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STORY: KENYA / PERFORMANCE-BASED HEALTHCARE
TRT: 7:02
SOURCE: WORLD BANK
RESTRICTIONS: NONE
LANGUAGE: ENGLISH / SAMBURU / NATS
DATELINE: 1-9 AUGUST 2012, SAMBURU COUNTY, KENYA
2 AUGUST 2012, KISIMA, KENYA
1. Wide shot, exterior Kisima Health Center
2. Med shot, Kisima Health Center sign with services
3. Wide shot, patients in line for services
4. Med shot, patients in line for services
5. Close up, child with mother
6. Close up, child with mother
7. Close up, children with mothers
8. Med shot, patients in line for services
9 AUGUST 2012, NAIROBI, KENYA
9. SOUNDBITE (English) Dr. Shanaaz Sharif, Director of Public Health, Kenya:
“Under the old system, what would happen is that any money we would send would get stuck at the district level. The idea of having set up the Health Sector Services Fund was to make sure that facilities got the funding, right, and they would be responsible for it. And then at the same time we would empower the communities to look after that fund and the facility.”
2 AUGUST 2012, KISIMA, KENYA
10. Pan right, patients in line for services to health workers
11. SOUNDBITE (English) Luke Nyagon, Accountant, Kisima Health Center:
“Through the Health Sector Services Fund we get the money directly to the facility accounts.”
12. Cutaway, public chalk board with budget information for Kisima Health Center
13. SOUNDBITE (English) Luke Nyagon, Accountant, Kisima Health Center:
“It has changed so many things in the facility. For example, there’s some facilities which didn’t have stethoscopes, blood pressure machines and renovations.”
14. Med shot, patient getting services
15. Med shot, nurse informing patient on how to use contraceptives
16. Close up, nurse informing patient on how to use contraceptives
17. Med shot, nurse testing patient’s blood pressure
18. Close up, patient getting services
8 AUGUST 2012, NAIROBI, KENYA
19. SOUNDBITE (English) Dr. Ramana Gandham, Lead Health Specialist, World Bank:
“We are focusing on Millennium Development Goal related indicators particularly on maternal and child health, like improved coverage for immunization, antenatal coverage, the institutional deliveries, contraception, as well as HIV-AIDS."
2 AUGUST 2012, KISIMA, KENYA
20. Close up, mother cleaning infant’s face
21. Med shot, mother setting infant down on scale
22. Close up, infant on scale
23. SOUNDBITE (English) Dr. Ramana Gandham, Lead Health Specialist, World Bank:
“And also there’s a dimension of quality. If they are not meeting the quality standard, they will not get any money.”
24. Med shot, health worker removing vaccine from storage
25. Med up, patient’s mother watching health worker put vaccine in needle
26. Wide shot, room where vaccines are given to children with several mothers waiting
27. Med shot, patient consulting with health worker
28. Close up, infant getting vaccine shot
29. Close up, infant getting vaccine shot
30. Close up, patients holding children
31. Med shot, health worker conversing with patient
32. Med shot, patient receiving prenatal care
33. Med shot, patient getting up from examination table
34. Close up, patient sitting down in chair
35. Med shot, patient getting blood pressure checked
36. SOUNDBITE (Samburu) Mercy, Patient, Kisima Health Center:
“I heard on [the radio] and from community health workers about the importance of coming to the clinic.”
37. Wide shot, patient walking past Kisima Health Center signage
38. SOUNDBITE (Samburu) Suri, Patient, Kisima Health Center:
”I have given birth in the hospital because I’ve heard from [the radio] the importance of delivering in the hospital.”
2 AUGUST 2012, MARALAL, KENYA
39. Wide shot, patient waiting for nurse
40. Med shot, nurse getting medicine for patient
41. Close up, nurse putting medicine in envelope
42. Close up, nurse giving medicine to patient
43. Med shot, patient holding child and medicine
44. SOUNDBITE (English) Lucy Wanjiru, Nurse, Catholic Dispensary Maralal:
”You know working too is not just a small thing, it’s hard work, but getting that money it’s motivated us so much to work extra hard.”
2 AUGUST 2012, KISIMA, KENYA
45. Med shot, World Vision logo on back of vehicle
46. Med shot, health workers and non-government organization monitors
47. Med shot, African Medical and Research Foundation (AMREF) health workers and World Vision officers
48. Pan right, patients and World Vision officer
49. Close up, World Vision officer reviewing health center records
50. Med shot, African Medical and Research Foundation (AMREF) health workers and World Vision officers
51. SOUNDBITE (English) Alfred Karissa, Nutrition Officer, World Vision:
“There is a joint verification team that actually at the end of every quarter goes to verify what has been reported in the district health information system.”
52. Cutaway, World Vision officer reviewing health center records
53. SOUNDBITE (English) Alfred Karissa, Nutrition Officer, World Vision:
“Then the Ministry with the support of the World Bank can actually give out the incentives if they have confirmed that the services that are being provided are both quality services and that community members are actually benefiting from the services being provided by the health facilities.”
1 AUGUST 2012, SUYAN MANYATTA, KENYA
54. Wide shot, villagers sitting in the meeting or community area
55. Wide shot, villagers sitting under a tree for a meeting
56. Med shot, mothers and children
57. Med shot, villagers
58. SOUNDBITE (Samburu) Ma Toraeli, Resident, Suyan Manyatta:
”Initially when a mother was unable to deliver they were helpless. Now the dispensary helps us to deliver.”
1 AUGUST 2012, BARSALOI, KENYA
59. Tilt up, Barsaloi
60. Med tracking shot, patient walking to health center
61. Wide shot, patient walking up to health center window
62. Wide shot, health center
63. Wide shot, patients waiting outside health center for service
64. Med shot, health worker putting gloves on to see patient
65. Close up, health worker examining infant
66. Med shot, health worker giving patient diagnosis
67. SOUNDBITE (English) Stephen Mwari Gichohi, Clinical Officer, Barsaloi Government Dispensary:
“Even if we are helped very much by the PBF to scale-up the indicators, maybe on deliveries, on immunization and other things, we’re having very much problems with transport.”
68. Cutaway, teenagers riding motorcycle
69. SOUNDBITE (English) Stephen Mwari Gichohi, Clinical Officer, Barsaloi Government Dispensary:
“There is nothing we can use to communicate in this place a distance of 50km of where we have the referral hospital.”
70. Med shot, District Public Health Nurse reviewing health center’s records
71. Close up, District Public Health Nurse looking at records
72. Close up, health center records
73. SOUNDBITE (English) Josphat Lenguris, Public Health Nurse, Samburu District:
“So to check on the quality of the immunization you provide we look, one, on how you store your vaccines. So we have to look at the fridge. How you arrange your vaccines in the fridge because again the vaccines are arranged according to the sensitivity to heat.”
74. Med shot, health worker opening vaccine storage
75. Close up, vaccine storage instructions
76. Close up, vaccine storage
8 AUGUST 2012, NAIROBI, KENYA
77. SOUNDBITE (English) Dr. Ramana Gandham, Lead Health Specialist, World Bank:
”We are using the existing vehicle, the Health Sector Services Fund, to focus more on the assessment of the performance and then rewarding results so that there is better motivation of health workers to deliver results and shift emphasis away from inputs.”
Getting healthcare out to rural areas in Kenya, such as Samburu County, can be a real challenge. Funds have been scarce, and trained doctors and nurses hard to attract.
The good news is that change is afoot. Money is now being sent directly from the government in Nairobi to each rural health center, through a special fund known as the Health Sector Services Fund.
SOUNDBITE (English) Dr. Shanaaz Sharif, Director of Public Health, Kenya:
“Under the old system, what would happen is that any money we would send would get stuck at the district level. The idea of having set up the Health Sector Services Fund was to make sure that facilities got the funding, right, and they would be responsible for it. And then at the same time we would empower the communities to look after that fund and the facility.”
Jointly supported by the Kenyan Government, Denmark’s development cooperation and the World Bank, money from this fund is making it possible for rural health centers like this one in Kisima to improve and maintain its infrastructure.
SOUNDBITE (English) Luke Nyagon, Accountant, Kisima Health Center:
“Through the Health Sector Services Fund we get the money directly to the facility accounts. It has changed so many things in the facility. For example, there’s some facilities which didn’t have stethoscopes, blood pressure machines and renovations.”
But that’s not all. Health centers in Samburu County are also getting additional money that is motivating and supporting staff to provide more services to patients while improving the quality.
This performance-based financing or PBF, supported by the Health Results Innovation Trust Fund, has been used to good effect in other African countries like Rwanda and Burundi.
SOUNDBITE (English) Dr. Ramana Gandham, Lead Health Specialist, World Bank:
“We are focusing on Millennium Development Goal related indicators particularly on maternal and child health, like improved coverage for immunization, antenatal coverage, the institutional deliveries, contraception, as well as HIV-AIDS. These are the areas where we are focusing on specific indicators to improve the coverage. And also there’s a dimension of quality. If they are not meeting the quality standard, they will not get any money.”
In Kisima, motivated community health workers are encouraging more women to bring their babies for growth monitoring and full immunization.
Nine month old Ntsekwa has been brought in for her measles vaccination. She is now fully immunized. Her mother Risper heard about the service from a community health worker, who also informed her of the benefits of handwashing and other hygienic practices.
Given the incentives, health workers are also getting more pregnant women to come in for regular antenatal checkups, and to deliver at a health center. Mercy, who is in her 36th week, is now making her fourth visit.
SOUNDBITE (Samburu) Mercy, Patient, Kisima Health Center:
“I heard on [the radio] and from community health workers about the importance of coming to the clinic.”
Also registered at Kisima health center is Suri. She has recently delivered her third child with skilled assistance at the facility.
SOUNDBITE (Samburu) Suri, Patient, Kisima Health Center:
”I have given birth in the hospital because I’ve heard from [the radio] the importance of delivering in the hospital.”
While services at public health centers like the one at Kisima are improving through performance-based financing, other health providers such as the Catholic Dispensary in the nearby town of Maralal are also receiving the same incentives from the government.
SOUNDBITE (English) Lucy Wanjiru, Nurse, Catholic Dispensary Maralal:
”You know working too is not just a small thing, it’s hard work, but getting that money it’s motivated us so much to work extra hard.”
Monitoring results is an important aspect of performance-based financing, and non-governmental organizations operating in the area are playing a key role.
SOUNDBITE (English) Alfred Karissa, Nutrition Officer, World Vision:
“There is a joint verification team that actually at the end of every quarter goes to verify what has been reported in the district health information system. Then the Ministry with the support of the World Bank can actually give out the incentives if they have confirmed that the services that are being provided are both quality services and that community members are actually benefiting from the services being provided by the health facilities.”
Although remote, Kisima and Maralal are not the end of the road. In fact, it is further into northern Samburu County that the going really gets tough for healthcare.
Here in Suyan manyata, a grueling four hour drive from Maralal, people appreciate health workers coming to immunize their children, but have to go a long distance to get help when they need it.
SOUNDBITE (English) Ma Toraeli, Resident, Suyan Manyatta:
”Initially when a mother was unable to deliver they were helpless. Now the dispensary helps us to deliver.”
This is a part of Kenya left untouched by the mobile revolution. There are no telephone services, not even in the large village of Barsaloi, where a public dispensary and one run by Colombian nuns stand side by side.
Agnes walked an hour in the mid-day sun to bring her grandchild, Salini, to be immunized. It turns out that Salini does not need immunization today, but instead has an ear infection which Stephen, the health worker in Barsaloi, is able to treat.
Too often, distance can prove fatal. When Salini was just a week old, her mother died of complications from childbirth.
SOUNDBITE (English) Stephen Mwari Gichohi, Clinical Officer, Barsaloi Government Dispensary:
“Even if we are helped very much by the PBF to scale-up the indicators, maybe on deliveries, on immunization and other things, we’re having very much problems with transport. There is nothing we can use to communicate in this place a distance of 50km of where we have the referral hospital.”
Although performance-based financing cannot fix all of the problems in remote areas it is helping to improve the quality of services delivered.
The district public health nurse, who is visiting, assesses the dispensary’s vaccine storage as part of the audit of the facility.
SOUNDBITE (English) Josphat Lenguris, Public Health Nurse, Samburu District:
“So to check on the quality of the immunization you provide we look, one, on how you store your vaccines. So we have to look at the fridge. How you arrange your vaccines in the fridge because again the vaccines are arranged according to the sensitivity to heat.”
The World Bank’s lead health specialist based in Nairobi, is upbeat about these efforts Kenya is making in healthcare.
SOUNDBITE (English) Dr. Ramana Gandham, Lead Health Specialist, World Bank:
”We are using the existing vehicle, the Health Sector Services Fund, to focus more on the assessment of the performance and then rewarding results so that there is better motivation of health workers to deliver results and shift emphasis away from inputs.”
