By Judith Ugwumadu | 14 March 2014
Financial management systems need to be strengthened if UK efforts to reduce child mortality in Kenya are to be successful, the independent aid watchdog said today.
The Independent Commission for Aid Impact examined UK Department for International Development health programmes focused on improving child mortality rates in Kenya.
It found they were performing well for ‘effectiveness’ and ‘value for money’, but ‘significant improvements’ should be made. Giving DFID’s programmes an overall rating of ‘green/amber’, the report highlighted that the decentralisation of Kenya’s health sector was putting at risk the progress made in child mortality so far.
The 2010 Kenyan Constitution outlined plans to abolish the regional layer of government and to transfer various functions to 47 counties. The process was supposed to take three years but was shortened to five months, to be finalised by July 2013. ICAI said this was too rapid to be fully effective. It was estimated that Kenya would devolve 65% of its health budget to counties in 2013/14, comprising around 40% of the budgets of the new localities.
ICAI said: ‘Our discussions with development agencies and health experts confirm that the risk of [county] governments spending [their health funding] on non-health budgets is high.
‘There is also a political incentive to fund visible items, such as hospitals, ambulances and bed distributions, even when this might not be the highest priority to improve. This poses risks to spending on essential services that promote child survival.’
ICAI recommended that DFID engage with emerging country government structures in Kenya to mitigate risks and to expand the opportunities presented by devolution to improve health outcomes. The ICAI report stated that DFID should prioritise the neediest areas and promote effective approaches to financial management and health systems in the new political context.
Despite this, ICAI chief commissioner Graham Ward praised DFID’s action in reducing under-five child mortality in Kenya through its wider influence in the international system and through its bilateral work.
Ward said: ‘[DFID] has implemented proven interventions, identified by global research and incorporating cross-country learning, particularly for malaria.’
But lead commissioner Mark Foster noted that sustaining gains in child mortality reduction was essential.
‘This requires continued DFID funding in the short term and a clear plan for further engaging with – and transferring responsibility to – the government of Kenya in the medium term. The core of sustainability lies in strengthening basic health systems. This is an area of DFID expertise and should be an increasing focus of its work,’ he said.
A further two recommendations were given to DFID. These were further engagement in strengthening basic health systems, such as tackling the deaths of nursing babies, and the development of a clear exit strategy for funding basic supplies in Kenya, focusing on achieving a long-term and co-ordinated approach amongst development and financing agencies.
A DFID spokesman said: ‘ICAI is right to recognise the UK’s global leadership in reducing child mortality and the substantial impact DFID has had in Kenya.
‘Working with partners like the Global Fund and the Global Alliance for Vaccinations and Immunisations, Britain has played a significant role in helping to lower child mortality rates around the world.
‘We will work with Kenya’s government to build a sustainable and independent health care system and continue to seek regular feedback to ensure no one is left behind.’
