The Effects of Health Purchasing Reforms on Equity, Access, Quality of Care, and Financial Protection in Kenya: A Narrative Review

The involvement of non-governmental organisations in achieving health system goals based on the WHO six building blocks: A scoping review on global evidence

BACKGROUND

Non-governmental organisations (NGOs) have the potential to make a significant contribution to improving health system goals through the provision of resources, health services and community participation. Therefore, this paper examines the role of NGOs in achieving health system goals, based on the six building blocks of a health system framework, and identifies strategies to enhance NGO involvement in achieving health system goals.

METHODS

A scoping systematic review methodology was used to map and synthesise the existing literature on the topic, following the latest JBI six-stage framework. Four databases and one search engine including PubMed, Web of Science (ISI), EMBASE, Scopus and Google Scholar were searched from January 2000 to January 2024. The results were synthesised using a directed content analysis approach, and the findings were categorised according to the dimensions of the six building blocks.

RESULTS

NGO involvement in health system goals can effectively address gaps in service delivery, strengthen the health workforce, improve health information systems, increase access to essential medicines, mobilise resources and promote good governance. In addition, six key strategies were identified, including joint planning, policy development, capacity building, resource allocation, developing collaboration, and improving the quality of health care, to enhance NGO participation in achieving health system goals.

CONCLUSION

NGOs can play a critical role in achieving health system goals, alongside government and other key health stakeholders. Governments need to use evidence-based policies and interventions to support NGOs to realise their potential in achieving health system goals.

Moving toward universal health coverage with a national health insurance program: A scoping review and narrative synthesis of experiences in eleven low- and lower-middle income countries

Universal Health Coverage (UHC) aims to provide access to quality health services to all while avoiding financial hardship. Strategies can include establishing a national health insurance scheme (NHIS). However, variations in the progress exist among countries with an NHIS. This study assesses strategies adopted in low- and lower-middle-income countries (LLMICs) with an NHIS to expand UHC. The research entailed a descriptive, qualitative review of the literature on LLMICs that have implemented an NHIS. PRISMA guidelines were used to identify studies and reports. A total of 569 texts were identified from 4 databases. A total of 78 texts were included, spanning 7 countries from Sub-Saharan Africa and 4 from Asia. The search was conducted in March 2023 and updated in April 2024. An analytical framework was used to systematically collect, analyze, and synthesize key features to review healthcare financing mechanisms and coverage dimensions. Countries generate revenue through various public and private means, including taxes, premiums, and out-of-pocket payments. Some have consolidated revenue streams into a single pool for efficiency, while others maintain separate pools. Healthcare services are procured from public and private providers, differing by country. Fee-for-service is the prevalent payment method, but capitation systems have been attempted to control expenses. Population coverage depends on whether enrollment in an NHIS is mandatory or voluntary and on its enforcement. Service provision can be comprehensive and universal or can vary with specific schemes. Mechanisms to avoid financial hardship can involve premium exemptions or subsidies. Progressing toward UHC requires addressing issues of financial sustainability, cost-containment, enrollment expansion, financial protection, and health equity. While policy options are context-specific, this review showcased experiences for other LLMICs committed to UHC with an NHIS. Recommendations on health financing include increasing the allocation of tax revenues to the insurance scheme, merging risk pools, and adopting strategic purchasing.

Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance

There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.

Leveraging local health system resources to address quality healthcare gaps in sub-Saharan African: lessons from the SafeCare quality improvement programme in Ghana

INTRODUCTION

In low- and-middle-income-countries (LMICs) like Ghana, universal access to quality healthcare remains a mirage and this undermines achievement of sustainable development goal (SDG) 3. The SafeCare Quality Improvement (QI) programme is an initiative of PharmAccess Foundation, a Netherlands-based non-governmental organisation (NGO). In 2009 SafeCare QI programme was launched in Ghana to help address gaps in healthcare quality standards, leveraging existing local resources. Over 600 private and public healthcare facilities are currently enrolled in the programme and is being adopted for nation-wide rollout by government of Ghana and implementing partners.

OBJECTIVE

This paper explored views and experiences of frontline health staff and policy makers on the SafeCare quality improvement programme in Ghana and how local resources were leveraged in its implementation.

METHODOLOGY

Design/setting: The evaluation was conducted in 53 private and public healthcare facilities from seven administrative regions of Ghana across the coastal, middle, and northern geopolitical belts. The regions are Ashanti (n = 12), Bono East (n = 8), Bono (n = 3), Greater Accra (n = 12), Oti (n = 4), Savannah (n = 8) and Western (n = 9).

SAMPLING

Quota and purposive sampling techniques were used to sample the healthcare facilities in accordance with the study eligibility criteria. Total of 45 focus group discussions (FGDs) and 47 individual in-depth interviews (IDIs) were conducted among frontline staff and policy makers from government and private local partner institutions.

ANALYSIS

 Group and individual interviews were audio recorded, transcribed verbatim and thematic content analysis done using Nvivo (version 12.0) software.

FINDINGS

Overall, participants perceived the relevance and benefits of the SafeCare programme to be "very satisfactory" while the programme impact, rollout process and success were perceived to be "satisfactory". Quality healthcare standards were perceived to have improved in beneficiary health facilities due to participation in the SafeCare programme. Patient satisfaction, service utilisation and revenue generation in healthcare facilities were also attributed to the SafeCare programme. Proposals were made for harmonisation of existing QI assessment tools to mitigate duplications. Agreed data sharing protocols and interoperability with existing national database were also recommended to promote sustainability. Finally, low staff motivation, high workload, lack of financial and material resources were cited as potential impediments to full compliance with the SafeCare QI standards by healthcare facilities enrolled in the programme.

CONCLUSIONS

SafeCare QI programme has contributed to QI and adherence to patient safety standards in Ghana. Sustainability is however dependent on continuous government commitment as the programme gets adopted as a national QI programme. Overlaps in content of QI assessment tools ought to be addressed to promote efficiency without compromising quality standards. The SafeCare programme demonstrates that health systems in LMICs have the potential to attain acceptable quality healthcare standards when they take advantage of existing local resources, including private-public partnership (PPP) and peer-learning opportunities.

Assessing the choice of National Health Insurance Fund contracted outpatient facilities in Kenya: A qualitative study

OBJECTIVE

To assess National Health Insurance Fund (NHIF) members' level of understanding, experiences, and factors influencing their choice of NHIF-contracted outpatient facilities in Kenya.

METHODS

We conducted a cross-sectional qualitative study with NHIF members in two purposefully selected counties (Nyeri and Makueni counties) in Kenya. We collected data through 15 focus group discussions with NHIF members. Data were analysed using a framework analysis approach.

RESULTS

Urban-based NHIF members had a good understanding of the NHIF-contracted outpatient facility selection process and the approaches for choosing and changing providers, unlike their rural counterparts. While NHIF members were required to choose a provider before accessing care, the number of available alternative facilities was perceived to be inadequate. Finally, NHIF members identified seven factors they considered important when choosing an NHIF-contracted outpatient provider. Of these factors, the availability of drugs, distance from the household to the facility and waiting time at the facility until consultation were considered the most important.

CONCLUSION

There is a need for the NHIF to prioritise awareness-raising approaches tailored to rural settings. Further, there is a need for the NHIF to contract more providers to both spur competition among providers and provide alternatives for members to choose from. Besides, NHIF members revealed the important factors they consider when selecting outpatient facilities. Consequently, NHIF should leverage the preferred factors when contracting healthcare providers. Similarly, healthcare providers should enhance the availability of drugs, reduce waiting times whilst improving their staff's attitudes which would improve user satisfaction and the quality of care provided.