IntroductionA 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.MethodsUsing 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.ResultsThe 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.ConclusionPublic 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.

BackgroundThis is a facility-based study designed to assess perceived quality of care and satisfaction of reproductive health services under the output-based approach (OBA) services in Kenya from clients’ perspective.MethodAn exit interview was conducted on 254 clients in public health facilities, non-governmental organizations, faith-based organizations and private facilities in Kitui, Kilifi, Kiambu, and Kisumu counties as well as in the Korogocho and Viwandani slums in Nairobi, Kenya using a 23-item scale questionnaire on quality of reproductive health services. Descriptive analysis, exploratory factor analysis, reliability test, and subgroup analysis using linear regression were performed.ResultsClients generally had a positive view on staff conduct and healthcare delivery but were neutral on hospital physical facilities, resources, and access to healthcare services. There was a high overall level of satisfaction among the clients with quick service, good handling of complications, and clean hospital stated as some of the reasons that enhanced satisfaction. The County of residence was shown to impact the perception of quality greatly with other social demographic characteristics showing low impact.ConclusionMajority of the women perceived the quality of OBA services to be high and were happy with the way healthcare providers were handling birth related complications. The conduct and practice of healthcare workers is an important determinant of client’s perception of quality of reproductive and maternal health services. Findings can be used by health care managers as a guide to evaluate different areas of healthcare delivery and to improve resources and physical facilities that are crucial in elevating clients’ level of satisfaction.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1940-9) contains supplementary material, which is available to authorized users.

Background Good health is a fundamental huma right, a valued asset, and a prerequisite for improved productivity. However, high poverty can lead to under utilization or lack of utilization of health care leading to poor health. Thus, poverty reduction and improvement of health care utilization are important in ensuring enjoyment of good health. Since 1982, poverty has remained above 40 per cent despite Kenya’s commitment to poverty reduction. Kenya’s health indicators have also not been impressive and health care utilization has remained low. Evidence shows that those who fell sick and reported lack of finances as the main reason for not seeking medical attention constituted 44 per cent, 38 per cent and 21.4 per cent in 2003, 2007 and 2013, respectively. These statistics point to poor health care utilization due to poverty. In Kenya, studies have concentrated on small segments of the population or parts of the country hence limiting generalization of the findings. Objective The objective of this paper was to determine the effect of poverty on health care utilization in Kenya. Method The study used a Negative Binomial Regression and the 2013 Kenya Household Expenditure and Utilization Survey dataset. The study also used Two Stage Residual Inclusion approach and a Control Function Approach to test and control for potential endogeneity and unobserved heterogeneity problems, respectively. Results The estimation results showed that reduction in poverty increased health care utilization. Other factors that had a positive and statistically significant effect on health care utilization were household size, early levels of education, and distance to the nearest health facility. Conclusion The study concludes that health care utilization is negatively affected by poverty other factors held constant. Thus, policies and strategies aimed at reducing poverty are needed. In particular the study recommends introduction of universal health care for all.

Purpose:The purpose of this study was to determine the constraints to growth of micro finance institutions in Nairobi County, KenyaMethodology:The study adopted a descriptive survey research design to study the factors constraining the growth of the MFls. A census of all the 54 MFIs registered with the Association of Microfinance Institutions of Kenya AMFI was carried out. The informants for the study were drawn from the senior employees.Data was collected using questionnaires. Data obtained was analyzed using descriptive statistics by use of graphs and pie charts.Results: The study findings revealed that Only 36 per cent MFIs offer micro savings as a service, the reason being that the rest (64%) are not registered as Deposit Taking Microfinance institutions by the Central bank of Kenya.Policy recommendation: The study recommends that loan repayment should be constantly monitored and whenever there is a default in repayment, a quick action should be taken. The Microfinance should also avoid granting loans to the risky customers or for speculative ventures, monitor loan repayments, and renegotiate loans whenever borrowers get into difficulties. Credit analysis of potential borrowers should be carried out in order to judge the credit risk with the borrower and to reach a lending decision

As international development partners reduce funding for family planning (FP) programs, the need to estimate the financial resources devoted to FP is becoming increasingly important both at all levels. This cross-sectional assessment examined the FP financing sources, agents, and expenditures in two counties of Kenya for fiscal years 2010/2011 and 2011/2012 to guide local decision-making on financial allocations. Data were collected through a participatory process. This involved stakeholder interviews, review of financial records and service statistics, and a survey of facilities offering FP services. Financing sources and agents were identified, and source amounts calculated. Types of FP provider organizations and the amounts spent by expenditure categories were identified. Overall, five financing sources and seven agents for FP were identified. Total two-year expenditures were KSh 307.8 M (US$ 3.62 M). The government's share of funding rose from 12% to 21% over the two years (p=0.029). In 2010/2011, the largest expense categories were administration, commodities, and labor; however, spending on commodities increased by 47% (p=0.042). This study provides local managers with FP financing and expenditure information for use in budget allocation decision-making. These analyses can be done routinely and replicated in other local counties or countries in a context of devolution. (Afr J Reprod Health 2017; 21[4]: 24-32).