Study on USAID Non-Project Assistance Programs in

The MOH has had difficulty in meeting KHCF targets for the reallocation of budgetary resourcestoward preventive and primary care services due to its large wage bill. Salaries consume upwards of 70percent of all budget expenditures. The remaining resources are not great enough to allow for themagnitude of reallocations called for under the KHCF program reforms. Debate occurred around thedevelopment and application of appropriate algorithms for the analysis of the MOH budget in order toallocate expenditures between preventive and primary services and "other." Without consensus as to themeans by which budget analysis is performed, improvements in resource allocation will be difficult toachieve. Despite the debate, the MOH was, for the first time, analyzing its budget and attempting to bringabout a greater coherence between stated policy and resource allocation decisions (whatever the algorithmemployed). This was seen by evaluators as a positive development.The lack of a comprehensive data collection and analysis system capable of providing informationnecessary for planning and monitoring program implementation represents another important institutionalweakness affecting the KHCF program. The KHCF program was slow to develop and implement its ownmonitoring and evaluation systems in hopes that these needs could be effectively piggybacked onto a morecomprehensive health and management information system. This proved unfeasible and the program wasforced to develop its own independent reporting and tracking system to monitor cost sharing revenues andexpenditures at all levels.Other institutional weaknesses have also plagued the KHCF program reforms. For example, themid-term evaluation identified the lack of ability and the human resources required to carry out a numberof operations basic to the operation of a health insurance system as limiting the NHIF’s ability toimplement its set of policy reforms. The MOH’s capacity in the area of financial, economic, and healthpolicy analysis are limited. The KHCF reform program faced competition from other donor programs andactivities for the attention of the limited MOH personnel involved in policy reform and implementation.18