Analysis of Nakuru County Budget

Analysis of Nakuru County 2014/2015 Budget
Allocations towards Health Sector
cedgg@2014
1
County 2014/2015 Budget: Revenue Sources and Budget Allocations
1.0
Revenue Estimates and Sources
The Nakuru County Fiscal Year (FY) 2014/2015 programme based budget shifts focus from input,
as was the case with the 2013/2014 budget to outputs and outcomes. Programme based budgeting
adds performance metrics to budgets whereby programs and functions have to show output results.
The County budget for the FY 2014/2015 is estimated at Ksh 9,872,659,542. The proposed budget
balances with the estimated revenue for the financial year of Ksh 9.8 billion. The Government
targets raising Ksh 2 billion from local sources. Shillings 7.2 billion is to be obtained from national
government transfer out of which Ksh 228 million is conditional for rural electrification.
The County is to receive Ksh 138 million as loans and grants and projected Ksh 620 million
conditional transfers to level 5 hospitals. The County also targets to raise Ksh 540 million from FIF
a form of Appropriation in Aid (AIA) from health facilities.
6%
National
government
20.40%
73.40%
Local Sources
FIF, Health AIA
2.0
Expenditure Estimates
The recurrent expenditure for the County in the FY 2014/2015 is estimated at Ksh 6,788,616,022.
This includes Ksh 900 million to be allocated to the County Assembly. Ksh 4.6 billion (47%) of the
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allocation towards recurrent expenditure will go towards employee compensation, whereas Ksh
2,149,036,783 consists of operation and maintenance costs across the board.
Allocation towards development expenditure in the FY includes Ksh 1.375 billion towards Ward
development projects. This will go towards among other things water works, development of road
infrastructure, construction and rehabilitation of health facilities.
An estimated amount of Ksh 1,029.1 billion (33%) of allocations towards development expenditure
is proposed for infrastructure development including roads, water and Information Communication
Technology (ICT). Shillings 38.692 million is proposed for education infrastructure for early
childhood education while Ksh 26 million is proposed for youth polytechnic and resource center.
3.0
Allocation to Sectors
The County health sector is estimated to receive the largest share of allocation of the budget at Ksh
3,475,968,141 accounting for 35.2% of the total expenditure of Ksh 9,872,659,542. This is followed
by Roads, Transport and public works taking Ksh 1,115,827,945 i.e. 11.3% of the total expenditure.
Agriculture, livestock and fisheries will receive 570,209,839 i.e. 5.8% while Environment, Water and
Natural Resources is to be allocated Ksh 367,764,899 i.e. 3.7%.
Office of Governor and Deputy Governor
2.70%
0.80%
3.70%
County Treasury
9.10%
Health
10.10%
Roads, Transport and Public Works
Agriculture, Livestock and Fisheries
6.20%
ICT and e Government
3.60%
Education, Culture, Youth Affairs, sports
and Social Services
Land, Housing and Urban Development
4.10%
35.20%
6.60%
Trade, Tourism and Cooperative
Public Service Management
0.70%
5.80%
Environment, Water and Natural
Resources
Public Service Board
11.30%
County Assembly
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3.1
Allocations to sectors: Recurrent expenditure
Total allocation towards development expenditure in the financial year is Ksh 6,248,616,022. The
health sector will also take the lion share of allocations towards recurrent expenditure at Ksh
3,033,577,621 accounting for 44.7% of total allocation towards recurrent expenditure. This is
followed by the County Assembly at 10.3%. Agriculture, livestock and fisheries will receive Ksh
373,248,839 accounting for 5.5% of the allocations.
Office of Governor and Deputy Governor
County Treasury
3.20%
1.00%
10.30%
2.50%
Health
9.80%
Roads, Transport and Public Works
Agriculture, Livestock and Fisheries
8.10%
ICT and e Government
2.30%
Education, Culture, Youth Affairs, sports and
Social Services
Land, Housing and Urban Development
2.10%
5.20%
0.30%
5.50%
Trade, Tourism and Cooperative
44.70%
Public Service Management
4.90%
Environment, Water and Natural Resources
Public Service Board
County Assembly
3.2
Allocations to sectors: Development expenditure
Total allocation proposed towards development expenditure in the financial year is Ksh
3,087,043,520. The County health sector is second in terms of allocations towards development
expenditure receiving Ksh 442,390,520 accounting for 14.3% of the allocations.
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Office of Governor and Deputy Governor
6.50%
1.90%
County Treasury
1.60%
0.20%
6.50%
Health
11.00%
Roads, Transport and Public Works
Agriculture, Livestock and Fisheries
6.50%
14.30%
ICT and e Government
Education, Culture, Youth Affairs, sports and
Social Services
Land, Housing and Urban Development
8.60%
9.70%
Trade, Tourism and Cooperative
25.40%
Public Service Management
6.40%
1.50%
Environment, Water and Natural Resources
Public Service Board
County Assembly
Kenya shillings 784,550,000 accounting for 25.4% of budgetary allocation towards the development
of roads in the County will largely contribute to the opening of rural economies making it easy for
farmers to transport agricultural produce as well as increase access to services such as health.
4.0
The Health Budget
Nakuru County vision for the health sector is a County that is free from preventable diseases and ill
health with an efficient and cost effective medical care system. Common diseases prevalence order
diseases of respiratory system, clinical malaria, pneumonia, diarrhea, typhoid fever.
The County health sector comprises of the Ministry of Health including the Provincial General
Hospital, all Sub-County health facilities, dispensaries and health centres. The sector MTEF is
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guided by the Second Medium Term Plan (MTP) of Vision 2030, the Kenya Health Policy 20122030, the Health Sector Strategic Plan (HSSP) and the Constitution of Kenya 2010.
Challenges affecting the sector as highlighted in the County Integrated Development Plan include
among others: Low access to health services due to long distances to access facilities, poor road
infrastructure, inadequate health infrastructure, inadequate drugs, inadequate trained personnel,
inadequate clean water, poor sanitation, water pollution and poor sanitation, and on time delivery of
medicines and medical supplies. Immunization in the county has decrease due to poor access to
vaccination clinics.
The sector seeks to address these challenges through continued investment in training of health
professionals, medical services, health, and sanitation infrastructure and improvement in the working
conditions of medical practitioners.
4.1
Budgetary allocations to health programmes
4.1.1
Allocation to Preventive and Promotion services:
Estimated allocation towards preventive and promotive services in the FY 2014/2015 is Ksh
100,386,122 accounting for 2.88% of the health vote. The programme is mandated to reduce
disease burden associated with environmental health risk factors, lifestyle related diseases and
conditions. The target is to establish 22 community health units in 2014/15.
An allocation of Ksh 67,017,766 will go towards environmental health and sanitation programme.
This is critical given that most of the prevalent diseases in the county including diarrhea, typhoid
fever and tuberculosis are as a result of unhygienic environmental conditions and unclean water.
Community health strategy will receive Ksh 25,572,969 while disease Surveillance and Emergency
Response, and Health Promotive Services are proposed to receive Ksh 5.2 million and Ksh
2,595,387 respectively.
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Enhanced prevention and promotion of health services will largely contribute curative costs as a
result of reduction in diseases.
5.18%
2.59%
Community health strategy
25.47%
Environmental health and
sanitation
Disease surveillance and
emergency response
Health promotive services
66.76%
4.1.2
Allocation to Curative Services
Estimated allocation towards providing essential quality health services that is affordable, equitable,
accessible and responsive services is Ksh 356,000,000 accounting for 10.24% of the health vote.
Shillings 349 million of the amount towards curative services has been set aside towards the
provision of essential health services at all levels. Ksh 3 million is for elimination and reduction of
communicable and non non-communicable diseases such as tuberculosis. Reproductive health
programme is to be allocated Ksh 4 million.
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0.84%
Essential health services at
all levels
1.12%
Elimination and reduction
of communicable and
non-communicable
diseases
Reproductive health
98.03%
4.1.3
Allocation to Administration and Planning
The allocation of Ksh 3,019,582,019 to administration and planning accounts for 86.87% of the
health vote. The bulk of this allocation is for Human Resources for Health taking 83.16% i.e. Ksh
2,511,227,031 of the allocation followed by Health Infrastructure Development at Ksh 442,390,520.
The proposed amount for research and development is Ksh 1,982,234.
0.07%
0.28%
14.65%
1.84%
Health infrastructure
develeopment
Health information system
Leadership / governance
Human resources for health
Research and development
83.16%
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5.0
Improving health service delivery

The County government plans to use a lot of resources towards the rehabilitation and
development of health facilities throughout the county. The government should consider
liaising with the Constituency Development Fund (CDF) in the development of health
facilities in the County so that more money from the County Revenue Fund kitty can be
focused towards the provision of health services. The 2014/2015 national budgets has
allocated Ksh 100 million to CDF for development projects.

The County government should consider focusing more resources towards preventive and
promotive services as prevalent diseases in the country including diarrhea, typhoid dysentery
and tuberculosis can be controlled. This will largely contribute towards the reduction of
curative costs.

Increasing access to health facilities which has been highlighted as one of the challenges in
the county requires increased allocation towards the development of rural roads. This
requires that resources coming to the county including CDF are well harmonized for better
outcomes.
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