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Homauni A, Markazi-Moghaddam N, Mosadeghkhah A, Noori M, Abbasiyan K, Jame SZB. Budgeting in Healthcare Systems and Organizations: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1889-1901. [PMID: 38033850 PMCID: PMC10682572 DOI: 10.18502/ijph.v52i9.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/16/2023] [Indexed: 12/02/2023]
Abstract
Background Budgeting is the process resource allocation to produce the best output according to the revenue levels involved. Among the constraints that healthcare organizations, including hospitals, both in the public and private sectors, grapple with is budgetary constraints. Therefore, cost control and resource management should be considered in healthcare organizations under such circumstances. Methods We aimed to identify methods of budgeting in healthcare systems and organizations as a systematic review. To extract and analyze the data, a form was designed by the researcher to define budgeting methods proposed in the literature and to identify their strengths, weaknesses, and dimensions. The search was conducted in Google Scholar, Web of science, Pub med and Scopus databases covering the period 1990-2022. Results Overall, 33 articles were included in the study for extraction and final analysis. The study results were reported in four main themes: healthcare system budgeting, capital budgeting, global budgeting, and performance-based budgeting. Conclusion Each budgeting approach has its own pros and cons and requires meeting certain requirements. These approaches are selected and implemented depending on each country's infrastructure and conditions as well as its organizations. These infrastructures need to be thoroughly examined before implementing any budgeting method, and then a budgeting method should be selected accordingly.
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Affiliation(s)
- Abbas Homauni
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Nader Markazi-Moghaddam
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Mosadeghkhah
- Department of Endocrinology, Aja University of Medical Science, Tehran, Iran
| | - Majid Noori
- Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Kourosh Abbasiyan
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Tsofa B, Waweru E, Munywoki J, Soe K, Rodriguez DC, Koon AD. Political economy analysis of sub-national health sector planning and budgeting: A case study of three counties in Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001401. [PMID: 36962920 PMCID: PMC10022076 DOI: 10.1371/journal.pgph.0001401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/27/2022] [Indexed: 05/06/2023]
Abstract
Devolution represented a concerted attempt to bring decision making closer to service delivery in Kenya, including within the health sector. This transformation created county governments with independent executive (responsible for implementing) and legislative (responsible for agenda-setting) arms. These new arrangements have undergone several growing pains that complicate management practices, such as planning and budgeting. Relatively little is known, however, about how these functions have evolved and varied sub-nationally. We conducted a problem-driven political economy analysis to better understand how these planning and budgeting processes are structured, enacted, and subject to change, in three counties. Key informant interviews (n = 32) were conducted with purposively selected participants in Garissa, Kisumu, and Turkana Counties; and national level in 2021, with participants drawn from a wide range of stakeholders involved in health sector planning and budgeting. We found that while devolution has greatly expanded participation in sub-national health management, it has also complicated and politicized decision-making. In this way, county governments now have the authority to allocate resources based on the preferences of their constituents, but at the expense of efficiency. Moreover, budgets are often not aligned with priority-setting processes and are frequently undermined by disbursements delays from national treasury, inconsistent supply chains, and administrative capacity constraints. In conclusion, while devolution has greatly transformed sub-national health management in Kenya with longer-term potential for greater accountability and health equity, short-to-medium term challenges persist in developing efficient systems for engaging a diverse array of stakeholders in planning and budgeting processes. Redressing management capacity challenges between and within counties is essential to ensure that the Kenya health system is responsive to local communities and aligned with the progressive aspirations of its universal health coverage movement.
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Affiliation(s)
- Benjamin Tsofa
- KEMRI-Wellcome Trust Research Programme–KEMRI Centre for Geographic Medicine Research -Coast, Kilifi, Kenya
- Department of Public Health–Pwani University School of Health Sciences, Kilifi, Kenya
- * E-mail:
| | - Evelyn Waweru
- KEMRI-Wellcome Trust Research Programme–KEMRI Centre for Geographic Medicine Research -Coast, Kilifi, Kenya
| | - Joshua Munywoki
- KEMRI-Wellcome Trust Research Programme–KEMRI Centre for Geographic Medicine Research -Coast, Kilifi, Kenya
| | - Khaing Soe
- United Nations Children’s Fund (UNICEF) Kenya, Country Office, Kisumu, Kenya
| | - Daniela C. Rodriguez
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, Baltimore, Maryland, United States of America
| | - Adam D. Koon
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, Baltimore, Maryland, United States of America
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Mbau R, Oliver K, Vassall A, Gilson L, Barasa E. A qualitative evaluation of priority-setting by the Health Benefits Package Advisory Panel in Kenya. Health Policy Plan 2022; 38:49-60. [PMID: 36373870 PMCID: PMC9849713 DOI: 10.1093/heapol/czac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/12/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Kenya's Ministry of Health established the Health Benefits Package Advisory Panel (HBPAP) in 2018 to develop a benefits package for universal health coverage. This study evaluated HBPAP's process for developing the benefits package against the normative procedural (acceptable way of doing things) and outcome (acceptable consequences) conditions of an ideal healthcare priority-setting process as outlined in the study's conceptual framework. We conducted a qualitative case study using in-depth interviews with national-level respondents (n = 20) and document reviews. Data were analysed using a thematic approach. HBPAP's process partially fulfilled the procedural and outcome conditions of the study's evaluative framework. Concerning the procedural conditions, transparency and publicity were partially met and were limited by the lack of publication of HBPAP's report. While HBPAP used explicit and evidence-based priority-setting criteria, challenges included lack of primary data and local cost-effectiveness threshold, weak health information systems, short timelines and political interference. While a wide range of stakeholders were engaged, this was limited by short timelines and inadequate financial resources. Empowerment of non-HBPAP members was limited by their inadequate technical knowledge and experience in priority-setting. Finally, appeals and revisions were limited by short timelines and lack of implementation of the proposed benefits package. Concerning the outcome conditions, stakeholder understanding was limited by the technical nature of the process and short timelines, while stakeholder acceptance and satisfaction were limited by lack of transparency. HBPAP's benefits package was not implemented due to stakeholder interests and opposition. Priority-setting processes for benefits package development in Kenya could be improved by publicizing the outcome of the process, allocating adequate time and financial resources, strengthening health information systems, generating local evidence and enhancing stakeholder awareness and engagement to increase their empowerment, understanding and acceptance of the process. Managing politics and stakeholder interests is key in enhancing the success of priority-setting processes.
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Affiliation(s)
- Rahab Mbau
- *Corresponding author. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail:
| | - Kathryn Oliver
- Department of Public Health Environment and Society, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK,Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O. BOX 43640-00100, 197 Lenana Place, Nairobi Kenya,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Campus, Roosevelt Drive, Oxford OX3 7LG, UK,Institute of Healthcare Management, Strathmore University, Karen Ole Sangale Road, P.O. BOX 59857-00200, Nairobi, Kenya
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County Health Leadership Practices and Readiness for Noncommunicable Disease Services in Kenya. Ann Glob Health 2022; 88:58. [PMID: 35936230 PMCID: PMC9306762 DOI: 10.5334/aogh.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Premature mortality from noncommunicable diseases (NCDs) is a contemporary development challenge. Low-income and lower-middle-income countries are disproportionately affected, with the poorest in society considered the most vulnerable. A paucity of literature exists on how leadership practices at the implementation level relate to ensuring readiness for NCD services. Objective: This study investigated any relationship between leadership practices and readiness for NCD services. Methods: This correlational study investigated any relationship between leadership practices at the county level and readiness for NCD services in Kenya using secondary data from a 2013 Service Availability and Readiness Assessment survey. Correlation and multiple linear regression tests were used to determine the strength and direction of any relationship between leadership practices (annual work planning, therapeutic committees, and supportive supervision), and NCD readiness (county readiness score). Findings: The findings indicated a statistically significant relationship between therapeutic committee (p = .002) and supportive supervision practices (p = .023) and NCD readiness. Leadership practices also had a statistically significant predictive relationship with NCD readiness (p = .009). Conclusion: Health leaders should ensure that leadership practices that have a predictive relationship with NCD readiness, such as therapeutic committee activities and supportive supervision visits, are implemented appropriately. Further, county health leaders should pay particular attention to the implementation of these leadership practices at nonpublic and Tiers 2, 3, and 4 health facilities that had lower NCD readiness scores.
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Tsofa B, Musotsi P, Kagwanja N, Waithaka D, Molyneux S, Barasa E, Maina T, Chuma J. Examining health sector application and utility of program-based budgeting: County level experiences in Kenya. Int J Health Plann Manage 2021; 36:1521-1532. [PMID: 33955046 PMCID: PMC8519121 DOI: 10.1002/hpm.3174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 02/12/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction In 2012, Kenya enacted a new Public Finance Management Act to guide the public‐sector planning and budgeting process. This new law replaced the previous line item budgeting, with a new program‐based budgeting (PBB) process. This study examined the experience of health sector PBB implementation at the county level in Kenya. Methods We carried out a review of the literature documenting the health sector application and utility of PBB in low‐ and middle‐income countries. We then collected empirical data to examine the experience of health sector application of PBB at County Level in Kenya. Results In the financial year 2017/18, counties utilised the PBB approach for health sector planning. The PBB approach was perceived by key stakeholders; to have improved the alignment of technical priorities with budgetary allocation, and to have increased transparency, accountability and openness of the process. Its challenges included lack of clear tools and guidelines to support implementation, low capacity at county level, political interference and the organisation of the public sector electronic financial management system around line item budgeting system. Conclusion PBB is potentially a useful tool for aligning health sector planning and budgeting and ensuring the Annual Work Plan is more result oriented. However, realisation of this goal would be enhanced by the developing clear tools and guidelines to support its implementation, building capacity for county health sector managers to better understand the PBB application, and reforming the public‐sector budgetary management system to align it with the PBB approach.
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Affiliation(s)
- Benjamin Tsofa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kenya.,Department of Public Health, School of Human and Health Sciences, Pwani University, Kenya
| | - Protus Musotsi
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kenya.,Department of Public Health, School of Human and Health Sciences, Pwani University, Kenya
| | - Nancy Kagwanja
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kenya
| | - Dennis Waithaka
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kenya
| | - Sassy Molyneux
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Edwine Barasa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kenya.,Department of Public Health, School of Human and Health Sciences, Pwani University, Kenya
| | - Thomas Maina
- The World Bank Group, Kenya Country Office, Kenya
| | - Jane Chuma
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kenya.,The World Bank Group, Kenya Country Office, Kenya
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Wanjau MN, Kivuti-Bitok LW, Aminde LN, Veerman L. Stakeholder perceptions of current practices and challenges in priority setting for non-communicable disease control in Kenya: a qualitative study. BMJ Open 2021; 11:e043641. [PMID: 33795302 PMCID: PMC8023733 DOI: 10.1136/bmjopen-2020-043641] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the stakeholders' perceptions of current practices and challenges in priority setting for non-communicable disease (NCD) control in Kenya. DESIGN A qualitative study approach conducted within a 1-day stakeholder workshop that followed a deliberative dialogue process. SETTING Study was conducted within a 1-day stakeholder workshop that was held in October 2019 in Nairobi, Kenya. PARTICIPANTS Stakeholders who currently participate in the national level policymaking process for health in Kenya. OUTCOME MEASURE Priority setting process for NCD control in Kenya. RESULTS Donor funding was identified as a key factor that informed the priority setting process for NCD control. Misalignment between donors' priorities and the country's priorities for NCD control was seen as a hindrance to the process. It was identified that there was minimal utilisation of context-specific evidence from locally conducted research. Additional factors seen to inform the priority setting process included political leadership, government policies and budget allocation for NCDs, stakeholder engagement, media, people's cultural and religious beliefs. CONCLUSION There is an urgent need for development aid partners to align their priorities to the specific NCD control priority areas that exist in the countries that they extend aid to. Additionally, context-specific scientific evidence on effective local interventions for NCD control is required to inform areas of priority in Kenya and other low-income and middle-income countries. Further research is needed to develop best practice guidelines and tools for the creation of national-level priority setting frameworks that are responsive to the identified factors that inform the priority setting process for NCD control.
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Affiliation(s)
- Mary Njeri Wanjau
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - Leopold Ndemnge Aminde
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Non-Communicable Disease Unit, Clinical Research Education, Networking & Consultancy, Douala, Cameroon
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Munywoki J, Kagwanja N, Chuma J, Nzinga J, Barasa E, Tsofa B. Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya. Int J Equity Health 2020; 19:165. [PMID: 32958000 PMCID: PMC7507677 DOI: 10.1186/s12939-020-01284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. METHODS We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. RESULTS We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. CONCLUSION Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country's efforts for promoting service delivery equity as a key goal - both for the devolution and the country's quest towards Universal Health Coverage (UHC).
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Affiliation(s)
- Joshua Munywoki
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya.
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.
| | - Nancy Kagwanja
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Jane Chuma
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- The World Bank Group, Kenya Country Office, Nairobi, Kenya
| | - Jacinta Nzinga
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Edwine Barasa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Benjamin Tsofa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya.
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.
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Ayah R, Ong'ech J, Mbugua EM, Kosgei RC, Waller K, Gathara D. Responding to maternal, neonatal and child health equipment needs in Kenya: a model for an innovation ecosystem leveraging on collaborations and partnerships. ACTA ACUST UNITED AC 2020; 6:85-91. [PMID: 32685187 PMCID: PMC7361008 DOI: 10.1136/bmjinnov-2019-000391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/07/2020] [Accepted: 03/23/2020] [Indexed: 01/21/2023]
Abstract
Background Up to 70% of medical devices in low-income and middle-income countries are partially or completely non-functional, impairing service provision and patient outcomes. In Sub-Saharan Africa, medical devices not designed for local conditions, lack of well-trained biomedical engineers and diverse donated equipment have led to poor maintenance and non-repair. The Maker Project’s aim was to test the effectiveness of an innovative partnership ecosystem network, the ‘Maker Hub’, in reducing gaps in the supply of essential medical devices for maternal, newborn and child health. This paper describes the first phase of the project, the building of the Maker Hub. Methods Key activities in setting up the Maker Hub—a collaborative partnership between the University of Nairobi (UoN) and the Kenyatta National Hospital (KNH), catalysed by Concern Worldwide Kenya—are described using a product development partnership approach. Using a health systems approach, a needs assessment identified a medical equipment shortlist. Design thinking with a capacity building component was used by the UoN (innovators, public health specialists, engineers) working closely and with KNH nurses, physicians and biomedical engineers to develop the prototypes. Results To date, four medical device prototypes have been developed. Two have been evaluated by the National Bureau of Standards and one has undergone clinical testing. Conclusions We have demonstrated an innovative partnership ecosystem that has developed medical devices that have undergone national standards evaluation and clinical testing, a first in Sub-Saharan Africa. Promoting a robust innovation ecosystem for medical equipment requires investment in building trust in the innovation ecosystem.
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Affiliation(s)
- Richard Ayah
- Science and Technology Park and School of Public Health, University of Nairobi, Nairobi, Kenya
| | - John Ong'ech
- Obstetrics & Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Rose Chepchumba Kosgei
- Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Vilcu I, Mbuthia B, Ravishankar N. Purchasing reforms and tracking health resources, Kenya. Bull World Health Organ 2020; 98:126-131. [PMID: 32015583 PMCID: PMC6986225 DOI: 10.2471/blt.19.239442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023] Open
Abstract
As low- and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. Our qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. We therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing. We also offer suggestions how this enhancement can be achieved.
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Affiliation(s)
- Ileana Vilcu
- ThinkWell, Rue du Mont-Blanc 15, 1201 Geneva, Switzerland
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Sparkes SP, Kutzin J, Earle AJ. Financing Common Goods for Health: A Country Agenda. Health Syst Reform 2019; 5:322-333. [DOI: 10.1080/23288604.2019.1659126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Susan P. Sparkes
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Joseph Kutzin
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Alexandra J. Earle
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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11
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McCollum R, Taegtmeyer M, Otiso L, Mireku M, Muturi N, Martineau T, Theobald S. Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya. Int J Equity Health 2019; 18:65. [PMID: 31064355 PMCID: PMC6505258 DOI: 10.1186/s12939-019-0967-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/22/2019] [Indexed: 01/17/2023] Open
Abstract
Background Universal health coverage (UHC) is growing as a national political priority, within the context of recently devolved decision-making processes in Kenya. Increasingly voices within these discussions are highlighting the need for actions towards UHC to focus on quality of services, as well as improving coverage through expansion of national health insurance fund (NHIF) enrolment. Improving health equity is one of the most frequently described objectives for devolution of health services. Previous studies, however, highlight the complexity and unpredictability of devolution processes, potentially contributing to widening rather than reducing disparities. Our study applied Tanahashi’s equity model (according to availability, accessibility, acceptability, contact with and quality) to review perceived equity of health services by actors across the health system and at community level, following changes to the priority-setting process at sub-national levels post devolution in Kenya. Methods We carried out a qualitative study between March 2015 and April 2016, involving 269 key informant and in-depth interviews from different levels of the health system in ten counties and 14 focus group discussions with community members in two of these counties. Qualitative data were analysed using the framework approach. Results Our findings reveal that devolution in Kenya has focused on improving the supply side of health services, by expanding the availability, geographic and financial accessibility of health services across many counties. However, there has been limited emphasis and investment in promoting the demand side, including restricted efforts to promote acceptability or use of services. Respondents perceived that the quality of health services has typically been neglected within priority-setting to date. Conclusions If Kenya is to achieve universal health coverage for all citizens, then county governments must address all aspects of equity, including quality. Through application of the Tanahashi framework, we find that community health services can play a crucial role towards achieving health equity.
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Affiliation(s)
- Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | | | | | | | - Tim Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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12
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Waithaka D, Tsofa B, Kabia E, Barasa E. Describing and evaluating healthcare priority setting practices at the county level in Kenya. Int J Health Plann Manage 2018; 33. [PMID: 29658138 PMCID: PMC6120533 DOI: 10.1002/hpm.2527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Healthcare priority setting research has focused at the macro (national) and micro (patient level), while there is a dearth of literature on meso-level (subnational/regional) priority setting practices. In this study, we aimed to describe and evaluate healthcare priority setting practices at the county level in Kenya. METHODS We used a qualitative case study approach to examine the planning and budgeting processes in 2 counties in Kenya. We collected the data through in-depth interviews of senior managers, middle-level managers, frontline managers, and health partners (n = 23) and document reviews. We analyzed the data using a framework approach. FINDINGS The planning and budgeting processes in both counties were characterized by misalignment and the dominance of informal considerations in decision making. When evaluated against consequential conditions, efficiency and equity considerations were not incorporated in the planning and budgeting processes. Stakeholders were more satisfied and understood the planning process compared with the budgeting process. There was a lack of shifting of priorities and unsatisfactory implementation of decisions. Against procedural conditions, the planning process was more inclusive and transparent and stakeholders were more empowered compared with the budgeting process. There was ineffective use of data, lack of provisions for appeal and revisions, and limited mechanisms for incorporating community values in the planning and budgeting. CONCLUSION County governments can improve the planning and budgeting processes by aligning them, implementing a systematic priority setting process with explicit resource allocation criteria, and adhering to both consequential and procedural aspects of an ideal priority setting process.
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Affiliation(s)
- Dennis Waithaka
- Health Systems and Research Ethics DepartmentKEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Benjamin Tsofa
- Health Systems and Research Ethics DepartmentKEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Evelyn Kabia
- Health Economics Research UnitKEMRI Wellcome Trust Research ProgrammeNairobiKenya
| | - Edwine Barasa
- Health Economics Research UnitKEMRI Wellcome Trust Research ProgrammeNairobiKenya
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
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