Understanding the performance of county health service delivery in Kenya: a mixed-method analysis

Abstract

To better understand the wide variation of performance among county health systems in Kenya, this study investigated their performance determinants. We selected five counties with varied performance and examined their performance across five domains containing 10 thematic areas. We conducted a stakeholder analysis, consisting of focus group discussions and key informant interviews, and administered a quantitative survey to quantify the magnitude of inefficiency. The study found that a shortage of funding was one of the most common complaints from counties, leading to inefficiency in the health system. Another major reason for inefficiencies was the delay in disbursing funding to health facilities, which affected the procurement of medical supplies and commodities essential for delivering healthcare to the population. In addition, lack of autonomy in procuring commodities and equipment was repeatedly mentioned as a barrier to delivering quality health services. Other reported common concerns contributing to the performance of county health systems were the lack of lab tests and equipment, low willingness to join health insurance, rigid procurement policies and lengthy procurement process, lack of motivation and incentives for service delivery, and poor economic status. Despite the common concerns among the five counties, they differed in some schematic areas, such as the county’s commitment to health and community mobilization. In summary, this study suggests various factors that determine county health system performance. Given the multifaceted nature of inefficiency drivers, it is necessary to adopt a holistic approach to address the causes of inefficiencies and improve the county health systems

A methodological framework to assess temporal trends and sub-national disparities in healthcare quality metrics using facility surveys, with applications to sick-child care in Kenya, Senegal, and Tanzania

“…Overall national gains in process quality in Kenya and readiness in Tanzania took place with rising subnational disparities. In Kenya, Senegal, and Tanzania, the progressive devolution of responsibilities, including health service provision, from the national to the local level of government (Dafflon and Madies, 2012) might be a driving factor of the diverging trends in healthcare quality between subnational areas; local decision-makers are indeed increasingly in charge of the funding of health facilities (e.g., managing medical supplies, commodities, health workforce) (Zeng et al ., 2022).…”

“…Overall national gains in process quality in Kenya and readiness in Tanzania took place with rising subnational disparities. In Kenya, Senegal, and Tanzania, the progressive devolution of responsibilities, including health service provision, from the national to the local level of government 23 might be a driving factor of the diverging trends in healthcare quality between subnational areas; local decision-makers are indeed increasingly in charge of the funding of health facilities (e.g., managing medical supplies, commodities, health workforce) 41 . Furthermore, access to basic amenities, diagnostic capacities, and essential medicines for child services, remained a major challenge in all three countries: while the availability of basic medical equipment, such as thermometer or child/infant scales, was relatively high across the three countries, only half of the facilities had access to electricity, malaria diagnostic tools, and several tracer drugs, such as amoxicillin, oral rehydration salts, or antimalarial medications, were not available in a quarter to a third of facilities offering curative child services.…”

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

“…Quantitative approaches were used to measure the level and determinants of efficiency. 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 inefficiency and its determinants [41,[45][46][47][48]. Beyond identification, qualitative approaches provided explanations of the relationship between identified determinants and health system efficiency [36,48,49].…”

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

“…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].…”