Family planning financing: tracking domestic family planning budget allocations at national and sub-national level in Kenya and Uganda

Data collection

In Uganda, the study was carried out between the months of May and September 2017 and it involved budget analysis of general health and FP funding at national and sub-national level. The study covered the fiscal year (FY) 2017/18. However, for comparison purposes, FY 2015/16 and FY 2016/17 were included in the analysis. Research assistants collected copies of approved budgets and work-plans from the Ministry of Health, Regional Referral Hospitals and the four districts of study. At the national level, data was collected from institutional records from the Ministry of Health, National Medical Stores and Regional Referral Hospitals and recurrent (wage & non-wage) and development (domestic & external) approved, released and spent figures were retrieved. At the sub-national level, copies of approved budgets and work-plans from which FP data was extrapolated were collected from four districts: Kamuli, Tororo, Mityana and Mukono. These four districts were selected because they are the locations of focus for DSW’s budget advocacy work in Uganda. Only approved documents with FP-related information, domestic allocations and government loans were included in the analysis. Documents that were not approved and those without family planning specific information and grants from donors were excluded from the analysis. The variables for which data was sought include domestic allocations, service delivery, capacity building, community mobilization and outreach and percentages of reproductive, new-born, maternal and child health) allocations.

In Kenya, the study was carried out between the months of June and October 2017. The budget study was implemented at the national level and in eleven counties of Kilifi, Mombasa, Nyandarua, Meru, Laikipia, Nakuru, Uasin Gishu, Trans-Nzoia, West-Pokot, Bungoma and Nandi. These counties were selected because they are DSW’s counties of focus in Kenya for FP budget advocacy. The indirect allocation by County Governments was estimated for each county, based on workload statistics from the District Health Information System (DHIS-2) and subjected to county allocation to health.

Data analysis

In Uganda, the DSW FP budget analysis tool provided the basis for data extraction. The DSW budget analysis tool, which is in Microsoft Excel format, provided data analysis at the district level, regional referral hospitals and at the national level. It contains sections for entering sources of funding (domestic or grants/donor) and components e.g. service delivery, capacity building, community mobilization and outreach and others. It also provides percentages that have been discussed and agreed with government officials for FP in situations where FP allocations are included in reproductive, maternal, newborn, child and adolescent health (RMNCAH) and exact FP allocations are not provided. The tool is programmed such that it updates itself once data has been inserted.

In Kenya, workload statistics obtained from the DHIS were subjected to the allocation for health for estimated allocation for family planning. This was done by calculating the percentage of FP service utilization from the total workload. All workloads were converted to the equivalent number of outpatient visits. For the conversion, one inpatient day or one bed-day was estimated to be equal to three outpatient visits. All the bed-days encompassing inpatient and maternity services were converted into outpatient visits and were added to all outpatient visits recorded to obtain the total workload equivalent. The FP percentage was then obtained by dividing total FP visits by total workload equivalent visits. This was done for every county for the FY 2015/16 and FY 2016/17. For FY 2017/18, an average budget increase/decrease over the previous two financial years (FY2015/16 & FY2016/17) were used to provide an estimate of the approximate increase/decrease in FY2017/2018, with the assumption that the same trend would continue. This was used to generate the FP utilization proportions for every county, since no workload statistics were available for this period. The proportions were then used to derive the allocations to FP services in each county using the percentage of FP workload in the total workload in the county. The workload data for each county was obtained from the DHIS-2. The county allocation to health was obtained from approved county government programme-based budgets. The health allocation was multiplied by the percentage of FP visits against all visits to get an estimate of county government allocation to FP for all the financial years under study. Microsoft Excel was used to calculate the allocations for health.

Uganda

In Uganda, during the 2017/18 FY, the government allocated 0.73% ($3.7 million) of its health sector budget ($506.7 million) to FP (Table 1), of which 98.8% ($3.6 million) was allocated to National Medical Stores (NMS), mainly for the supply of reproductive health commodities (Ongwae, 2019). Analysis of the four districts shows that only 0.5% ($7,966), 0.8% ($10,046), 0.9% ($9,663) and 1.9% ($35,395) of the health sector budget was allocated to FP in Kamuli, Mityana, Mukono and Tororo, respectively, during FY 2017/18. During FY 2016/17, Kamuli, Mityana, Mukono, and Tororo allocated $2,272, $3,175, $3,421 and $12,729, respectively, of their health sector budgets towards FP.

Kenya. In Kenya, the FP budget allocation at the national level reduced from $6.05 million 2015/16 to $2.93 million in 2017/18 (Table 2). The decrease in FP budget allocation at the national level is partly attributed to devolution, which has resulted in more resources being allocated to the counties. At the subnational level in Kenya, there was a combined increase in the estimated sub-national FP budget allocations in all eleven counties of 21.8% ($2.1 million), from $9.8 million (FY 2016/17) to $12 million (FY 2017/2018) (Ongwae, 2019).

Underlying data

For the Ugandan budget analysis, all source documents used are indicated in the data file and can be downloaded from the Ugandan Ministry of Finance, Planning and Economic Development budget website. For the Kenyan budget analysis, source data comprised of Kenyan county allocations to health from county Programme Based Budgets (PBB), which are supposed to be publicly available on the counties’ websites. Unfortunately, not all counties have made this information available online. Website links to counties whose data are available online for financial years 2016/17 and 2017/18 have been provided in the summarized workload statistics data file. For the counties whose data are not currently available online, links are provided to the counties' websites where contact information can be retrieved for the county finance department, who can facilitate access to the source documents.

Open Science Framework: Family planning financing: tracking domestic family planning budget allocations at national and sub-national level in Kenya and Uganda http://www.doi.org/10.17605/OSF.IO/DRN2H (Ongwae, 2019)

This project contains the following underlying data:

Extended data

Open Science Framework: Family planning financing: tracking domestic family planning budget allocations at national and sub-national level in Kenya and Uganda http://www.doi.org/10.17605/OSF.IO/DRN2H (Ongwae, 2019)

This project contains the following extended data:

Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).