National Hospital Insurance Fund Research Articles

Funding Strategies on Performance of Health Insurance in Kenya: A Case of National Hospital Insurance Fund in Garissa Township

Funding Strategies on Performance of Health Insurance in Kenya: A Case of National Hospital Insurance Fund in Garissa Township

Factors influencing contraceptive uptake among women of reproductive age in Kenya

Background Modern Contraceptive Methods (MCM) use is among the interventions preventing unplanned pregnancies and unsafe abortions globally. Nevertheless, MCM uptake is still low. We aimed at determining factors influencing contraceptive uptake among women of reproductive age 15 to 49 years, in Kenya. Methods We used secondary data collected by Performance, monitoring for Action (PMA). PMA used cross sectional multi-stage cluster survey design and collected the data between November and December 2019. The study was approved by NACOSTI/202974 and KNERC KNH/ERC/R/192. Results The study obtained a sample size of 9477 women of reproductive age (WRA) from 11 counties in Kenya. Both descriptive and inferential statistical analysis with a P value of 0.05 was done using Stata 16.1. The prevalence of modern contraceptives uptake was 43.2% among all WRA, which was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55). More than half (53.4%) of the married women were using a modern contraceptive, while only about two in every 10 of the unmarried were using a modern contraceptive. Women affiliated with the Islam religion were less likely to use modern contraceptive (aPOR 0.6, 95% CI 0.42, 0.89 p=0.010) as compared to the Catholics. Family planning (FP) services were found to be lower (aPOR 0.535(95% CI 0.29,0.98 p=0.043) in National Hospital Insurance Fund (NHIF)-covered facilities than in non-NHIF-covered ones. Adolescent FP service provision and prescription was significant (aPOR 4.0 95% CI; 1.05,15.41, p=0.42). Conclusion Low uptake for MCM is influenced by sociodemographic factors and Health system factors. Efforts to increase MCM uptake should focus on rural residents, unmarried women, Islamic religion women and accreditation of NHIF services in all facilities.

FINANCIAL IMPLICATIONS OF MOTIVATION ON EMPLOYEE PERFORMANCE IN THE PUBLIC SERVICE: A CASE STUDY OF NATIONAL HOSPITAL INSURANCE FUND

The Salaries and Remuneration Commission's continuous review of state and public officers' salaries, aimed at enhancing morale and productivity, has not translated into improved public service delivery, as evidenced by public dissatisfaction with diminishing service quality and a declining number of public servants. This study investigates the impact of motivation on employee performance in the public service, using the National Hospital Insurance Fund (NHIF) as a case study. Specific objectives include assessing the effects of compensation, career development opportunities, retirement benefits, and employee recognition on NHIF employee performance. Rooted in theories such as Hierarchy of Needs, Total Reward, Theory of Work Adjustment, and Expectancy Theory of Motivation, this study adopts a descriptive research design. Targeting administrative staff at NHIF Nairobi, the study population comprises 230 staff, and a stratified simple random sampling method is used. Primary data is collected through questionnaires, validated through validity and reliability tests, and analyzed quantitatively using descriptive statistics. The findings reveal that organizations offering competitive salaries attract skilled and high-value employees, contributing significantly to organizational performance. Similarly, organizations investing in training, clear growth paths, mentorship, and meaningful tasks cultivate a highly motivated workforce. The study recommends that NHIF management implement fair, performance-based compensation, regularly reward highperforming employees, provide career development programs, and foster a culture of non-monetary recognition for positive contributions. This research is pertinent to NHIF policymakers, the Central Government of Kenya, other public service sectors, human resource practitioners, and researchers. By exploring the financial implications of motivation on employee performance, the study provides insights for policymaking, resource allocation, and strategic decision-making in public service organizations.

The impact of health insurance enrollment on health outcomes in Kenya

BackgroundThe achievement of the global agenda on universal health coverage (UHC) is pivotal in ensuring healthy lives and promoting the well-being of all. However, achieving healthy lives and wellbeing of all has been hampered by the challenge of health care financing. As such, healthcare financing, through health insurance is gaining popularity in developing countries such as Kenya, in their pursuit to achieve universal health coverage. The primary purpose of health insurance and delivery is to improve health. However, there is a paucity of evidence on the effectiveness of health insurance in improving the health outcomes and health status of the Kenyan population. Therefore, this study aimed to analyze the impact of health insurance on health outcomes in Kenya.MethodsThe study utilized the most recent nationally representative Kenya Integrated Household Budget Survey (KIHBS) 2015/16 dataset in order to analyze the impact of health insurance on health outcomes. The instrumental variable 2-stage least squares (IV 2SLS) and control function approach (CFA) estimation techniques were used to cater for potential endogeneity and heterogeneity biases present in ordinary least squares (OLS) estimators.ResultsHealth insurance enrolment leads to a reduction in mortality, thereby improving the health status of the Kenyan population, despite low levels of insurance uptake. However, the insured population experienced higher chronic illnesses and out-of-pocket (OOP) expenditures raising concerns about financial risk protection. The fact that health insurance is linked to chronic illnesses not only reinforces the reverse causality of health insurance and health status, but also that the effects of potential adverse selection strongly drive the strength and direction of this impact.ConclusionsWe conclude that health insurance enrolment reduces mortality and hence has a beneficial impact in promoting health. Health insurance coverage therefore, should be promoted through the restructuring of the National Hospital Insurance Fund (NHIF) fragmented schemes and by consolidating the different insurance schemes to serve different population groups more effectively and equitably. The government should revisit the implementation of a universal social health insurance scheme, as a necessary step towards UHC, while continuing to offer subsidies in the form of health insurance to the marginalized, vulnerable and poor populations.

Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey

ObjectivesThe under-five mortality (U5M) rate in Kenya (41 per 1000 live births) remains significantly above international goals (25 per 1000 live births). This is further exacerbated by regional inequalities in...

Innovation and Realization of Universal Health Care Coverage in Kenya: A Case of National Hospital Insurance Fund

Purpose: The National Hospital Insurance Fund (NHIF) plays a role of health financing which is a key pillar of universal health care coverage in Kenya. However, as of 2014, the Universal Health Care (UHC) index in Kenya was at [52%] compared to [55.0%] in 2019, which represent a mere improvement in access to health by [3%] in a span of 6 years. Thus, a lot has to be done in ensuring that everybody has access to affordable and quality health care services. Although innovation is an important construct, there is scanty of literature and evidence to link it with realization of universal health care coverage in the economy. Thus, the effect of innovation on realization of UHC Coverage by NHIF was explored. Specifically, process innovation and technological innovation in relation to realization of UHC by NHIF was determined. Diffusion of innovation theory and the technology acceptance model theory guided the inquiry.
 Methodology: Explanatory descriptive survey design was embraced targeting [155] respondents. In total, [112] respondents were selected through stratified random technique. Information in primary mode was obtained through questionnaire that had semi-structured items. The questionnaire was pilot tested among [12] respondents selected away from the study sample. Processing of the gathered views was done descriptively and inferentially. Tables and figures were used in presenting the analyzed findings.
 Findings: It was noted that process innovation and technological innovation all have significant influence on realization of Universal Health Care coverage by National Hospital Insurance Fund. The study concludes that innovation significantly predicts realization of universal health care.
 Recommendations: The study recommends that policy makers at National Hospital Insurance Fund should regularly review the existing policies and amount of premiums contributed by members especially the self-employed people so that the same is affordable. Information and communication technology managers working at National Hospital Insurance Fund should invest in latest and modern state of the art technologies and replace the existing and obsolete ones.

“It is like an umbrella covering you, yet it does not protect you from the rain”: a mixed methods study of insurance affordability, coverage, and financial protection in rural western Kenya

Countries in Sub-Saharan Africa are increasingly adopting mandatory social health insurance programs. In Kenya, mandatory social health insurance is being implemented through the national health insurer, the National Hospital Insurance Fund (NHIF), but the level of coverage, affordability and financial risk protection provided by health insurance, especially for rural informal households, is unclear. This study provides as assessment of affordability of NHIF premiums, the need for financial risk protection, and the extent of financial protection provided by NHIF among rural informal workers in western Kenya.Methods We conducted a mixed methods study with a cross-sectional household survey (n = 1773), in-depth household interviews (n = 36), and 6 focus group discussions (FGDs) with community stakeholders in rural western Kenya. Health insurance status was self-reported and households were categorized into insured and uninsured. Using survey data, we calculated the affordability of health insurance (unaffordability was defined as the monthly premium being > 5% of total household expenditures), out of pocket expenditures (OOP) on healthcare and its impact on impoverishment, and incidence of catastrophic health expenditures (CHE). Logistic regression was used to assess household characteristics associated with CHE.Results Only 12% of households reported having health insurance and was unaffordable for the majority of households, both insured (60%) and uninsured (80%). Rural households spent an average of 12% of their household budget on OOP, with both insured and uninsured households reporting high OOP spending and similar levels of impoverishment due to OOP. Overall, 12% of households experienced CHE, with uninsured households more likely to experience CHE. Participants expressed concerns about value of health insurance given its cost, availability and quality of services, and financial protection relative to other social and economic household needs. Households resulted to borrowing, fundraising, taking short term loans and selling family assets to meet healthcare costs.Conclusion Health insurance coverage was low among rural informal sector households in western Kenya, with health insurance premiums being unaffordable to most households. Even among insured households, we found high levels of OOP and CHE. Our results suggest that significant reforms of NHIF and health system are required to provide adequate health services and financial risk protection for rural informal households in Kenya.

Informal workers and Kenya’s National Hospital Insurance Fund: Identifying barriers to voluntary participation

AbstractThis article investigates the barriers to informal workers’ voluntary participation in Kenya’s national health insurance scheme – the National Hospital Insurance Fund. Based on primary data from both qualitative and quantitative methods, we find that the key determinants of enrolment include social factors, such as marital status, which create demand for insurance, and the role of informal workers’ associations that promote the voluntary uptake of health insurance and prevent default through contribution support. Participation barriers and reasons for inactiveness stem from the nature of informal work characterized by irregular earnings, which combine with apprehension about having to pay penalty charges for the late payment of premiums, inadequate levels of knowledge about health insurance schemes, institutional constraints such as complex registration procedures, as well as premium costs and poor‐quality services, all of which discourage enrolment or the reactivation of lapsed membership. There is thus a need for health insurance schemes, such as Kenya’s National Hospital Insurance Fund, to educate informal workers on insurance services and protocols and to improve services to encourage uptake and reduce default behaviour.

The National Hospital Insurance Fund under Resource Allocation Discrepancies and Economic Restructuring, 1973–1986

The National Hospital Insurance Fund under Resource Allocation Discrepancies and Economic Restructuring, 1973–1986

Strategic Change Management and Performance of National Hospital Insurance Fund in Kenya

Change is inherent in contemporary organizations and its management is not only critical to organizational performance and survival but is also at the centre of organization development. Since the performance of organizations is dependent on the fit between them and their environment, any change in environment require firms to adapt to the environment. The purpose of this study was to examine the effect of strategic change management on performance of the National Hospital Insurance Fund in Kenya. The specific objectives of this study were; to establish the effect of technology change management on performance of the National Hospital Insurance Fund, Kenya, to determine the effect of leadership change management on performance of the National Hospital Insurance Fund in Kenya, to assess the effect of culture change management on performance of the National Hospital Insurance Fund in Kenya and to establish the effect of environmental change management on performance of the National Hospital Insurance Fund in Kenya. This study was informed by resource based view theory, theory of reasoned action and change theory. The study adopted descriptive research design. The target population of the study was made up of 200 employees at NHIF headquarter in Nairobi. Census approach was used to study all the 200 employees made up both management employees and junior employees. Before data collection, both validity and reliability testing was conducted to test for the suitability of the research tools. The primary data was collected using structured questionnaires. Pilot study was done involving 13 respondents. Content validity was used to test for validity. Cronbach Alpha coefficient was used in testing reliability. The collected data was analyzed using both descriptive statistics and inferential statistics. Descriptive statistics such as mean and standard deviation was adopted. The relationship between the dependent variable and the independent variables was tested using linear regression model and correlation analysis. The results were then presented in form of figures, tables and chats. The study established that technology change management, leadership change management, culture change management and environmental change management had a positive and significant influence on performance. The study concluded that technology assists organizations with managing changes to operations. Implementing change leadership can make many positive impacts on organizations and aids the management in reaching the organizational goals through problem solving, executing changes such as developing new marketing strategies can build a business's brand and help a business fulfill their mission. Organization culture grows around shared beliefs and attitudes, it is an authentic, and therefore effective, tool in organizations. Environmental change management is a common part of business growth. Regardless of the reason for the change, understanding why companies implement change strategies can help the management navigate fluctuating circumstances in their organization. The study recommended that a technology change management team requires a special combination of skills and personalities. The organization should ensure that their leaders have the right tools to guide them. The organization culture should encompass existing qualities that have been recognized across all levels of the company and then tightly defined, rather than plucked out of thin air and enforced upon the business. The study also recommended that the organization should establish a sense of urgency - inspire people to move, make objectives real and relevant.

Willingness to renew national hospital insurance fund among voluntary scheme members in Kajiado County-Kenya

Objective: This study established determinants for readiness to renew the NHIF (national hospital Insurance fund) among informal sector national scheme members in Kenya for universal health coverage (UHC). Methods: This was a cross sectional survey on 394 purposively sampled national health insurance members in Kajiado County. Data was collected through questionnaires rated on a 5-point Likert scale. Binary logistic regression was used to establish the significant determinants associated with the willingness to renew the insurance covers. P-values of less than 0.05 were considered statistically significant. Results: Majority of the participants were male (n=266, 67.5%), over 36 years of age (n=330, 83.7%), married (n=200, 50.8%) and lived in large households of over 3 people (n=358, 90.9%). Overall, respondents showed high willingness to continue paying the insurance premiums and renew their insurance covers for health services (Median: 3.86, IQR 0.75). Controlling for all factors, married (AOR 15.6, 2.3-106.4), large household sizes with more than 3 people, low household income per month (less than KSh. 5000), awareness of NHIF fund services (AOR 13.2, 3.1-55.5), service provider factors (AOR 109, 14.8-803.8) and adverse selection on willingness to renew (AOR 0.043, 0.009-0.202) were significant determinants of willingness to renew the insurance cover (p<0.05). Conclusion: Individual factors - married, belonging to larger household, and lower income group, awareness of NHIF services and system/external factors - service provider’s factors and adverse selection on the other hand influenced willingness to renew insurance covers. There is need to increase the community’s awareness on the health insurance risk-benefits through member education and improve access to quality health services in the health facilities to enhance renewal of the NHIF covers by members.

Influence of Strategic Planning on Corporate Performance: A Case of National Hospital Insurance Fund, Kenya

The major role of the ministry of health in Kenya is to promote the health status of Kenyans through access to effective and affordable services . To address citizens' major health sector challenges, the Kenya government, in 1966, set up NHIF to provide medical insurance coverage. Unfortunately, key stakeholders have raised dissatisfaction with service provision, sighting that the corporation has lost sight of its cardinal goals leading to the loss of funds ventured in by principals. In recent cases, regular system failure during the online self-service, including payment, and laxity in addressing client-related cases have been reported failure to timely remit funds to offset facilities bills like the case of Kenyatta hospital costing 311 million in 2017 suggests a lack of strategic plans. Whereas previous studies largely focused on funding, they never considered strategic planning in NHIF and more so in Busia, Western Kenya. Moreover, no known studies have focused on a mission, objective, and vision that ensures improvement and, thus, better performance. The purpose of this study was to analyze the influence of strategic planning on corporate performance. It was guided by three objectives: To establish the influence of the mission statement on corporate performance, To establish the influence of an organization's objectives on corporate performance and To determine the influence of an organization's policies on corporate performance The study covered scholars' work on empirical studies on strategic planning and performance and was guided by resource-based theory. The study employed a correlational research design targeting 49 NHIF staff as a population, of whom 4 were used for the pilot study and 45 for the actual study. The Census sampling approach was opted for as the target population was a manageable number. The research instrument was a questionnaire and questionnaire schedules. Instrument reliability was ascertained using Cronbach's Alpha coefficient, where all the variables met the threshold of 0.701, implying internal consistency. In contrast, validity was ascertained by expert judgment from the school of business and economics. Data were analyzed using descriptive statistics (percentage), and inferential statistics were used to generate quantitative reports. In contrast, content analysis was used to analyze quantitative data, and it was presented in tables. Findings revealed that: The use of a mission statement in strategic decision-making was a statistically insignificant predictor of corporate performance β 1 = .038 (p = .269), Organization's objectives were positive significant predictors of corporate performance (β 2 = .429 (p = .000) and Organization's policies were positive significant predictors of corporate performance (β 3 = .432 (p = .000) These values of the organization's objectives and the organization's policies are statistically significant since the p-values are less than 0.05, meaning that a unit change in the use of an entity's objective and policies intensify results in an increase in performance of 0.429 and 0.432 respectively, all things being fixed. The study, therefore, concludes that a mission statement should not be embraced in an attempt to increase corporate performance. Using the organization's objectives and adopting policies in strategic planning should be embraced as they lead to increased corporate performance. The study recommends that the NHIF Busia branch should continue embracing objectives and policies in strategic decision-making as this was found to improve the corporate performance of funds. The importance of the study is that it presents an overview of the influence of strategic planning on corporate performance. This is intended to offer insights and additional sources of reference to researchers and NHIF policy-makers.

A descriptive survey of substance use treatment facilities in Uasin Gishu County Kenya

BackgroundSubstance use disorders are a major problem in Uasin Gishu County, Kenya. The objective of this study was to describe the existing resources within substance use treatment facilities in the County, with the aim of guiding policy and interventions.MethodsThis was a cross-sectional study. We collected data from six substance use treatment facilities within Uasin Gishu County between August and November 2021. We used a researcher-designed questionnaire to collect information on: availability of in-patient and out-patient services; facility ownership (private-for-profit vs government-run); bed capacity; mode of payment for services; cost of services; availability of medicines for substance use treatment; and staffing characteristics. Descriptive statistics were used to summarize the data.ResultsOne facility was run by the National government and the rest were private-for-profit. Uasin Gishu County government had no substance use treatment facility of its own. The total number of beds available within the six facilities was 174 against a population of 1.1 million. All six facilities had stocked at least one medication for substance use disorder treatment. None of the facilities had buprenorphine, buprenorphine naloxone, or methadone. Out-of pocket was the most common mode of payment for services with patients paying using this mode in all the six facilities. Only one facility was accredited by the National Hospital Insurance Fund (NHIF). All facilities had at least one certified addiction counselor and at least one psychologist. Half of the facilities did not have a nurse and two did not have a doctor. The qualification held by most staff was addiction counseling with 41.3% of them having achieved this qualification.ConclusionThe facilities were well staffed with psychologists and addiction counselors. Gaps were found as regards bed capacity, use of pharmacotherapy, insurance coverage and availability of nursing staff and doctors. We recommend that the County government in collaboration with key stakeholders invests in substance use treatment in order to address the high burden of substance use disorders in Uasin Gishu County.

Barriers to Peritoneal Dialysis Utilization among End Stage Kidney Disease Patients in Kenya

Aim: barriers to peritoneal dialysis utilization among end stage kidney disease patients in Kenya. Background: Peritoneal Dialysis (PD) is the use of the capillary rich peritoneal membrane as a dialyzer whereby waste products diffuse from the capillaries into the dialysate during dwell time. Peritoneal Dialysis is a proven viable treatment for Kidney failure (KF) but it is not popularly utilized in Kenya. However, the uptake of PD in Kenya has been shown to be low owing to various barriers that have created a hindrance to utilization of the procedure among patients suffering from end stage kidney disease (ESRD). Methodology: A descriptive – analytical cross sectional study was conducted in 6 government dialysis centres in Kenya purposively selected. The study targeted 346 patients with ESKD, 6 nephrologists, 19 general physicians, 125 nurses in six government owned dialysis centers in Kenya. The targeted policy makers were 6 from each hospital, 4 from the county governments, 2 from the national hospital insurance fund (NHIF) and 2 from the ministry of health (MOH). The nurses and patient participants were sampled through simple random sampling while the doctors and policy makers were sampled by census based on their specialization and/or deployment in dialysis units and their positions respectively. The study sought to establish barriers to utilization of PD among patients with ESKD. The study entailed mixed methods where both quantitative and qualitative data collection methods were employed. Both structured and unstructured questions were utilized in a self-administered / research assisted questionnaire. Quantitative data was analyzed using SPSS Version 22.0. Qualitative data was organized, shared, and managed using N Vivo 11 software and was analyzed using thematic areas. Hypothesis testing was done using chi- squared test whereby P-values of less than 0.05 were considered statistically significant with a 95% confidence interval (CI). Data presentation was done using tables, charts and in narrative form. Results: The research revealed low utilization of PD in the selected Hospitals where only 0.2% (1) was on PD. Chi-square tests of associations revealed that patients who had been educated on PD and patients who were educated on the equipment required for PD were more likely to utilize the PD modality of dialysis (p<0.01 and p=0.01603, respectively). Results from the multivariate logistic regression showed that only patients who had been educated on PD were more likely to choose the PD modality (p= 0.01222). Various barriers to PD utilization were identified. From the research findings, the Cost of PD fluids seems to be a major constraint given that many countries in Africa do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. Low patient education and motivation was also found to be a major barrier with a huge population unaware of PD. There was lack of expertise/experience for catheter insertion with insufficient PD training for nephrology fellows, which has been a barrier to PD initiation and retention. Some nurses also lacked training and experience in conducting PD procedure. The policy makers in the National Hospital Insurance Fund also confirmed that PD services were not among the services covered by the fund hence patients had to pay for themselves. Additionally, there was no sound policy or a standard Model to guide utilization of PD in Kenya unlike in other countries. The barriers were categorized as patient related, healthcare related as well as policy related. Conclusions and Recommendations Despite similar clinical and humanistic outcomes between HD and PD, PD may be the more convenient and resource-conscious option of dialytic kidney replacement therapy (DKRT). Underutilization of PD is mainly related to lack of PD dianeal solutions, accessories, dearth of trained personnel, social-economic factors, and lack of advocacy to project PD as the first option for Kidney replacement therapy (KRT). In order to address the identified barriers, the development of a functional PD team is essential for a successful patient outcome. There is also need to develop a policy on management of PD services as well as a standard Model to guide PD utilization.

Opportunities to Integrate Primary Health Care Digital Innovations in Maternal and Child Health Care Services in Kenya

Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.

Analysis of Cost Associated with Treatment of Road Traffic Injuries among Victims at the Kenyatta National Hospital Nairobi City Kenya

Previous studies have pointed out that road traffic injuries (RTIs) as a leading cause to fatalities of over one million victims globally per year which bears negative impact on health, economy and development of the society as a whole. Furthermore, young men and women at their most economic age group have been identified as the most vulnerable group to road traffic injuries (RTIs) resulting to mortality and very severe morbidity due disability. However, there is little or no published evidence on healthcare resource allocations and utilization after RTIs, especially in developing countries that include those in Africa. Objective: The main objective of this study was to analyze the total hospital cost related to RTI (Road traffic injury) victims admitted for a period of 3 months. The study demonstrated effects of direct and indirect medical cost , productivity loss and hospital length of stay on total cost of road traffic injuries of RTI victims at KNH. Methods: This was a cross sectional study design done at the Kenyatta Hospital Nairobi, surgical wards and Accident & Emergency. A sample (n=124) consisted of new victims admitted to the Hospital due to RTI from January 25th 2019 to 24th April 2019., this was two thirds of the sample size at 74% respondent rate who gave consent and all ethical approvals granted. The data collection of direct and indirect medical cost was by data extraction tool, testing of the tools was done at the surgical ward. Productivity loss of the victims was calculated by use of Work Productivity and Activity Impairment Questionnaire (WPAIQ). SPSS version 22 was applied and descriptive statistics to show frequencies and Percentages for categorical variables (victim’s unique individualized characteristics). Multi Linear Regression Model Test was used test the relationship between the independent and dependent variables. Results: The study results indicated that direct cost factors (laboratory cost, A&E Charges and Diagnostic Cost) (X1: β1 =.199, P<. 047), (X3: β3 =.469, P< .037), and (X4: β4 =.029, P< .048) had a significant influence on the overall cost of treatment of RTI victims seeking treatment at the KNH, there was no significant relationship between Bed Charges (X2: β2 =.117, P>.689) and the cost of treatment of RTI victims seeking treatment at the KNH. The findings of the study also indicated that Y= 7.949+.001X1+0. 458X2+0. .239 X3+ 0. .305X4+e where a .199 change in direct cost, .117 changes in indirect cost, .469 change in total productivity cost and .029 changes in duration of stay in hospital influenced a unit change on the cost of treatment of RTI victims seeking treatment at the KNH. Most distribution of injuries was lower limbs at 51.6% Conclusion & Recommendation: The study concludes that Road traffic accident is an economic burden to individual, family and country at large. The study recommends, need for an awareness on importance of National Hospital insurance fund (NHIF) as a universal health coverage fund for people at an affordable cost, there is need to reduce the indirect cost of treatment associated indirect cost of treatment, support to from one person or two further increasing productivity time associated with the injury. Further motion study on cost analysis will give a detailed insight on these area of study.

Towards Universal Health Coverage

This paper explores the universal health coverage (UHC) in Kenya through the lens of its potential to progressively realize the constitutional promise of the right to the highest attainable standard of health. The health sector in Kenya has experienced tremendous changes since the government piloted the UHC program in four counties that led to the abolition of all fees, more than 200 community health units launched, 7700 community health volunteers with over 700 health workers recruited (MOH, 2020). Still, the government is in the process of scaling up UHC, reforming the national hospital insurance fund (NHIF) to establish a mandatory universal health coverage scheme. This paper sought to examine the framing of UHC; assess the healthcare system between 2017 -2020; investigate the challenges faced in the implementation of UHC in Kenya. The researcher utilized documents analysis to collect the relevant data using a coding schedule. A purposive search was undertaken to identify key policy documents and relevant documents. 18 documents were sampled. The findings reveal that Kenya’s healthcare facilities index stands at 59%, with a density of 2.2 per 10,000 population, the workforce density is at 15.6/10,000. Four counties including Tharaka Nithi (33.8), Nyeri (31.0), Uasin Gishu (28.2), and Nairobi (26.3) have achieved well above the WHO target. Several strategies and programs such as Afya Care, abolished maternity fees for mothers delivering at public facilities, and expansion of the National Health Insurance Fund, has been initiated to drive the UHC agenda. The Ministry of Health’s (MoH) budget also continues to rise, in 2018/19 the MoH received its largest allocation. Kenya, now more than ever, has an opportunity to accelerate progress towards equitable access to healthcare.

Quality of life of ostomates at a teaching and referral hospital in Kenya

Background: Ostomy surgery is performed to maintain gastrointestinal function. However, there is a lack of knowledge and experience about ostomies among patients and clinicians in public hospitals in Kenya. The issue is compounded by the social isolation and stigma ostomates face in the wards and in the community after discharge. Although it is not easy to identify the exact number of ostomates in Kenya and other African countries, there is need to shift the focus from curing symptoms in ostomates to maximising patients’ quality of life (QoL) and integrating services for ostomates in mainstream public hospitals. Aim: To understand the effects of ostomies on patients’ QoL, with a focus on nutrition, psychosocial aspects and challenges around sexuality after ostomy creation. Method: A descriptive study was undertaken using an interviewer-administered QoL questionnaire with 81 patients. Results: Most patients were male (54%); the largest age group was 35–44 years (24.7%). Colorectal carcinoma, intestinal obstruction and traumatic injuries were the main indications for ostomy. Ostomates resumed sexual activity, but did not find it fulfilling (P=0.002). Most reported feeling depressed, with suicidal attempts that negatively correlated with QoL. Ostomates adjusted their diets regardless of whether their level of QoL was poor, fair, good or excellent after ostomy creation (P=0.564). Conclusion: Ostomates experience low QoL. Patients’ lives can be improved by focusing on providing individualised ostomy care services after discharge. Enhancing stoma therapy training for nurses and running ostomy clinics alongside mainstream services, as well as support for ostomates towards enrolment into the country’s National Hospital Insurance Fund, will also improve patients’ QoL.

Examining the implementation of the Linda Mama free maternity program in Kenya.

BackgroundIn 2013, Kenya introduced a free maternity policy in all public healthcare facilities. In 2016, the Ministry of Health shifted responsibility for the program, now called Linda Mama, to the National Hospital Insurance Fund (NHIF) and expanded access beyond public sector. This study aimed to examine the implementation of the Linda Mama program.MethodsWe conducted a mixed‐methods cross‐sectional study at the national level and in 20 purposively sampled facilities across five counties in Kenya. We collected data using in‐depth interviews (n = 104), administered patient‐exit questionnaires (n = 108), and carried out document reviews. Qualitative data were analysed using a framework approach while quantitative data were analysed descriptively.Results Linda Mama was designed and resulted in improved accountability and expand benefits. In practice however, beneficiaries did not access some services that were part of the revised benefit package. Second, out of pocket payments were still being incurred by beneficiaries. Health facilities in most counties had lost financial autonomy and had no access to reimbursements from NHIF for services provided; but those with financial autonomy were able to boost facility revenue and enhance service delivery. Further, fund disbursements from NHIF were characterised by delays and unpredictability. Implementation experiences reveal that there was inadequate communication, claim processing challenges and reimbursement rates were deemed insufficient.ConclusionsOur findings show that there are challenges associated with the implementation of the Linda Mama program and highlights the need for process evaluations for programs to track implementation, ensure continuous learning, and provide opportunities for course correcting programs' implementation.

Gender Differences in Insurance, Surgical Admissions and Outcomes at a Kenyan Referral Hospital

IntroductionGender is an important factor in determining access to healthcare resources. Women face additional barriers, especially in low- and middle-income countries. Surgical costs can be devastating, which can exacerbate engendered disparities. Kenya's National Hospital Insurance Fund (NHIF) aims to achieve universal coverage and protect beneficiaries from catastrophic health expenditures. We examine gender differences in NHIF coverage, health-seeking behavior, and surgical outcomes at a tertiary care hospital in Eldoret, Kenya. Materials and MethodsAll patients ≥13 years admitted to the general surgery service at Moi Teaching and Referral Hospital from January 2018-July 2018 were enrolled. Health records were retrospectively reviewed for demographic data, clinical parameters, NHIF enrollment, and cost information. Descriptive analyses utilized Wilcoxon Rank Sum, Pearson's Chi-square, and Fisher's Exact tests. Results366 patients were included for analysis. 48.6% were enrolled in NHIF with significant female predominance (64.8% versus 37.9%, P < 0.0001). Despite differing coverage rates, male and female patients underwent surgery and suffered in-hospital mortality at similar rates. However, women only comprised 39.6% of admissions and were significantly more likely to delay care (median 60 versus 7 days, P < 0.0001), be diagnosed with cancer (26.6% versus 13.2%, P = 0.0024), and require a palliative procedure for cancer (44.1% versus 13.0%, P = 0.013). ConclusionMany financial and cultural barriers exist in Kenya that prevent women from accessing healthcare as readily as men, persisting despite higher rates of NHIF coverage amongst female patients. Investigation into extra-hospital costs and social disempowerment for women may elucidate key needs for achieving health equity.