Phase: Pilot started in Samburu County in 2011. Scaling up from 2014 onwards
Coverage Estimate: 28%
Supported by: MOH, WB
Description: In 2011, Kenya started an RBF pilot in Samburu county. Based on early signs of success of the pilot, the Kenya Government has embarked on scaling up the approach, whereby performance-based incentives to primary care facilities for the achievement of pre-defined targets in maternal and child health services, and HIV-related services in 20 arid and semi-arid counties, covering a population of nearly 12 million (28% of the country population).
Yet, there are also a number of criticisms:
- The set of PBF indicators is limited to a dozen primary and secondary ones, i.e. less than the recommended 25-35 indicators in a full package.
- In the pilots, a joint committee related to the DHMT, which also conducted the quality assurance, plays the role of the verifier so that there is no separation of functions between the regulation, quantity and quality verification and the payment of the health facilities.
- The current KHSSP project budget is budgeted at below 1 US$ per capita, which is far below the 3-4 US$ per capita figure that is currently considered the requirement for a mature RBF/PBF application.
- The PBF program lacks the community verification component.
- Revenues are not directed towards the facilities but to the County health departments, which do not respect their autonomy.
- Facilities ability to decide where to purchase inputs is limited.
- There are no independent CDV Agencies at County level
- Lack of involvement of the private health facilities.
The low feasibility score of 22% according to the SINA Health questionnaire implies that advocacy for a more pure design is necessary. Notably the per capita budget should increase, a review of the indicators is required and health facilities should obtain more autonomy. Moreover, a rethink of how to separate the functions of regulation, contract development and verification and provision should be advanced.