unraveling the new budgeting process in kenya: the new law ... · with the national government,...

HEALTH RIGHTS TODAY [1] EDITION 15

EDITION 15

HEALTH RIGHTS ADVOCACY FORUM NEWSLETTER

Josphine Nyambura HERAF staff training Community Monitoring Facilitators on county budgeting process

HEALTH RIGHTS TODAY

This newsletter has been produced with the financial and technical support from OXFAM. The content is the sole responsibility of HERAF and can in no way be taken

as the Views of the OXFAM. The views contained in this newsletter are not necessarily HERAF’s but the authors.

By Josphine NyamburaKenya is currently experiencing a major shift in its political, economic and administrative structure as it shifts from a centralized governance system to a devolved system of government. The county governments will enjoy a distinct and inter-dependent relation with the national government, enjoy guaranteed share of national revenue, revenue raising powers and control over health service delivery within their various jurisdictions while the national government is responsible for health policy and national health referral hospitals.

Over the last decade, the health sector has been receiving slightly below 10% of the total government outlays resulting to a mismatch between policy and resource allocation in the sector. Consequently, there has been significant constraints affecting delivery of healthcare such as shortage in distribution and hiring of personnel evidenced by the doctors and nurses strikes during the year 2012. Even though the bulk of resources shall be devolved to county governments, it is important to note that availed resources are finite and the health sector competes with other sectors for resources. In light of this, addressing Health sector challenges therefore calls for creative solutions.

Unraveling the New Budgeting Process in Kenya: The New Law and National Budget Calendar

To allow for the smooth running of the devolved system, the budget calendar has changed to allow for more public participation at national and local level. This is as outlined in the Public Finance Management Act (PFM Act) 2012:


The views contained in this newsletter are not necessarily HERAF’s but the reporters. This newsletter has been produced with the financial support of the OXFAMThe contents of this newsletter are the sole responsibility of HERAF and can in no way be taken to be the views of the OXFAM.

Disclaimer

EDITORIALHERAF is a non-governmental organization that brings

together health professionals, NGOs, FBOs, and PLWHA

organizations to advocate for health as a fundamental human

right in Kenya. It was established in 2006 and registered as

a non-governmental organization in Kenya by the NGO

Coordination Board in 2007.

Our VisionA Kenyan community where health is upheld and enjoyed as

a human right

Our MissionTo empower Kenyans to enjoy the right to health through

increased human rights awareness, evidence based policy

advocacy, strengthening citizens participation in health sector

governance, and budgeting processes.

Our Core ValuesWe strive to reflect these core values in all our work:

Respect to human rights

Effective, progressive and positive impact.

Upholding dignity and diversity

Leader and a powerful advocate for health rights.

Equitable, inclusive and accessible.

Accountable, relevant and transparent in our

operations and a model to others.

Plan, research and measure our success and realign

our efforts where needed.

C reativity, innovation and continuous learning.

Our Strategic Partnerships Civil Society Organizations including

• Health Professional Bodies Association

• Non-Governmental Organizations (NGOs)

• Community Based Organisations (CBOs)

• Faith Based Organisations (FBOs)

• Organizations of People Living with Diseases

• Health, HIV&AIDS and Human Rights Networks

and Organisations

Research Institutions and Universities involved in

health related issues.

In a bid to empower Kenyans to enjoy the right to health through increased human

rights awareness, evidence based policy advocacy, strengthening citizen’s participation

in health sector governance, and budgeting processes, HERAF embarked on evidence-

based health system strengthening advocacy initiatives. With the 2010 Constitution,

and the new government currently in force, HERAF among other Health CSOs have

been in discussions on the impact of Kenya’s devolution of power from the central

government to the counties in the health sector.

Devolution in the health sector has also led to changes in the health sector

service delivery, recruitment and retention of human resources for health, funding,

procurement of essential drugs and commodities. Though the bulk of resources shall

be devolved to county governments, it is important to note that availed resources are

finite and the health sector competes with other sectors for resources.

In light of this, addressing health sector challenges therefore calls for ingenious

solutions. As CSOs, our role has become critical in the budgeting process by ensuring

the public stays focused on the real issues at hand. It is vital to follow up on the

attendance of the County budget and economic forums and public hearings to ensure

representation and informed participation from the stakeholders. This is the only way

of safeguarding accountability and transparency in the new form of governance, to

ensure that issues of corruption and malpractices in government offices come to an

end.

In this edition, we give you highlights on devolution in the health sector, community

monitoring of health services, outline the unraveling of the new budgeting process in

Kenya, give an overview of use of information, communication and technology (ICT)

and new media in health Sector, provide updates on part 4 of the draft health bill, state

some implications of devolution on delivery of health services, and provide a report on

Kenya’s Health MDGs Status. We also look into the appointment of the new cabinet

minister for health and what health service providers think about his appointment; this

and much more.

It is the hope of HERAF that after reading this edition, as a stakeholder in the health

sector, you will be enlightened on devolution in the health sector, community

monitoring of health services, the new budgeting process in Kenya, use of information,

communication and technology (ICT) and new media in health Sector, part 4 of the

draft health bill, and on Kenya’s Health MDGs Status.

Editorial TeamHERAF

About us


The PFM Act sets the rules for how national and county government could raise and spend money. Along with the 2010 Constitution, it is the main document that tells the President, MPs, Governors, Senators, County Assembly Members and ordinary people what role they have to play and the time to participate in decisions about how public money is used.

The new budget calendar highlights important dates, forums and documents that require public participation:

Timeline Activity

August 30National Treasury releases a circular to all government agencies starting the process, and setting out guidelines for public participation. The County Executive Member for finance must also release a circular by this date doing the same at county level.

September 1.Counties must prepare and table a county development plan in the County Assembly by this date. The plan must be made public within 7 days.

September 1 to February 15

During this time, the National Treasury and the various ministries and agencies should undertake some type of consultation with the public and other stakeholders. This can include sector hearings as in the past, or visits by Treasury to counties to solicit views. Views from the public should feed into the formulation of the Budget Policy Statement

January 1.By January of every year, the Commission on Revenue Allocation should submit its recommendations for the division of revenue between national and county governments, and among the counties, to the rest of government.

February 15Cabinet Secretary for Finance to submit the Budget Policy Statement to Parliament. Also the deadline for the debt management strategy paper, and the Division of Revenue and County Allocation of Revenue Bills to go to Parliament.

February 28Deadline for Budget Policy Statement to be approved by Parliament. This is also the deadline for the County Fiscal Strategy Paper to be tabled in each County Assembly.

March 1 Deadline for Budget Policy Statement to be made available to public.

March 16 This is the deadline for passing the Division of Revenue and County Allocation of Revenue Bills.

PRINCIPLES OF PUBLIC FINANCE AS PER ARTICLE 201 OF THE CONSTITUTION

The following principles shall guide all aspects of public finance in the republic –a) There shall be openness and accountability, including public participation in Financial matters;b) The public finance system shall promote an equitable society and in particular –

i. The burden of taxation shall be shared fairlyii. Revenue raised nationally shall be shared equitably among national and County governmentiii. Expenditure shall promote the equitable development of the country, Including making special provision for marginalized groups and areas

c) The burdens and benefits of the use of resources and public borrowing shall be shared equitably between present and future generations;d) Public money shall be used in a prudent and responsible way; ande) Financial management shall be responsible and fiscal reporting shall be clear.


April 30

This is the deadline for the Cabinet Secretary to submit the budget proposal, or Budget Estimates to Parliament. It is also the deadline for the Judiciary and the Parliamentary Services Commission to submit their budgets to Parliament. This is also the date for the county budget proposal to be submitted to the County Assembly.

May This is likely when the Budget Committee will begin to hold public hearings on the budget.

May 15This is the deadline for the Cabinet Secretary to give any comments on the Judiciary and Parliamentary budget requests.

May-June This is when the Budget Committee will table its recommendations on the budget in Parliament.

JuneThe national Finance Bill to authorize tax and revenue collection is tabled in Parliament. A County Finance Bill is to be tabled at this time in the County Assembly.

June 30This is the end of the financial year, and the deadline for the Appropriations Bill to be passed by Parliament to authorize spending for the new budget year.

JulySometime in the latter half of July, the final approved budget estimates should be available to the public

November

Government must publish the Budget Review and Outlook Paper, reviewing last year’s budget performance and this budget year’s initial forecasts from the Budget Policy Statement in February. There is no deadline for the County Budget Review and Outlook Paper, but it should be available around this time as well.

December 15Government must publish an implementation report on the first quarter of budget implementation from July-September no later than 45 days after the end of the quarter.

Based on the above, a draft statement of revenue estimates for 2013/14 has been presented to parliament by treasury.

The Budget Estimates showed that the finance ministry will target total revenue of 986.2 billion shillings. At the county level, several counties including Mombasa, Baringo, and Nyeri Counties have already presented their estimates. The members of National Assembly and the senate are expected to scrutinize the proposed spending and revenue plans and have a final version of the budget in mid-June.

As CSOs, our role become critical in the budgeting process by ensuring the public stays focused on the real issues at hand. For example it would be important to follow up on the attendance of the County budget and economic forums and public hearings to ensure representation and informed participation from the stakeholders. This is the only way of ensuring accountability and transparency in the new form of governance, to ensure that issues of corruption and malpractices in government offices cease.


Part 4 of the Draft Health Bill: Establishment of Health Services Commission (HSC) Stakeholders Consultative Meeting UpdateBy Teresa MutuaThe Ministry of Health organized one day stakeholder’s consultative meeting on Thursday, 2nd of May 2013, at Fair View Hotel, Nairobi to discuss Part 4 of the Draft Health Bill that elaborates on establishment of Health Services Commission. The agenda of the meeting was to interrogate and build consensus on Health Services Commission as advised by the Cabinet when the Health Bill was tabled for discussion.

There was consensus among all the stakeholders present for establishment of Health Services Commission to cater for human resources for the health sector. The Commission would ensure that all health care workers have one body to which they could channel all their issues to as well as provide a mechanism for coordination of health policies and monitoring of health service delivery.

The legal team from the Health Ministries made presentations about the evolution of the Health Service Commission (HSC) examining its functions as proposed during the drafting of the Constitution until the Naivasha draft where the HSC was dropped. There was also a presentation of the draft HSC Amendment Bill as prepared by the Task Force from the Ministries of Health in January, 2013.

Some of the functions and responsibilities of the HSC as agreed by stakeholders were as follows:

· Maintain a register/database for all trained health workers

· Recruit and employ registered health workers

· Assign health workers employed by the Commission for service in any public hospital or health facility

· Promote health workers on merit

· Deploy health workers according to service need

· Exercise disciplinary control over health workers employed by the Commission

· Terminate the employment of health workers employed by the Commission

· Set and regularly review the education and training requirements for persons entering the health service

· Regularly review the demand and supply of health workers

· Facilitate further training· Advice the national and county

governments on matters relating to health professions and health service delivery

· Advice the government on policy and other activities necessary to achieve and maintain Constitutional and other legal provisions on health rights

· Prepare periodic reports on the commission’s activities as well as progress reports on the attainment of health rights as provided for in the Constitution

· Liaise where necessary with other persons or agencies in order to fulfill its mandate

As consultations and discussions towards establishment of HSC go on, stakeholders should be wary of situations and circumstances that may frustrate this process:

· Interference with the Constitution- some of the functions proposed to be functions of the HSC are already functions of the Public Service Commission (PSC) in the Constitution. What would be the consequences of proposing the HSC with the proposed functions in the Health Bill?

· Health care services delivery – Schedule 4 of the Constitution allocates this function to County governments with referral services and policy development going to national government. Schedule 4 should therefore be unbundled.

· Positions of constitutional offices such as Constitution Implementation Commission (CIC), Transition Authority (TA), Public Service Commission (PSC) and the Office of Attorney General. How supportive are they to establishment of HSC or will they be a hindrance?

It was agreed during the meeting that the Technical Committee working on Health Bill will be strengthened by incorporating more and legal experts and drafters for purposes of guiding the Committee on the legal facets of the Bill. It would be in a position to advice as to whether to have the Commission in the Bill or in the Constitution through An amendment Bill or to pursue a multi-tier approach. Thereafter, the Health Bill would be revised and forwarded to the Cabinet and/or AG

It is our opinion too that more consultative forums will be organized by the Ministry of Health Technical Committee on Draft Health Bill to ensure wider consultation and consensus building amongst all stakeholders on proposed Health Services Commission Constitutional Amendment Bill and the Health Bill before they are forwarded to Cabinet and Parliament for discussion. This will ensure that there is ownership in entire sector.


Kenya’s Health MDGs Status ReportAccording to the presentation made on 15th May 2013 by Head MDGs-PIU, from the Ministry of Planning Gideon M. Mailu during a Post 2015 MDGs Forum it was evidence that the country has made considerable progress in the realisation of a number of Millennium Development Goals (MDGs). These include the achievement of universal primary education, promoting gender equality and empowering women, reducing child mortality, combating HIV/AIDS, Malaria and other diseases and ensuring environmental sustainability. The progress of health MDGs were as follows:

Goal 4: Reduce Child Mortality · Both Infant mortality and under-

five mortality rates have remained at 52 deaths per 1,000 live births and 74 deaths per 1,000 live births respectively as was the case in 2009

· The proportion of one year olds who are fully immunized was 80% in 2011 against 90% 2015 target up

from 78 % in 2009. · Drugs for prevention of mother

to child transmission of HIV are available in almost all Government health facilities.

Goal 5: Improve Maternal Mortality · As at 2011, 43.8% of births in Kenya

were attended to by trained health personnel against a 2015 target of 90 %.

· Only 43% of deliveries take place in health facilities.

· Maternal mortality rates are at 488 per 100,000 live births in 2011 against a 147 target by 2015.

· Contraceptive prevalence rate is at 46 % up from 39% in 2000 against a 2015 target of 70 %.

There is evidence that Goal 4 and 5 are faced with regional disparities and are lagging behind in the country. Goal 6: Combat HIV and Aids,

Malaria and other Diseases · The overall HIV prevalence rate

among adults 15-49 years was estimated to be 6.3% in 2011 (KDHS 2008-9) down from 7.4% in 2007 (KAIS 2007) and 6.7% in 2003 (KDHS2003).

· The HIV prevalence among youths aged 15-24 years was 2.9% in 2011 down from 3.8% in 2007.

· Prevalence rate among adults 15-49 years was estimated to be 6.3% in 2011 (KDHS 2008-9) 7.4 % in 2007(KAIS 2007).

· The proportion of Kenyan households owning at least one Insecticide Treated Net rose from 6% in 2003 (KDHS 2003) to 48% in 2007 (KMIS 2007) and 56% in 2008/09.

· The proportion of under-five children using ITNs increased from 5% in 2003 and 39% in 2007 to 47% in 2008/09.

Institutional Strengthening of Health CSOs and NGOsHERAF’s strategic re-engineering process began in 2012 and it entailed building institutional capacity through revitalization of plans and activities, while increasing transparency and accountability in the realization of HERAF’s mandate. HERAF collaborated with FANIKISHA, a USAID funded project to strengthen its systems. To this end, FANIKISHA carried out an organizational capacity assessment whereby they found out the baseline problems at HERAF to be; having an unstructured operations of the board due to lack of a governing document that guides its affair. The strategic plan was coming to an end in 2013 and the operational environment had changed with the inauguration of the new constitution of Kenya and the devolved systems of governance. Furthermore, HERAF had no resource mobilization strategy in place as well as a lucrative finance manual which was deemed to be insufficient and needed to be improved.

With FANIKISHA’s recommendations, HERAF embarked on process of renaissance which led to an improved efficiency in service delivery by developing a governance manual that ensures the board reviews and approves the organizational policies and procedures while payments and cheques are done on time. It reads audit reports and translates them with a clear interpretation of the organizations policies. The board also sets performance targets and evaluates them. HERAF developed and is currently using a new strategic plan that is more relevant, responsive, and has a direct reference to current projects in the organization. The strategic plan is a reference point for resource mobilization and programming. It has similarly adopted a more efficient, transparent and accountable process on the use of the donors’ funds by developing a comprehensive financial manual that ensures efficiency in the operations and requisition processes enhanced by credibility and openness thereby making it rigorous. This entails

annual and quarterly budgets, a petty cash management system in, an online banking system, and a call system for cheques confirmation among others.

HERAF has a well-documented procurement process with a procurement committee as well as a grant manual with trained staff on grant management. Under Human Resource, a standardized appraisal system has been put in use and individual staffs have been appraised using the template. There are clearer job descriptions, duties and responsibilities. Under advocacy, various steps have been made to put HERAF at the fore front, these include; funding CSO engagement in devolution within the health sector, sharpening its focus on health policy advocacy, promoting, and identifying with it, and having a better conceptualization of advocacy within the organization. In Monitoring and Evaluation, HERAF has two staff with the relevant skills and capacity thus making a great improvement on the


news from the regions

Kenya Adolescent Reproductive Health and Development (ARHD) Policy Implementation Assessment Report is complete

This policy assessment was conducted in Kenya under the IDEA Project from November 2011 to September 2012 in partnership with the National Council for Population and Development (NCPD) and the Division of Reproductive Health (DRH). Qualitative data was collected from 195 participants in Nairobi, Thika, Kisumu, Wajir, and Watamu through individual interviews and focus group discussions.

A summary of the key findings and recommendations are below.NCPD will be collaborating with the Division of Reproductive Health and other partners to disseminate the findings of the assessment in the coming months. The findings will be

used to revise the ARHD Policy as it approaches the end of its timeline in the coming year.Kenya: Homabay Women Representative Gladys Wanga is appealing to the donor community to reconsider their plans of cutting funds for HIV/AIDS programs. Wanga says plans to reduce the global fund will greatly hamper the gains made so far in fighting the scourge through sustainable treatment. The MP says that women will be the worst hit if the donors pull out significantly saying the government may not be in a position to bridge the gap immediately.

Streamline the Health Sector

The Kenya Medical Association has decried the poor state of the health sector in the country and called upon the Jubilee Government to conduct comprehensive reforms in streamlining the sector. KMA

national chairperson Dr. Elly Nyaim says various issues need to be addressed urgently including the deployment of manpower and budget allocation to the sector

Health Sector Short Changed in Budgetary Allocation

This year’s budget estimates tabled in Parliament shows the Health ministry has been allocated Sh34 billion or 2 per cent of the budget against an estimate of Sh140 billion to effectively improve access to health care.

This falls short of the Abuja Declaration that requires any national government to set aside at least 15 per cent of its budget to the health sector.

content of reports writing. Furthermore, in Institutional Strengthening which is the main mandate of the first approach of the FANIKISHA project, HERAF has improved service delivery by development and implementation of policies and standards of operations, this has led to adherence and compliance to set standards and tools by the staff , management and the board, enhanced coordination of the organization systems and operations. Staffs are responsible for different areas of Institutional Strengthening, and the board provide oversight on systems and operations, and the organization

has a Performance based monitoring system of Institutional Strengthening implementation for the staff.

Various other areas are being strengthened and by end of June 2013, HERAF will be graduating from the first technical strategy of FANIKISHA to the second one which is mentored grants. It will be expected to engage in hands-on experience with grants management, whereby its affiliates will be able to use mentored grants to procure technical assistance directly from the private sector, for themselves, or their affiliates that will help to supplement institutional

strengthening activities and to support program activities. HERAF’s engagement with FANIKISHA visualizes an increase in the access to and improvement of the quality of health services in Kenya. It is the vision of HERAF to have a Kenyan community where health is upheld and enjoyed as a human right by empowering citizens to enjoy the right to health through increased human rights awareness, evidence based policy advocacy, strengthening citizens participation in health sector governance and budgeting processes.

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Contacts: The Executive Director, Health Rights Advocacy Forum (HERAF),Muthangari Road off Gitanga Road, Valley Arcade, P.O Box 100667-00101, Nairobi, KenyaTel: 254 - 20 -3861482/3 | Fax: 254 - 20 -3861483 | Email: [email protected] | Website: www.heraf.or.keFacebook: https://www.facebook.com/HERAFKenya Twitter Handle: https://twitter.com/HERAF2012.

Concept & Design: Em’s Creations | [email protected] | www.ems-creations.webs.com

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1. HERAF staff and partners at a validation meeting

2. HERAF staff and Finance Consultants during a review meeting of the Finance manual at HERAF’s board room

3. HERAF staff facilitating a community consensus meeting

4. Health CSOs follow closely during a deliberation on their role in the devolved government forum organized by KANCO, LVCT, NEPHAK, and HERAF

5. HERAF staff, board member, and partners during a validation meeting

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unraveling the new budgeting process in kenya: the new law ... · with the national government,...

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