Delayed payments mar Linda Mama services

Unpredictable and delayed disbursement of funds to healthcare facilities has negatively affected the implementation of the Linda Mama programme, says a report.

 This, the report states, has led to shortage of essential medical supplies including misoprostol, which is one of the medications commonly used by medics to induce labour and treat post-partum bleeding.

The study was conducted by researchers from the Kenya Medical Research Institute-Wellcome Trust Research Programme in collaboration with ThinkWell in 20 facilities in five counties. The facilities sampled included one public county referral hospital, one public sub-county hospital, one public health centre, and one faith-based hospital/health centre in each county.

The counties were selected because the National Hospital Insurance Fund (NHIF) was keen to understand Linda Mama implementation in both public and private facilities where parallel initiatives were in place.

“We randomly selected patients seeking maternal care, antenatal, delivery and postnatal care from the selected facilities. We also assessed the structural quality of care offered in the selected healthcare facilities by collecting data on the availability of tracer medicines and medical equipment that are essential for MCH (maternal and child health),” said Edwin Barasa from the Kemri health economics research unit.

According to the Linda Mama implementation manual, NHIF was to ensure timely payment of service providers – within 30 days of receiving invoices.

In practice, according to the report, healthcare facilities reported delays in receiving payments for up to three months. The timing and amount to be reimbursed was also unpredictable.

“The delays affect service delivery because a hospital is just like a hotel. A mother comes, uses my supplies, and goes, but I have not been paid, it depletes my supplies and that results in poor service. Again, the amount that we expect to be disbursed to us is also not predictable, they reimburse what they want,” a county health administrator was quoted in the report.

The findings, published in the Health Planning and Management journal, revealed that many hospitals lacked essential items because they did not have the funds.

The delays in disbursement of funds by NHIF were partly blamed on delays by the Ministry of Health to send the cash to NHIF. For instance, in the financial year 2018/2019, the government did not release all the Linda Mama funds, therefore, NHIF missed the budget target by 14 per cent.

A senior officer at NHIF who spoke on condition of anonymity said that they can only reimburse hospitals once they get money from the Health ministry.

“It takes a while before the Ministry of Health gives us money, and this is a managed scheme. If we don’t have money, we wait until funds come,” the officer said.

Health Principal Secretary Susan Mochache acknowledged that late disbursement of funds from the National Treasury has hindered uptake of the services and that the hospitals are burdened. This, she noted, might affect the gains the country has made in reducing maternal and neonatal deaths.

“We are in talks with Treasury for cash flow to support Linda Mama, this will ensure that the funds are released to NHIF early and to hospitals without delay,” she said.

In the last one year, most public health facilities across the country that offer services to the mothers faced financial challenges, with NHIF failing to remit funds since November 2020.

The Health ministry has transferred about Sh11 billion to NHIF in the last four financial years to support pregnant women and infants in accessing health services under the Linda Mama programme.