Abstract
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 stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health are still relevant, emerging epidemiological trends such as an increase in the burden of non-communicable diseases should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency. County health system efficiency in Kenya could be enhanced by improving the timeliness of financial flows to counties and health facilities, giving health facilities financial autonomy, improving the number, skill mix, and motivation of healthcare staff, managing political interests, enhancing anticorruption strategies, strengthening management capacity and coordination in the health sector.
Highlights
Kenya has made a commitment to achieve Universal Health Coverage (UHC) by the year 2030 [1]
In this paper we present findings from the analysis of group discussions of health sector stakeholders in Kenya on their perceptions of how efficiency of county health systems in Kenya can be conceptualized, and the factors that influence the efficiency of county health systems
Hard inputs include tangible health system building blocks while soft inputs include less tangible aspects of health systems such as managerial processes, policies and stakeholder relationships. This aligns with the conceptualization of health systems as comprised of both hard and soft elements which is based on the recognition that software aspects of health systems influence their functioning [27, 28]
Summary
Kenya has made a commitment to achieve Universal Health Coverage (UHC) by the year 2030 [1]. The country’s UHC policy outlines 4 objectives namely a) strengthen access to health services b) ensure quality of health services, c) protect individuals and households from the financial risks of ill health d) strengthen the responsiveness of the health system. Despite Kenya’s commitment to achieve universal health coverage (UHC), this aspiration faces, among others, the challenge of a constrained fiscal space for health [2, 3]. Kenya’s public expenditure on health is 2.3% of the country’s gross domestic product (GDP) [3], far lower than the recommended level of 5% required to achieve UHC [4]. Improving the efficiency of health systems is one of the key strategies for unlocking additional resources in the health sector [5, 6], needed to advance the country’s UHC goal
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