Benjamin Tsofa
Biographic Data
| ID | 6330901 |
|---|---|
| NAME | Benjamin Tsofa |
| GIVEN NAMES | Benjamin |
| FAMILY NAME | Tsofa |
| SIGNATURE | TSOFA B |
| AFFILIATIONS | Kenya Medical Research Institute |
| ORCID | 0000-0003-1000-1771 |
| VERIFIED | Yes |
| TOTAL WORKS | 33 |
| TOTAL CITATIONS | 4 |
| AUTHOR COUNT | 32 |
| EDITOR COUNT | 1 |
| FIRST PUBLICATION YEAR | 2010 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 1 |
Implementing community case management of malaria
Malaria detection in Kilifi, County, primarily relies on intermittent active surveillance at healthcare facilities. To strengthen control of uncomplicated malaria, community health promoters (CHPs) were engaged in community health education, case detection, and treatment. This study examines lessons from integrating CHPs in community case management of malaria (CCMm). We use a mixed-method, concurrent cross-sectional design, to document stakehold…
Poverty is a social issue, not a mathematical problem”
Background Kenya rolled out a UHC indigent program aimed to expand financial protection and health service access for poor households through subsidized health insurance under the national insurer, National Health Insurance Fund (NHIF). As Kenya transitions to a new social health insurance framework under the Social Health Authority (SHA), understanding the implementation experience of the UHC indigent program is critical for informing the roll o…
Understanding the role of ‘software’ in health system capacity for non-communicable disease response
Research on health system capacity to manage non-communicable diseases (NCDs) has largely focused on ‘system hardware’ such as infrastructure, workforce, and commodities. However, this overlooks the critical role of ‘system software’ elements, such as relationships, norms, and power, and the complex adaptive nature of health systems. This study aimed to explore how health system hardware and software elements interact to shape the capacity of the…
Advancing health policy and systems research and analysis
Health systems are at a crossroads. Globally, health systems are straining under the weight of responding to persistent and emergent challenges. Uncertainties in health financing, service delivery, new technologies and disease burdens are hindering health systems abilities to maximize collective and scaled action to achieve health equity and social justice. In March 2025, a group of health policy and systems experts were convened by an organizati…
Understanding what factors influence community health worker involvement in hypertension service delivery in Kenya
The systematic involvement of community health workers (CHWs) in hypertension management can improve outcomes and achieve blood pressure control. However, much of this evidence is from effectiveness trials conducted under ideal conditions, with little evidence from programmes operating in routine conditions. In Kenya, recent policy changes have expanded CHW roles to routinely incorporate non-communicable disease (including hypertension) service d…
Understanding mental health among university students in Kenya
Objective While mental health conditions play a significant role in the global disease burden, their determinants and predictors are still not well understood in Kenya. This study examined the prevalence of mental health conditions among university students and the factors associated with them. Methods This cross-sectional study evaluated 1,424 students at Pwani University in Kenya, assessing anxiety, depression, and psychosis, using validated sc…
Implementing community-based interventions for the management of chronic conditions in low- and middle-income countries
The rising prevalence of chronic diseases in low- and middle-income countries (LMICs) poses significant challenges to already overburdened health systems. Community-based interventions are recognised as effective strategies for managing these conditions. However, implementing such interventions faces barriers that can hinder their effectiveness. This scoping review aims to assess qualitative studies examining barriers and facilitators to implemen…
Access to hypertension services and health-seeking experiences in rural Coastal Kenya
Globally, hypertension causes 10.8 million deaths annually. However, in Kenya, like in other low-and middle-income countries, access to hypertension care remains limited and inequitable. Understanding patients’ journeys in accessing care along the care cascade is critical to inform patient-centred care and policy improvements. This study aimed to explore patient experiences in accessing primary care services for hypertension along the care cascad…
Management capacity of primary healthcare facilities in low- and middle-income countries
How health facilities are managed determines their performance and health service delivery. Management capacity of health facilities comprises the competency of managers at the individual level and the management support and work environment in their institutions. Evidence shows this management capacity influences service delivery and performance of the facility. For LMICs, there are evidence gaps as existing evidence is scarce, varied in the ass…
Power, interests, and maternal health care
The maternal and newborn health (MNH) service delivery redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and reduce mortality by centralizing delivery services at designated hubs. Using a political economy lens, we examined how ideology, political dynamics, and institutional structures shaped the agenda-setting, adoption, implementation, a…
Understanding health system responsiveness to public feedback at the sub-national level
Responsiveness is one of four health system goals alongside health outcomes, equity in financing and efficiency. Many studies examining responsiveness report a composite satisfaction index or proportions of patients describing satisfaction with dimensions of responsiveness. Consequently, responsiveness is predominantly based on collation of service users’ feedback and could be termed service responsiveness . We conceptualise system responsiveness…
Power and positionality in the practice of health system responsiveness at sub-national level
Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to…
Political economy analysis of sub-national health sector planning and budgeting
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 i…
Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya
Public Finance Management (PFM) practices influence the attainment of health system goals. PFM processes are implemented within the budget cycle which entails the formulation, execution, and monitoring of government budgets. Budget monitoring and accountability actors, structures, and processes are important in improving the efficiency of health systems. This study examined how the budget monitoring and accountability processes influence the effi…
Political economy analysis of subnational health management in Kenya, Malawi and Uganda
The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management …
How does power shape district health management team responsiveness to public feedback in low- and middle-income countries
Responsiveness is a core element of World Health Organization’s health system framework, considered important for ensuring inclusive and accountable health systems. System-wide responsiveness requires system-wide action, and district health management teams (DHMTs) play critical governance roles in many health systems. However, there is little evidence on how DHMTs enhance health system responsiveness. We conducted this interpretive literature re…
The autonomy of public health facilities in decentralised contexts
The financing of public health facilities influences their performance. A key feature that defines health facility financing is the degree of financial autonomy. Understanding the factors that influence public health facility financial autonomy is pertinent to developing strategies to addressing challenges that arise from constrained autonomy. In this paper, we apply a complexity lens to draw on a body of research that we have conducted in Kenya …
Sars-CoV-2 seroprevalence in three Kenyan health and demographic surveillance sites, December 2020-May 2021
Background Most of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. Methods We selected random age-stratified population-based samples at HDSSs in Kisumu, Nai…
Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda
Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing the odds of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. We conducted a cross sectional prevalence study and prospective cohort stu…
Service delivery reform for maternal and newborn health in Kakamega County, Kenya
This protocol describes a hybrid effectiveness/implementation evaluation study with an adaptive design. The impact evaluation ("effectiveness") study focuses on maternal and newborn health outcomes, and will be accompanied by an implementation evaluation focused on program reach, adoption, and fidelity
Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya
Efficiency gains is a potential strategy to expand Kenya’s fiscal space for health. We explored health sector stakeholders’ understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stake…
An innovative leadership development initiative to support building everyday resilience in health systems
Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya…
Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution
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…
Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County
Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the st…
Shocks, stress and everyday health system resilience
Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses…
Shocks, stress and everyday health system resilience
Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses…
Geographic access to care is not a determinant of child mortality in a rural Kenyan setting with high health facility density
Significant spatial variations in mortality were observed across the area, but were not correlated with distance to health facilities. We conclude that given the present density of health facilities in Kenya, geographic access to curative services does not influence population-level mortality
Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model
BACKGROUND: The vast majority of deaths in the Kilifi study area are not recorded through official systems of vital registration. As a result, few data are available regarding causes of death in this population. OBJECTIVE: To describe the causes of death (CODs) among residents of all ages within the Kilifi Health and Demographic Surveillance System (KHDSS) on the coast of Kenya. DESIGN: Verbal autopsies (VAs) were conducted using the 2007 World H…
Research Involving Health Providers and Managers
There is a growing interest in the ethics of Health Policy and Systems Research ( HPSR ), and especially in areas that have particular ethical salience across HPSR . Hyder et al (2014) provide an initial framework to consider this, and call for more conceptual and empirical work. In this paper, we respond by examining the ethical issues that arose for researchers over the course of conducting three HPSR studies in Kenya in which health managers a…
Tracking implementation and (un)intended consequences
In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility'…
Everyday resilience in district health systems
Recent global crises have brought into sharp relief the absolute necessity of resilient health systems that can recognise and react to societal crises. While such crises focus the global mind, the real work lies, however, in being resilient in the face of routine, multiple challenges. But what are these challenges and what is the work of nurturing everyday resilience in health systems? This paper considers these questions, drawing on long-term, p…
We are toothless and hanging, but optimistic”
Our study illustrates the importance in accelerated devolution contexts for: 1) mid-level managers to adopt new ways of working and engagement with higher and lower levels in the system; 2) clear lines of communication during reforms to these actors and 3) anticipating and managing the effect of change on intangible software issues such as trust and motivation. More broadly, we show the value of examining organisational change from the perspectiv…
Devolution and its effects on health workforce and commodities management – early implementation experiences in Kilifi County, Kenya
The devolved government system in Kenya has significantly increased county level decision-space for HRH and EMMS management functions. However, harnessing the full potential benefits of this increased autonomy requires targeted interventions to clarify the roles and responsibilities of different actors at all levels of the new system, and to build capacity of the counties to undertake certain specific HRH and EMMS management tasks. Capacity consi…
How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya
We conclude by arguing that, to enhance the benefits of decentralised health systems, resource allocation, priority setting and financial management functions between central and decentralised units are guided by considerations around decision space, organisational structure and capacity, and accountability. In acknowledging the political nature of decentralisation polices, we recommend that health sector policy actors develop a broad understandi…
Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution
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…
Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County
Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the st…
Shocks, stress and everyday health system resilience
Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses…
Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya
Efficiency gains is a potential strategy to expand Kenya’s fiscal space for health. We explored health sector stakeholders’ understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stake…
An innovative leadership development initiative to support building everyday resilience in health systems
Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya…
The autonomy of public health facilities in decentralised contexts
The financing of public health facilities influences their performance. A key feature that defines health facility financing is the degree of financial autonomy. Understanding the factors that influence public health facility financial autonomy is pertinent to developing strategies to addressing challenges that arise from constrained autonomy. In this paper, we apply a complexity lens to draw on a body of research that we have conducted in Kenya …
Sars-CoV-2 seroprevalence in three Kenyan health and demographic surveillance sites, December 2020-May 2021
Background Most of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. Methods We selected random age-stratified population-based samples at HDSSs in Kisumu, Nai…
Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda
Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing the odds of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. We conducted a cross sectional prevalence study and prospective cohort stu…
Service delivery reform for maternal and newborn health in Kakamega County, Kenya
This protocol describes a hybrid effectiveness/implementation evaluation study with an adaptive design. The impact evaluation ("effectiveness") study focuses on maternal and newborn health outcomes, and will be accompanied by an implementation evaluation focused on program reach, adoption, and fidelity
Political economy analysis of sub-national health sector planning and budgeting
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 i…
Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya
Public Finance Management (PFM) practices influence the attainment of health system goals. PFM processes are implemented within the budget cycle which entails the formulation, execution, and monitoring of government budgets. Budget monitoring and accountability actors, structures, and processes are important in improving the efficiency of health systems. This study examined how the budget monitoring and accountability processes influence the effi…
Political economy analysis of subnational health management in Kenya, Malawi and Uganda
The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management …
How does power shape district health management team responsiveness to public feedback in low- and middle-income countries
Responsiveness is a core element of World Health Organization’s health system framework, considered important for ensuring inclusive and accountable health systems. System-wide responsiveness requires system-wide action, and district health management teams (DHMTs) play critical governance roles in many health systems. However, there is little evidence on how DHMTs enhance health system responsiveness. We conducted this interpretive literature re…
Understanding health system responsiveness to public feedback at the sub-national level
Responsiveness is one of four health system goals alongside health outcomes, equity in financing and efficiency. Many studies examining responsiveness report a composite satisfaction index or proportions of patients describing satisfaction with dimensions of responsiveness. Consequently, responsiveness is predominantly based on collation of service users’ feedback and could be termed service responsiveness . We conceptualise system responsiveness…
Power and positionality in the practice of health system responsiveness at sub-national level
Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to…
Understanding mental health among university students in Kenya
Objective While mental health conditions play a significant role in the global disease burden, their determinants and predictors are still not well understood in Kenya. This study examined the prevalence of mental health conditions among university students and the factors associated with them. Methods This cross-sectional study evaluated 1,424 students at Pwani University in Kenya, assessing anxiety, depression, and psychosis, using validated sc…
Implementing community-based interventions for the management of chronic conditions in low- and middle-income countries
The rising prevalence of chronic diseases in low- and middle-income countries (LMICs) poses significant challenges to already overburdened health systems. Community-based interventions are recognised as effective strategies for managing these conditions. However, implementing such interventions faces barriers that can hinder their effectiveness. This scoping review aims to assess qualitative studies examining barriers and facilitators to implemen…
Global Maternal and Child Health (26 works) · Medicine (23 works) · Political science (18 works) · Healthcare Systems and Reforms (16 works) · Business (14 works) · Public health (13 works) · Nursing (12 works) · Public relations (12 works) · Economics (11 works) · Sociology (10 works)