Determinants of equitable allocation of funds to public hospitals in Kenya
One of the key funding objectives is equity. A snapshot of the country's. health outcomes indicates some disparities. Underlying this is the way funds are allocated. Provision of medical services is carried out by health facilities. As is the case in other developing countries, hospitals tend to dominate the health system. The government usually provides financial support to all public hospitals which are meant to protect the catchment population against social and economic consequence of ill health. Subsidiary legislation has also been issued to govern management of hospital funds in the country. The focus of this study was to determine if the public hospital resource allocation practice takes into consideration the. differences in levels of need for different counties and also to describe the preexisting political, economic and social conditions under which people engage in procedure and benefit distribution. A cross sectional study design was used to address the research objectives adequately. This was a descriptive study which aims to answer the basic 'w" questions - Who Where, What, When, What, Why and so what? as contained in the study's objectives. All the 47 Counties were targeted. The findings of this study indicate that the current basis for allocation differs with what has been recommended under the Commission on Revenue Allocation criteria. It's heavily dependent on utilisation data. Comparison of share of a county hospital fund and the share of devolved funds indicated that poor counties receive fewer hospital funds than their equity target. Regression analysis showed that increase in funding over the last 4 years was mainly based on utilisation data and hospital size. Most of the other determinants were ignored. The qualitative findings also correlated these results. Respondents felt that HIV and rural population groups should be prioritised as well as poverty and size of the hospital in resource allocation. Inadequate resources were seen as the key obstacle in achieving an equitable distribution of resources.