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The performance of public health facilities depends on purchasing arrangements, and mechanisms used to finance their operations. How public healthcare facilities are financed can affect health system goals in several ways. For example, the reliability of sources of funds may influence achievement of financial risk protection goals.
In this study, the authors examine how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. One finding of much interest was that in Kenya, a majority of public facilities still relied on user fees for their operations. In a country where only 18% of the people are covered by the national health insurance fund, user fees could potentially be a barrier to universal health coverage. The authors end the paper by suggesting that assessing the needs of the  health facility may guide appropriate resource allocation and help prevent some of the identified challenges.  
 
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