Performance assessment of the county healthcare systems in Kenya

A mixed-methods analysis

Datos Bibliográficos

ID21879733
AutoresMark W Moses (0000-0002-9897-932X, Independent researcher, autor de correspondencia), Julius Korir (0000-0002-3322-2203, Kenyatta University), Wu Zeng (0000-0002-3473-3638, Georgetown University), Anita Musiega (0000-0001-6765-295X, Kenya Medical Research Institute), Joyce Oyasi (Independent researcher), Ruoyan Lu (Fujian Medical University), Jane Chuma (World Bank, Nairobi, Kenya), Laura Di Giorgio (World Bank)
Año2021
Volumen6
Número6
Páginase004707
Fecha de publicación2021-06-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2020-004707
PMID34167962
OpenAlexW3175548623
IdiomaEN
Citas recibidas9
Referencias citadas37

INTRODUCTION: A well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system is critical to progress towards UHC. We aimed to measure and compare the performance of Kenya's public healthcare system at the county level and explore remediable drivers of poor healthcare system performance. METHODS: Using administrative data from fiscal year 2014/2015 through fiscal year 2017/2018, we measured the technical efficiency of 47 county-level public healthcare systems in Kenya using stochastic frontier analysis. We then regressed the technical efficiency measure against a set of explanatory variables to examine drivers of efficiency. Additionally, in selected counties, we analysed surveys and focus group discussions to qualitatively understand factors affecting performance. RESULTS: The median technical efficiency of county public healthcare systems was 84% in fiscal year 2017/2018 (with an IQR of 79% to 90%). Across the four fiscal years of data, 27 out of the 47 Kenyan counties had a declining technical efficiency score. Our regression analysis indicated that impediments to the flow of funding-measured by the budget absorption rate which is the ratio between funds spent and funds released-were significantly related to poor healthcare system performance. Our analysis of interviews and surveys yielded a similar conclusion as nearly 50% of respondents indicated issues stemming from poor budget absorption were significant drivers of poor healthcare system performance. CONCLUSION: Public healthcare systems at the county-level in Kenya general performed well; however, addressing delays in the flow of funding is a concrete step to improve healthcare system performance. As Kenya-and other countries-provides additional funding to meet their UHC goals, establishing a strong and robust public financial management system is critical to ensure that the benefits of UHC are realised

Business · Economic growth · Economics · Fiscal year · Health care · Healthcare system · Kenya · Political science · Public economics · Public health · Public healthcare · Stochastic frontier analysis · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing · Finance