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Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya

Author

Listed:
  • Lizah Nyawira
  • Rahab Mbau
  • Julie Jemutai
  • Anita Musiega
  • Kara Hanson
  • Sassy Molyneux
  • Charles Normand
  • Benjamin Tsofa
  • Isabela Maina
  • Andrew Mulwa
  • Edwine Barasa

Abstract

Efficiency gains is a potential strategy to expand Kenya’s fiscal space for health. We explored health sector stakeholders’ understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health are still relevant, emerging epidemiological trends such as an increase in the burden of non-communicable diseases should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency. County health system efficiency in Kenya could be enhanced by improving the timeliness of financial flows to counties and health facilities, giving health facilities financial autonomy, improving the number, skill mix, and motivation of healthcare staff, managing political interests, enhancing anticorruption strategies, strengthening management capacity and coordination in the health sector.

Suggested Citation

  • Lizah Nyawira & Rahab Mbau & Julie Jemutai & Anita Musiega & Kara Hanson & Sassy Molyneux & Charles Normand & Benjamin Tsofa & Isabela Maina & Andrew Mulwa & Edwine Barasa, 2021. "Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya," PLOS Global Public Health, Public Library of Science, vol. 1(12), pages 1-17, December.
    • Handle: RePEc:plo:pgph00:0000077
    DOI: 10.1371/journal.pgph.0000077
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    References listed on IDEAS

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    1. Rahab Mbau & Edwine Barasa & Kenneth Munge & Stephen Mulupi & Peter K. Nguhiu & Jane Chuma, 2018. "A critical analysis of health care purchasing arrangements in Kenya: A case study of the county departments of health," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(4), pages 1159-1177, October.
    2. Goddard, Maria & Hauck, Katharina & Preker, Alex & Smith, Peter C., 2006. "Priority setting in health – a political economy perspective," Health Economics, Policy and Law, Cambridge University Press, vol. 1(1), pages 79-90, January.
    3. Dennis Waithaka & Benjamin Tsofa & Evelyn Kabia & Edwine Barasa, 2018. "Describing and evaluating healthcare priority setting practices at the county level in Kenya," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(3), pages 733-750, July.
    4. Bossert, Thomas, 1998. "Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance," Social Science & Medicine, Elsevier, vol. 47(10), pages 1513-1527, November.
    5. Timothy J. Coelli & D.S. Prasada Rao & Christopher J. O’Donnell & George E. Battese, 2005. "An Introduction to Efficiency and Productivity Analysis," Springer Books, Springer, edition 0, number 978-0-387-25895-9, December.
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