BackgroundCurrent assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program.MethodsA total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analyzed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents.ResultsFacility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions.ConclusionsPublic and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.
The core thesis of this study is to explore the legal and technological feasibility to interoperate two mobile health-based solutions in Kenya: Ushauri-Text for Adherence (T4A), and Mobile Laboratory (mLab), to enhance HIV/AIDS care and treatment. This paper focuses on two aspects namely data interoperability by analysing secondary data abstracted from the mLab and the Ushauri databases from June 2017 to June 2018 and doctrinal analysis of the legal and policy environment to support the interoperability. This paper is a case study of the mLab and the Ushauri systems in terms of the technological stack for interoperability which has some legal implications. It includes a pilot study that employed a multistage sampling method in which thirty-nine health facilities in Siaya, Homa bay, Nyeri, and Muranga were selected. Findings show a satisfactory legal environment to augment the interoperability of the two mHealth systems. It is also evident that the two systems were considerably interoperable in terms of technology, semantics, data, and processes. However, interoperating them could largely be compromised by language semantics leading to a discrepancy of characters and numbering in unique identifiers in data entry. Though data in the systems were for the same individuals, it is critical to note that there was a low level of concordance in patient identification numbers in the same facilities where the same patients were receiving clinical services. Additionally, healthcare workers across the various facilities did not follow the NASCOP (2010) eleven-digit unique identifier system. Standardizing human activities while using systems such as the allocation of patient identifiers and following laid down standards while developing systems are critical ways of ensuring interoperability. This paper highlights the need to achieve full-scale implementation of laid down policies and legal requirements such as the systems’ interoperability certification process to standardise the systems and make them interoperable.
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