Improving the mobilization of internally generated fund within the health sector: the case of Mamprobi Polyclinic

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Financing Health Services in developing countries has become a major source of concern as it has become more difficult for governments to shoulder the burden of financing health care. Major changes in the economic, demographic, epidemiological, socio-cultural and political environment have brought about an increase in government’s obligation in the provision in other sectors. As a result, budgetary allocations to the health sector have seen decreases over the years, with attendant reduction in quality of services. As a way of solving this problem of quality of service, various governments have exploited other sources of financing. These have taken many forms, one of which is the payment of user fees. It is normal for people to expect quality care when they are paying fees in any way. This expectation, however, has not been met, for various reasons, prominent among them being the poor performance of the Internally Generated Fund (IGF). Attempts have been made to rectify this by way of putting in place rules, regulations and instructions on the management of the finances. These have, however, not yielded the expected results. This has stimulated interest in researching into the human aspect, specifically the perceptions of the staff on the mobilization of the IGF. The objective of this study is to look at the factors causing the low revenue mobilization at Mamprobi Polyclinic and make recommendations towards improving it. Primary data was collected through the observation of activities at the Polyclinic and questionnaires administered to a sample of 100 staff members of all levels. The respondent rate was 79%. There were also some key informant interviews and a focus group discussion. Secondary data was also collected from the records and annual reports of the Polyclinic, and various research papers and books from various sources. The study revealed that the operation of the system of revenue mobilization, complies with the rules and regulations stipulated by the ATF. Although the IGF in Mamprobi Polyclinic has been increasing since 1995, the rate of increase in its utilization exceeds the income. The study also showed that 77% of respondents are not satisfied with what the IGF is used for, and are also not involved in the decision making stage in the utilization of the IGF. Although 77% of respondents think the IGF is an appropriate means of financing health in Ghana, 23% think otherwise. The latter think funding of health could be done through other means, including a Health Insurance Scheme, since most of the community members are poor and are unable to afford the user fees. These respondents (23%) think that there cannot be improvements in the IGF under the present operational conditions, including the late reimbursement of the exemptions. Results also revealed that monitoring and reconciliation of the IGF is done only 10% of the time. Control can thus be said to be weak. In addition, participation in decision-making in the utilization of the IGF is by only 27%, while 73% are not involved in any form at all. The 77% who think it is feasible to improve the performance of the IGF gave the following suggestions, among others: -More efforts need to be made in rationalizing the utilization of the IGF through budgeting and adherence to budgets; -Various ways of reducing costs of services need to be looked at; -All members of staff should be involved in the decision making stage of the utilization of the IGF, one way or the other; -The methods of communication in the Polyclinic need to be improved on, at all levels and between levels. All these imply that more is expected of the management of the Polyclinic if improvements in the performance of the IGF are to be achieved while control and monitoring need to be strengthened through a planned and systematic supervisory programme.
A Thesis submitted to the board of postgraduate studies, Kwame Nkrumah University of Science and Technology, Kumasi in partial fulfilment of the requirements for the degree of Masters of Science in Health Services Planning and Management, 2001