1,721,159 research outputs found
Socioeconomic inequalities and inequities in the screening and treatment of diabetes and hypertension in Kenya
Full text linkThe burden of non-communicable diseases (NCDs) is on a disproportionate rise in low-and middleincome countries (LMICs). Equity in the utilisation of screening and treatment services for NCDs is important in reducing associated disease burden. For instance, the 2030 Sustainable Development Goal 3.4 that aims to reduce by one-third premature NCDs mortality, has adopted prevention and treatment as critical interventions for achieving this target. However, little is known about equity in the use of screening and treatment services for major NCDs like diabetes and hypertension in Kenya. This dissertation assesses horizontal equity (i.e. equal treatment for equal need) in the screening and treatment for diabetes and hypertension. Further, it examines factors contributing to inequality. Data from the 2015 STEPwise cross-sectional survey on NCDs risk factors were used in the analysis. Concentration curves, concentration indices and horizontal inequity index were used to assess socioeconomic inequality and inequity in the screening and treatment for diabetes and hypertension. The Wagstaff decomposition approach was used to examine factors contributing to socioeconomic inequality in screening and treatment. For a granular presentation of inequity and inequality findings, analyses were conducted across the wealth and regional divides in Kenya. Overall, the rich benefited disproportionately more in the utilisation of screening and treatment services, given their population share of need. Of note, inequalities in the use of screening and treatment interventions for diabetes and hypertension were observed in the geographic regions. In general, non-need factors such as educational attainment, area of residence, exposure to media, employment, and wealth status were the largest contributors to inequality in both screening and treatment. By contrast, need factors like sex also significantly contributed to inequality in diabetes and hypertension screening. After controlling for need, a statistically significant pro-rich inequity in the use of diabetes and hypertension screening was observed. Both the use of diabetes and hypertension treatment were pro-rich though a statistically significant result was only seen for the former. For equity in the screening and treatment for diabetes and hypertension in Kenya, demand enhancing mechanisms such as health education through the mass media and free NCD screening in the public sector should be implemented. Also, given the interplay of factors beyond the health sector that affect utilisation of healthcare services, there is a need for multi-sectoral approaches at various levels to address drivers of social inequality with a critical focus in rural and marginalised areas
Multi-criteria decision analysis in priority setting for universal health coverage in Kenya
No full textThe Doctor of Philosophy (DPhil) project and thesis explored the use of quantitative Multi-Criteria Decision Analysis (MCDA) in priority setting for Universal Health Coverage (UHC) in Kenya, using the example of Kenya’s UHC benefit package. The specific objectives of the DPhil project were: 1) to identify and select health interventions for consideration for inclusion in Kenya’s UHC benefit package, 2) to identify and select priority setting criteria, and 3) to determine the relative importance stakeholders place on priority setting criteria and hence prioritise health interventions into the UHC benefit package.
The thesis has six chapters. Chapter one provides the introduction while chapter two outlines a literature review on the application of MCDA in health intervention priority setting in Low- and Middle-Income Countries (LMICs). A total of 28 studies were identified. In the third chapter, an interim list of 14 health interventions to be prioritised were identified and selected using online modified Delphi technique and in person modified nominal group technique. In chapter four, six priority setting criteria (burden of disease, congruence with existing priorities, cost of intervention, effectiveness of intervention, equity, and health systems capacity) and levels were identified using a four-stage process.
Chapter five focused on prioritisation of health interventions using discrete choice modelling, where preferences of 312 stakeholders were elicited. The most important criteria were burden of disease, effectiveness of intervention, equity, congruence with existing priorities, and health systems capacity respectively. The highest ranked health interventions were provision of insecticide treated nets (ITNs) to children and pregnant women, immediate anti-retroviral therapy (ART) initiation, and Covid-19 vaccine. Nonetheless, promotion of proper diet had the lowest cost per value (hence highest ranked) among the 14 interventions when unit costs of the interventions were included in the model. In conclusion, despite the limitations of the project, MCDA is feasible to implement in Kenya
Replication Data for: A discrete choice experiment on health care providers' preferences for capitation payment mechanism in Kenya
No full textData associated with a discrete choice experiment that aimed to elicit the preferences of health care providers for the attributes of capitation payment mechanism in Kenya. The study focused on four capitation attributes, namely, capitation rate per individual per year, payment schedule, services to be paid by the capitation rate, and timeliness of payments. Choice and socio-demographic data were collected between July 2018 and November 2018 from 233 senior management team members in 98 health facilities in seven counties, namely, Bomet, Kakamega, Kilifi, Makueni, Meru, Migori, and Siaya. A stratified random sampling approach was used
Economic evaluation and decision making for quality improvement in complex community health systems
Full text linkCommunity health is a fundamental part of many healthcare systems and is widely advocated as a means to increase access to and coverage of health services, yet the quality of care in large-scale community health programmes is mixed. Quality improvement (QI) approaches are now being tested in community settings and there is limited evidence that integrating QI approaches can underpin success of community programmes. However, how best to measure that success and the cost and value thereof to the different decision makers in complex community health systems is not yet known.
This thesis provides the first economic evaluation of QI in community health systems, linking this to an exploration of decision making that includes an assessment of how economic evidence like this is used. Using an interdisciplinary mixed methods approach, I worked across several countries (Ethiopia, Kenya, Indonesia, Malawi, and Mozambique) to provide evidence to inform policy decisions. I first examined the costs of a QI intervention in all five countries and then used those data as the foundation of a cost-effectiveness decision tree model for the intervention in Kenya. Through interviews with national and global decision makers, I qualitatively examined the use and value of evidence in community health programmes. I present the results in a series of three related publications, linking them together with a literature review and discussion that show how these studies build upon each other and what they add to the existing evidence base.
This thesis shows that QI for community health is a good investment contingent on an existing cadre of community health workers. The budget impact of the QI intervention is low (less than 0.53% of general government health expenditure) and the modelled cost-effectiveness yields an incremental cost-effectiveness ratio of US$249.43 per disability-adjusted life year. The absolute costs are highly dependent on context and the intensity of the intervention. Qualitative findings indicate that decision makers are not satisfied with existing evidence and have limited capacity to assess its relevance for their settings and perspectives. As a result, power and politics fill this evidence gap.
Evidence must be at the heart of decisions in funding universal health coverage for them to be sustainable. To achieve this, the global community must strengthen the relevance of evidence and build the capacity of decision makers to understand and apply it. For a complex system, useful evaluation should describe context and mechanism of an intervention, estimate the effect size on both programmatic and health impacts and accurately reflect the opportunity costs
Learning sites for health system governance in Kenya and South Africa: Reflecting on our experience
Full text linkBackground:
Health system governance is widely recognised as critical to well-performing health systems in low- and middle-income countries. However, in 2008, the Alliance for Health Policy and Systems Research identified governance as a neglected health systems research issue. Given the demands of such research, the Alliance recommended applying qualitative approaches and institutional analysis as well as implementing cross-country research programmes in engagement with policy-makers and managers. This Commentary reports on a 7-year programme of work that addressed these recommendations by establishing, in partnership with health managers, three district-level learning sites that supported real-time learning about the micro-practices of governance – that is, managers’ and health workers’ everyday practices of decision-making.
Paper Focus:
The paper’s specific focus is methodological and it seeks to prompt wider discussion about the long-term and engaged nature of learning-site work for governance research. It was developed through processes of systematic reflection within and across the learning sites. In the paper, we describe the learning sites and our research approach, and highlight the set of wider activities that spun out of the research partnership, which both supported the research and enabled it to reach wider audiences. We also separately present the views of managers and researchers about the value of this work and reflect carefully on four critiques of the overall approach, drawing on wider co-production literature.
Conclusions:
Ultimately, the key lessons we draw from these experiences are that learning sites offer particular opportunities not only to understand the everyday realities of health system governance but also to support emergent system change led by health managers; the wider impacts of this type of research are enabled by working up the system as well as by infusing research findings into teaching and other activities, and this requires supportive organisational environments, some long-term research funding, recognising the professional and personal risks involved, and sustaining activities over time by paying attention to relationships; and working in multiple settings deepens learning for both researchers and managers. We hope the paper stimulates further reflection about research on health system governance and about co-production as a research approach
What role can health policy and systems research play in supporting responses to COVID-19 that strengthen socially just health systems?
Full text linkFil: Gilson, Lucy. University of Cape Town. Health Policy and Systems Division. Section Editor Health Policy Processes; Sudráfica.Fil: Spicer, Neil. Health Policy and Planning and Institute of Tropical Medicine. Section Editor Health Systems Research; Bélgica.Fil: Shawar, Yusra. Johns Hopkins University. Section Editor Health Policy Processes, Health Policy and Planning; Estados Unidos.Fil: Prashanth, N S. Institute of Public Health; India.Fil: George, Asha. Health Systems Global and University of the Western Cape; Sudáfrica.Fil: Molyneux, Sassy. Kenya and Oxford University. Kenya Medical Research Institute-Wellcome Trust Research Programme; Reino Unido.Fil: Marchal, Bruno. Health Policy and Planning and Institute of Tropical Medicine. Section Editor Health Systems Research; Bélgica.Fil: Guinaran, Ryan. Benguet State University; Filipinas.Fil: Barasa, Edwine. Kenya Medical Research Institute-Wellcome Trust Research Programme; Kenia.Fil: Van Belle, Sara. Institute of Tropical Medicine; Bélgica.Fil: Schneider, Helen. University of the Western Cape; Sudáfrica.Fil: Dossou, Jean-Paul. Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD); Benín.Fil: Shiffman, Jeremy R. Johns Hopkins University. Section Editor Health Policy Processes, Health Policy and Planning; Estados Unidos.Fil: Ayepong, Irene. Health Policy and Planning and Institute of Tropical Medicine. Section Editor Health Systems Research; Suiza.Fil: Sheikh, Kabir. Health Policy and Planning and Alliance for Health Policy and Systems Research. Section Editor Health Systems Research; Suiza.Fil: Maceira, Daniel. CEDES. Centro de Estudios de Estado y Sociedad. Área de Economía; Argentina.Fil: Whyle, Eleanor. University of Cape Town; Sudáfrica
Replication Data for: Patient costs of hypertension care in public healthcare facilities in Kenya
No full textThe dataset was used to estimate patients costs for seeking hypertension care in two counties in Keny
Examining priority setting and resource allocation practices in county hospitals in Kenya
No full textHospitals consume a significant proportion of healthcare budgets and are a key avenue for the delivery of key interventions. Understanding how hospitals use resources is therefore an important question. Priority setting research has however focused on the macro (national) and micro (patient) level, and neglected the meso (organizational, hospital) level practices. There is also a dearth of literature on priority setting in developing country hospitals, although they are recognized to suffer severe resource scarcity. This thesis describes and evaluates priority setting practices in Kenyan hospitals and identifies strategies for improvement. METHODOLOGY: A case study approach was used, where two public hospitals in coastal Kenya were selected as cases and three priority setting processes examined as nested cases. Data were collected over a seven month fieldwork period using in - depth interviews, document reviews, and non - participant observations. A modified thematic approach was used for data analysis. FINDINGS: Hospitals exhibit properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in the system hardware (resource scarcity) and software (tangible - guidelines and procedure s and intangible - leadership and actor relationships) led to the emergence of undesired properties. Both hospitals had comparable system hardware and tangible software, but differences in intangible software contributed to variations in priority setting practices. For example, good leadership and actor relations in one hospital lead to better inclusion of stakeholders and perceptions of fairness while weak leadership, heightened tensions among actors and less inclusive processes in the other hospital lead to distrust and perceptions of unfairness. RECOMMENDATIONS: The capacity of hospitals to set priorities should be improved across the interacting aspects of organizational hardware, and tangible and intangible software. Interventions should however recognize that hospitals are CASs. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence
Costs and effects of a multifaceted intervention to improve the quality of care of children in district hospitals in Kenya
No full textIn Kenya, an intervention to improve the quality of care of children was developed and tested in district hospitals. This was a multifaceted intervention employing clinical practice guidelines, training, supervision, feedback and facilitation, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. This thesis presents an economic evaluation of this complex intervention
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