Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis

Moses, Mark; Korir, Julius; Zeng, Wu; Musiega, Anita; Oyasi, Joyce; Lu, Ruoyan; Chuma, Jane; Giorgio, Laura Di

doi:10.1136/bmjgh-2020-004707

Cited by 14 publications

(23 citation statements)

References 36 publications

(32 reference statements)

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“…Quantitative approaches were used to measure the level and determinants of e ciency. Qualitative approaches were used to examine study participants' perceptions about the objectives of the health system [41,45] and existence and nature of health system ine ciency and its determinants [41,[45][46][47][48]. Beyond identi cation, qualitative approaches provided explanations of the relationship between identi ed determinants and health system e ciency [36,48,49].…”

Section: Methods Used To Analyze E Ciencymentioning

confidence: 99%

“…Of the papers that used panel data, 36(67%) used the Malmquist productivity index (MPI) approach to measure e ciency changes over time, while 18 (33%) included time as a covariate in a regression analysis. Four publications (2%) employed qualitative approaches [36,46,[53][54][55] while 2 studies (2%) used a mixed methods approach by combining both qualitative and quantitative methods [47,49].…”

Section: Methods Used To Analyze E Ciencymentioning

confidence: 99%

“…Total health expenditure as a share of GDP was positively associated with the technical e ciency of health systems [38,42,65,99]. The role of availability of funds was also highlighted in Kenya [47,48]. This was thought to be because greater healthcare spending was essential in improving health outcomes [65].…”

Section: Health Systemmentioning

confidence: 99%

“…Public nance management arrangements also in uenced health system e ciency. Enhanced capacity to execute budgets, ow of funds directly to providers, timeliness of funds disbursements to local authorities and health facilities, the exibility of budgets, and the autonomy of local authorities and health facilities over resources enhanced e ciency [45,47,48].…”

Section: Health Systemmentioning

confidence: 99%

“…Procurement ine ciencies were also identi ed. This included fragmented procurement of health commodities, high procurement prices, and supply chain challenges leading to delays in deliveries and stock-outs, and procurement corruption [45,47,53]. Verhoeven et al (2007) found that high spending on pharmaceuticals was associated with lower health system e ciency.…”

Section: Health Systemmentioning

confidence: 99%

See 4 more Smart Citations

Analysing the Efficiency of National and Sub-national health systems - A Systematic Review of Literature

Mbau

Musiega

Nyawira

et al. 2022

Preprint

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Introduction Health system efficiency is a priority concern for policy makers globally as countries aim to achieve universal health coverage. Efficiency analysis in the health sector has typically focused on the efficiency of healthcare facilities (hospitals, primary healthcare facilities), with few studies focusing on system level (national or sub-national) efficiency. We carried out a thematic review of literature that assessed the efficiency of health systems at the national and sub-national level. Methods We conducted a systematic search of PubMed, Google, and Google scholar between 2000 and 2021 and a manual search of relevant papers’ reference lists. A total of 131 papers were identified. We analysed and synthesized data from the selected papers using a thematic approach. Findings There were more publications from high and upper middle-income countries (62%) than from low income and lower-middle income countries. There were also more publications focusing on national level (60%) compared to sub-national health systems efficiency. Only 5% of studies used either qualitative methods or mixed methods while 95% used quantitative approaches. Data envelopment analysis was the most common methodological approach used, followed by stochastic frontier analysis. A range of regression methods were used to identify the determinants of health system efficiency. While studies used a range of inputs, these generally considered the building blocks of health systems, health risk factors, and social determinants of health. Outputs used in efficiency analysis could be classified as either intermediate health outputs, single health outcomes or composite measures of health outcomes. Factors that were found to affect health system technical efficiency include demographic and socio-economic characteristics of the population, macro-economic characteristics of the national and sub-national regions, population health and wellbeing, the governance and political characteristics of these regions, and health system characteristics. Conclusion This review highlights the limited evidence on health system efficiency in low- and middle-income countries. It also reveals the dearth of efficiency studies that use mixed methods approaches by incorporating qualitative inquiry. The review offers insights on the drivers of the technical efficiency of national and sub-national health systems, highlights potential targets for reforms to improve health system efficiency.

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Section: Methods Used To Analyze E Ciencymentioning

confidence: 99%

Section: Methods Used To Analyze E Ciencymentioning

confidence: 99%

Section: Health Systemmentioning

confidence: 99%

Section: Health Systemmentioning

confidence: 99%

Section: Health Systemmentioning

confidence: 99%

See 3 more Smart Citations

Analysing the Efficiency of National and Sub-national health systems - A Systematic Review of Literature

Mbau

Musiega

Nyawira

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

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Inequality Dimensions of Kenya’s Responses to COVID-19

Muriungi

Musau²

2023

The First 100 Days of Covid-19

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Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

Mbau

Musiega

Nyawira

et al. 2022

Appl Health Econ Health Policy

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Background Efficiency refers the use of resources in ways that optimise desired outcomes. Health system efficiency is a priority concern for policy makers globally as countries aim to achieve universal health coverage, and face the additional challenge of an aging population. Efficiency analysis in the health sector has typically focused on the efficiency of healthcare facilities (hospitals, primary healthcare facilities), with few studies focusing on system level (national or sub-national) efficiency. We carried out a thematic review of literature that assessed the efficiency of health systems at the national and sub-national level. Methods We conducted a systematic search of PubMed and Google scholar between 2000 and 2021 and a manual search of relevant papers selected from their reference lists. A total of 131 papers were included. We analysed and synthesised evidence from the selected papers using a thematic approach (selecting, sorting, coding and charting collected data according to identified key issues and themes). Findings There were more publications from high-and upper middle-income countries (53%) than from low-income and lower middle-income countries. There were also more publications focusing on national level (60%) compared to sub-national health systems' efficiency. Only 6% of studies used either qualitative methods or mixed methods while 94% used quantitative approaches. Data envelopment analysis, a non-parametric method, was the most common methodological approach used, followed by stochastic frontier analysis, a parametric method. A range of regression methods were used to identify the determinants of health system efficiency. While studies used a range of inputs, these generally considered the building blocks of health systems, health risk factors, and social determinants of health. Outputs used in efficiency analysis could be classified as either intermediate health service outputs (e.g., number of health facility visits), single health outcomes (e.g., infant mortality rate) or composite indices of either intermediate outputs of health outcomes (e.g., Health Adjusted Life Expectancy). Factors that were found to affect health system efficiency include demographic and socio-economic characteristics of the population, macro-economic characteristics of the national and sub-national regions, population health and wellbeing, the governance and political characteristics of these regions, and health system characteristics. Conclusion This review highlights the limited evidence on health system efficiency, especially in low-and middle-income countries. It also reveals the dearth of efficiency studies that use mixed methods approaches by incorporating qualitative inquiry. The review offers insights on the drivers of the efficiency of national and sub-national health systems, and highlights potential targets for reforms to improve health system efficiency.

show abstract

Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis

Cited by 14 publications

References 36 publications

Analysing the Efficiency of National and Sub-national health systems - A Systematic Review of Literature

Analysing the Efficiency of National and Sub-national health systems - A Systematic Review of Literature

Inequality Dimensions of Kenya’s Responses to COVID-19

Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

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