited in the study, the maternal mortality rate showed little improvement, with 362 deaths per 100,000 live births recorded in 2018–2020, compared to 355 deaths per 100,000 live births in 2021–2022, indicating only a slight reduction over the years.
Further, Dr. Njogu-Ndongwe calls for outcome-based budgeting to gauge investments’ impacts on health services and also stronger data linkages between the Kenya Health Information System and Integrated Financial Management Information System (IFMIS) which could improve oversight and provide critical information for addressing public health challenges, such as maternal mortality.
IFMIS is a digital platform used by governments to plan, manage, and report on public financial resources.
“These insights suggest that enhancing data systems and prioritizing key indicators could improve the tracking of public funds, ultimately ensuring that investments in health and education translate to meaningful improvements for citizens,” noted Dr Ndongwe.
Further, the study reveals that transparency makes it difficult to track whether investments and money allocated are truly improving the health outcomes of the people and that of the healthcare centers.
On his part, Dr. Martin Atela, Project Director for IDinsight said that while funds are consistently flowing from the national treasury to counties, the impact of these funds on health and education outcomes is often unclear.
“Counties currently lack effective systems for sharing data on financial allocations and their impacts, this gap is critical, especially as the government faces financial constraints and citizens demand greater accountability,” notes Dr Atela.
He adds that integrating financial data with health outcome metrics is essential for effective budgeting and monitoring, ensuring that resources allocated to critical sectors translate into real-world improvements.
Further, there is an urgent need for a structured conversation around integrating financial and non-financial data according to Dr Atela. “For instance, if the government allocates Sh 100 billion to health, it must be able to assess whether this expenditure achieves the desired health outcomes,” reiterates Dr Atela.
The study emphasizes the importance of aligning budgets with actual results to ensure that public money is effectively used and that any shortcomings can be identified and addressed.
“We need a system where financial data is shared from counties upwards to show the tangible impacts of spending,” says Dr. Atela. This clarity, he notes, is especially crucial as the government grapples with a shrinking tax base and increased public demand for accountability.
Dr. Atela further highlights the importance of integrating financial and non-financial data to evaluate the effectiveness of public spending. “If we are allocating billions to healthcare, are we achieving our targets? If not, what needs to change?” he asks, stressing that achieving universal healthcare requires reliable data that links spending to health outcomes.
Further, He calls for robust data collection at the facility level to ensure comprehensive tracking of funds and services, stating that prioritizing on few key indicators by the government at devolved health levels could simplify this task for frontline workers who are always burdened.
“We are proposing that priority should be given to a few key indicators for every ministry and agency that can help the government collect the most useful data because one can’t do everything,” notes Dr Atela.
The study by IDnisight was supported by Bill and Melinda Gates and was conducted in September 2023-May 2024 in four Counties namely, Nairobi, Kilifi, Nakuru, and Trans Nzoia.