The Facilities Improvement Fund (FIF) Bill 2023 wants to give Kenya’s public hospitals control of their own money. But who manages that money – and how they are chosen – is the big question.
The Appointments That Sparked the Debate
- Calvin Okoth, alias Gaucho, was appointed to the board of Mama Lucy Kibaki Hospital
- Musician Ken wa Maria (Kennedy Wambua Ngunze) and mobiliser Triza Miroya were appointed to the board of Mama Margaret Uhuru Hospital
- Critics say these appointments reward political loyalty rather than merit
- Supporters argue that community figures can represent public interests and raise the profile of health issues
- Both sides are really pointing to the same problem: there are no clear, enforceable rules for who qualifies
The Problem This Law Is Trying to Fix
- Public hospitals in Kenya collect money from patients and insurance schemes like SHA
- That money does not stay at the hospital – it goes to the county government
- The county then shares it across many sectors, including roads and agriculture
- Hospitals must compete for funding even for basics like medicines and equipment
- A busy hospital can collect millions and still run out of supplies because it controls none of that money
What the FIF Bill Wants to Do
- Let each hospital keep the money it collects in its own bank account
- Use that money only to improve services at that same hospital
- This is called ring-fencing – the funds are locked in for health use only
- Money would come from patient fees, insurance payments, county allocations, government grants, and donations
- This money is meant to top up government funding, not replace it – so counties cannot use this as an excuse to cut health budgets
Who Would Manage the Money?
Two groups would share responsibility at each facility:
1. The Hospital Management Team
- Made up of health professionals already working at the facility
- Prepares budgets, monitors spending, and ensures financial rules are followed
2. The Health Facility Management Committee
- Brings in community members to represent the public
- Ensures local voices are part of decisions about how the facility is run
How Community Committees Are Chosen – The Clear Rules
For health centres and dispensaries, the Bill is specific. Each committee must have 7 to 9 members, including:
- The facility in-charge, who serves as secretary
- A sub-county health official
- A village representative
- Representatives from women’s groups, youth groups, and faith-based organisations
- Two members from vulnerable or marginalised communities
The committee is appointed by the County Executive Committee Member of Health.
Additional rules:
- The chairperson is elected from within the committee, not appointed from outside
- At least one third of members must be women
- The committee must reflect the diversity of the local community
- Members serve three-year terms, renewable once
- Terms are staggered, so not everyone leaves at the same time
Hospital Boards: Where the Rules Run Out
- For bigger facilities like county and sub-county hospitals, the Bill refers to Hospital Management Boards
- But it does not spell out a clear, standard process for how board members should be appointed
- Different counties can apply different criteria
- There is no minimum qualification required
- This is the gap at the centre of the current controversy
What Good Board Appointments Should Look Like
Based on the principles in the Bill, here is what appointments at all levels should reflect:
- Community representation: Boards should reflect the gender, diversity, and marginalised groups within the community they serve
- Independent chairperson: The chair should be elected from within the board, not imposed from outside
- Fixed terms: Members serve three years, renewable once, with staggered exits to maintain continuity
- Clear accountability: The County Chief Officer for Health is the official accounting officer, and all spending requires formal approval
- Separation of roles: Professionals handle financial management, boards provide governance and community oversight; these two roles must not be mixed up
The Financial Safeguards Already in the Bill
- No money can be spent without official authorisation
- All transactions must go through an integrated financial system
- Unused funds roll over to the next year and do not lapse
- All funds are audited under the Public Audit Act 2015
- Misuse of funds attracts penalties under the Public Finance Management Act
Why This Matters to You
If the Bill works as intended:
- Hospitals will have more reliable funding for medicines and supplies
- Facilities will be better maintained
- Primary healthcare at the community level will be stronger
- Kenya moves closer to Universal Health Coverage – quality care for everyone, without financial hardship
But funding alone is not enough:
- Strong, transparent governance must go hand in hand with financial reform
- The people overseeing public hospital funds must be competent, independent, and accountable
- Without clear appointment rules for hospital boards, the risk of mismanagement and public mistrust remains
The Bottom Line
The FIF Bill is a significant and necessary reform. The community committee rules are clear and well-designed. The hospital board appointment rules are not. Fixing that gap – by setting transparent, merit-based, standardised criteria for all board appointments – is the reform Kenya’s health system urgently needs.
Source: Facilities Improvement Fund (FIF) Bill 2023
