Kenya: Late payment Mar Linda Mama Services

Unpredictable and delayed disbursements of funds to health facilities have negatively impacted the implementation of the Linda Mama program, a report said.

This has resulted in a shortage of vital medical supplies, the report said, including misoprostol, one of the drugs commonly used by medical professionals to induce labor and to treat postpartum bleeding.

The study was carried out by researchers from the Kenya Medical Research Institute-Wellcome Trust Research Program in collaboration with ThinkWell at 20 facilities in five counties. Institutions studied included a public referral hospital, a subdistrict public hospital, a public health center, and a denominational hospital / health center in each county.

The districts were chosen because the National Hospital Insurance Fund (NHIF) was interested in understanding Linda Mama’s implementation in public and private institutions where parallel initiatives were being carried out.

“We have randomly selected patients in the selected facilities who would like maternal care, maternity care, childbirth care and postpartum care. We also assessed the structural quality of care in the selected healthcare facilities by collecting data on the availability of tracer drugs and medical equipment necessary for MCH (maternal and child health), “said Edwin Barasa of Kemri Health Economics Research Unit.

According to Linda Mama’s implementation guide, NHIF should ensure that service providers are paid on time – within 30 days of receiving invoices.

In practice, the health facilities reported payment delays of up to three months, according to the report. The timing and amount of the reimbursement could not be foreseen either.

“The delays affect the delivery of services because a hospital is like a hotel. A mother comes, uses up my supplies and goes, but I haven’t been paid, that leads to depletion of my supplies and that leads to poor service “, a district health administrator is quoted in the report.

The results, published in the journal Health Planning and Management, showed that many hospitals did not have the necessary funds.

The delays in the NHIF’s disbursement of funds were partly attributed to the Department of Health’s delays in transferring the money to the NHIF. In the 2018/2019 budget year, for example, the government did not release all of the Linda Mama funds, so NHIF missed its budget target by 14 percent.

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A senior NHIF official, who spoke on condition of anonymity, said they can only reimburse hospitals if they receive money from the Ministry of Health.

“It takes a while for the Ministry of Health to give us money and this is a managed system. If we don’t have the money, we wait for the money to come, ”said the officer.

Health Secretary Susan Mochache admitted that the late disbursement of funds from the Treasury Department is hindering the use of services and putting a burden on hospitals. This could have an impact on the progress the country has made in reducing maternal and newborn mortality.

“We are in discussion with the Treasury Department about the cash flow in support of Linda Mama. This will ensure the funds are released to NHIF early and promptly to the hospitals,” she said.

In the past year, most public health facilities across the country that provide maternal services have faced financial challenges as NHIF stopped sending funds as of November 2020.

The Department of Health has remitted approximately Sh11 billion to NHIF over the past four fiscal years to help pregnant women and infants access health services through the Linda Mama program.

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