Public Healthcare Service Delivery (ELG0007)

• Leveraging OGP for a Transparent COVID-19 Response in Africa (November 1, 2020)

Commitment 3: Re-engineer public healthcare service delivery processes and, disclose medical drugs supply chain management decisions and updates.
Commitment Start and End Date: 1st September, 2018 – 31st August, 2020
Lead implementing agency/actor
Department of Health and Sanitation
Commitment description
What is the public problem that the commitment will address?
Public perception regarding waiting time by patients at health facilities and, referrals for common medical conditions and medical drugs indicate inadequacies in the operations and management of public health facilities hence creating barriers of access to timely and quality services. This is further compounded by the current application of input-based facility planning and budgeting which has proven to have a disconnect to health outcomes because the allocations of resources (e.g. drug quantities) is not commensurate to needs of respective facilities to meet the demands of the target beneficiaries. For example, the input-based approach applies a formula that equally treats needs of all health facilities of similar level and capacity rather than considering service delivery workload, which is determined by different regions’ patient demands/ ailments, as basis for allocating medical drugs quantity to health facilities. For instance, one region frequently suffers from tropical diseases such as malaria compared to other regions. Such diseases are more common in lowlands compared to highlands within the county yet equal allocations of drugs to treat this type of disease are provided to health facilities of similar level across these different regions regardless of disease prevalence.
What is the commitment?
The county department in charge of Health and Sanitation will optimize the county’s patient experience by reengineering public healthcare management practices through creation of a standard and consistent patient experience across all healthcare facilities. Currently, health facilities, even those at the same level in the healthcare hierarchy, have different features including facility color, navigation features across various services sections and patient flow which impedes comparability of the efficiency of service delivery and, citizen feedback on satisfaction and recommendations for improvements. In addition, the county will adopt program-based facility planning and budgeting to strengthen access to accountable, timely and quality healthcare.
How will the commitment contribute to solve the public problem?
By automating and standardizing key service delivery operations and management features (systems and processes), the commitment will provide data for evidence-based decision making as well as mechanisms for predictable, transparent and accountable delivery of healthcare by facilitating citizens and stakeholders to assess and provide feedback on efficiency, access to, and quality of public health services with particular focus on medical drugs and waiting time.
Why is this commitment relevant to OGP values?
This commitment is relevant to access to information, civic participation, transparency and accountability because it will provide citizens, CSOs and county officials with access to accurate facility data, involve citizens in drug quantification exercise, promote transparency in service delivery and provide mechanisms for holding service delivery officials accountable.
Additional information
Citizens identified inaccessibility to medical drugs as a major community issue, where those accessing healthcare are given prescriptions to purchase drugs from private chemists to offset the county government health facilities’ drugs shortfalls. This is an issue despite the annual allocation in the county budget for drugs. For the fiscal year 2017-2018, the health sector was allocated Ksh 100 million for medical drugs. This allocation reflected a deficit of Ksh 40 million (estimate of value of drugs purchased by patients from private chemists from government facilities’ prescriptions). For the fiscal year 2018-2019, Ksh 75 million was allocated to drugs which as a consequence of the previous year’s deficit, means that patients have to allocate more of their incomes into drugs purchase every year. In addition, in 2013 the county government had 89 health facilities but by the end of 2018 this number is expected to have grown to 150 given the cumulative investments in health infrastructure which the county government sees as an avenue to enhance healthcare access. However, given the already limited resources in the health sector, particularly in area the of drugs management, citizens believe the challenge of accessing drugs across the county will be exacerbated and stock-outs will become rampant. Inevitably therefore, citizens expect the county government through its health facilities to address drug stock-outs and a long-term plan to manage it. Although the county government has been trying to address the challenge using budgetary measures, citizens believe the issue requires creativity and innovation in utilizing available human, technology and budget resources to address it.
Milestone Activity with a verifiable deliverable
Department of Health and Sanitation will automate the County and Sub-county Hospitals operations and management to capture and provide for: • Outpatient Information (OPD) and including waiting times for various services sought/offered • Modules which include: Drugs supply chain management and realtime display of pharmacy records; patient information management; facility accounts and applications of fund; inpatient management and; patient care
Staff time, consultancy, conference costs, stationery and ICT equipment
Sep 2018 – Jan 2020
Department of Health and Sanitation will collaborate with health facility user communities to design and adopt standardized health facility brand design, which includes operational features such as the same ‘look and feel’, streamlined patient flow and navigation through service delivery sections and cascade county health services standard service charters to smallest units of health delivery system (including generation of digital versions) showing the services offered at different sections (laboratory, OPD, Maternity and specialized clinics) of the facility to create a reference point for service delivery expectations by patients visiting the facilities.
Staff time, consultancy and ICT equipment
Sep 2018 Nov 2019
Department of Health and Sanitation will publicly declare, on public notice boards, available medical drugs in health facilities on daily basis and, provide quarterly summaries that state the dates that drugs were received and the quantities in stock.
Staff time, stationery, display boards and ICT platforms
Sep 2018 Continuous
Department of Health and Sanitation will disclose morbidity information to citizens and CSOs by publishing the information on notice boards for Dispensaries and health centers, and publish the same information on the county website on monthly basis.
Staff time, display boards, ICT equipment and ICT platforms
Sep 2018 Continuous
Department of Health and Sanitation will expand the ‘patient experience initiative’ to change the patients’ perception on the waiting time by improving the infrastructure at the facilities, which include benches and Television Screens (TVs) to provide patients with entertainment content and serve as a medium of communication for the county government to deliver informative content relating to services being offered at health facilities and notices such as information on help-lines and other complaints and compliments channels.
Consultancy, staff time and ICT software and equipment
Sep 2018 Jan 2020
Department of Health and Sanitation and partner CSOs will carry out a regular client satisfaction survey to determine the level of satisfaction and use the findings as a basis for initiating strategies for continuous improvements of the patient experience of various segments such women, youth, PWDs etc
Staff time, consultancy and staff training
Sep 2018 Continuous
Department of Health and Sanitation in collaboration with the respective facility-user communities and CSO partners will conduct participatory quantification of medical drugs for all facilities using facility consumption (and workload) data to facilitate informed program-based facility planning and budgeting to promote serviceoutput sensitive approach.
Staff time and meeting costs
Sep 2018 Mar 2019
Contact information
Name of responsible person from implementing agency
Dr. Gideon Kiprop
Title, Department
Head of Pharmaceutical Services, Department of Health and Sanitation
Email and Phone
Head of Pharmaceutical Services, Department of Health and Sanitation
Email and Phone
kippsgee@gmail.com /+254720775111
Other Actors Involved
World Vision Kenya, Center for Innovation in Open Governance (CIOG Kenya), Academic Model Providing Access to Healthcare (AMPATH), Health Rights, Transparency International Kenya.