44 research outputs found
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
NHIF-contracted outpatient facility choice data
No full textThis data was part of Jacob Kazungu’s PhD work. It contains data from a Discrete Choice Experiment (DCE) conducted among NHIF members to understand their preferences and trade-offs for the attributes of NHIF contracted outpatient providers in Kenya. It also collected data on the attributes for those who had already selected a facility
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Whom to buy from: Examining NHIF members’ preferences and the inequities in the distribution of and access to NHIF-contracted facilities in Kenya
No full textBackground
Globally, countries are increasingly leveraging strategic health purchasing (SHP) to accelerate their progress towards universal health coverage (UHC). SHP involves making evidence-based decisions on 1) services to buy, 2) providers to buy from, and 3) payment methods. This thesis examined NHIF members’ preferences and the inequities in the distribution of NHIF-contracted facilities in Kenya.
Methods
I employed a convergent parallel mixed methods design. First, I conducted a discrete choice experiment (DCE) involving both qualitative (15 focus groups with NHIF members, 12 interviews with facility managers, and 3 interviews with NHIF staff) and quantitative (402 NHIF members) data collection. Qualitative data were analyzed thematically, while quantitative data were analyzed using panel mixed-multinomial logit and latent class models. Secondary data assessed the spatial access to NHIF-contracted outpatient facilities by calculating the proportion of the population living within 60- and 120-minute travel times using the WHO AccessMod tool.
Results
NHIF members preferred outpatient facilities that always had drugs [β=1.572], were closer to households [β=-0.082], had shorter waiting times [β=-0.195], had respectful staff [β=1.249], and had clinical officers [β=0.478] or medical doctors [β=1.525]. Members were willing to travel up to 17.8 km for drug availability, 17.7 km for a medical doctor, and 14.6 km for respectful staff, and wait an additional 8.9, 8.8, and 7.2 hours respectively. Patient choice encouraged private and faith-based providers to compete for NHIF members, unlike public providers. Providers adapted their services to meet NHIF members' needs, improving access and quality of care. However, only 81.4% of the population lived within a one-hour travel distance of an NHIF-contracted facility, with significant disparities in marginalized counties.
Conclusion
The findings highlight priorities that can guide resource allocation at county level, service provision priorities by providers, and strategic purchasing decision particularly whom to buy from and provider contracting by the NHIF (now the Social Health Authority – SHA) to advance UHC goals.</br
Replication Data for: Crude childhood vaccination coverage in West Africa: trends and predictors of completeness
No full textAfrica currently has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on delivery of vaccines to achieve and sustain high coverage. In this paper, we reviewed trends in vaccination coverage, dropouts rates and explored the country-specific predictors of a fully immunised child (FIC) in Western Africa.
We utilized datasets from Demographic and Health Surveys available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d’Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo to obtain prevalence estimates of vaccination for Bacillus Calmette-Guerin, Polio, Measles and Diphtheria, Pertussis and Tetanus vaccines in children aged 12 – 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-Measles dropouts, and the proportions of the fully immunised child (FIC). Factors predictive of FIC within each country were explored using Chi-squared tests and multivariable logistic regression models.</p
Replication Data for: Crude childhood vaccination coverage in West Africa: trends and predictors of completeness
No full textAfrica currently has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on delivery of vaccines to achieve and sustain high coverage. In this paper, we reviewed trends in vaccination coverage, dropouts rates and explored the country-specific predictors of a fully immunised child (FIC) in Western Africa.
We utilized datasets from Demographic and Health Surveys available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d’Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo to obtain prevalence estimates of vaccination for Bacillus Calmette-Guerin, Polio, Measles and Diphtheria, Pertussis and Tetanus vaccines in children aged 12 – 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-Measles dropouts, and the proportions of the fully immunised child (FIC). Factors predictive of FIC within each country were explored using Chi-squared tests and multivariable logistic regression models
Examining levels, distribution and correlates of health insurance coverage in Kenya
No full textOBJECTIVE:To examine the levels, inequalities and factors associated with health insurance coverage in Kenya. METHODS:We analysed secondary data from the Kenya Demographic and Health Survey (KDHS) conducted in 2009 and 2014. We examined the level of health insurance coverage overall, and by type, using an asset index to categorise households into five socio-economic quintiles with quintile 5 (Q5) being the richest and quintile 1 (Q1) being the poorest. The high-low ratio (Q5/Q1 ratio), concentration curve and concentration index (CIX) were employed to assess inequalities in health insurance coverage, and logistic regression to examine correlates of health insurance coverage. RESULTS:Overall health insurance coverage increased from 8.17% to 19.59% between 2009 and 2014. There was high inequality in overall health insurance coverage, even though this inequality decreased between 2009 (Q5/Q1 ratio of 31.21, CIX = 0.61, 95% CI 0.52-0.0.71) and 2014 (Q5/Q1 ratio 12.34, CIX = 0.49, 95% CI 0.45-0.52). Individuals that were older, employed in the formal sector; married, exposed to media; and male, belonged to a small household, had a chronic disease and belonged to rich households, had increased odds of health insurance coverage. CONCLUSION:Health insurance coverage in Kenya remains low and is characterised by significant inequality. In a context where over 80% of the population is in the informal sector, and close to 50% live below the national poverty line, achieving high and equitable coverage levels with contributory and voluntary health insurance mechanism is problematic. Kenya should consider a universal, tax-funded mechanism that ensures revenues are equitably and efficiently collected, and everyone (including the poor and those in the informal sector) is covered
Crude childhood vaccination coverage in West Africa: Trends and predictors of completeness.
No full textBackground: Africa has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on vaccine delivery to achieve and sustain high coverage. In this paper, we review trends in vaccination coverage, dropouts between vaccine doses and explored the country-specific predictors of complete vaccination in West Africa. Methods: We utilized datasets from the Demographic and Health Surveys Program, available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d'Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo, to obtain coverage for Bacillus Calmette-Guerin, polio, measles, and diphtheria, pertussis and tetanus (DPT) vaccines in children aged 12 - 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-measles dropouts, and proportions of the fully immunised child (FIC). Factors predictive of FIC were explored using Chi-squared tests and multivariable logistic regression. Results: Overall, there was a trend of increasing vaccination coverage. The proportion of FIC varied significantly by country (range 24.1-81.4%, mean 49%). DPT1-to-DPT3 dropout was high (range 5.1% -33.9%, mean 16.3%). Similarly, DPT1-measles dropout exceeded 10% in all but four countries. Although no single risk factor was consistently associated with FIC across these countries, maternal education, delivery in a health facility, possessing a vaccine card and a recent post delivery visit to a health facility were the key predictors of complete vaccination. Conclusions: The low numbers of fully immunised children and high dropout between vaccine doses highlights weaknesses and the need to strengthen the healthcare and routine immunization delivery systems in this region. Country-specific correlates of complete vaccination should be explored further to identify interventions required to increase vaccination coverage. Despite the promise of an increasing trend in vaccination coverage in West African countries, more effort is required to attain and maintain global vaccination coverage targets
Examining patient choice and provider competition under the National Health Insurance Fund outpatient cover in Kenya: does it enhance access and quality of care?
No full textBackground: While patient choice and provider competition are predicted to influence provider behaviour for enhancing access and quality of care, evidence on provider perceptions and response to patient choice and provider competition is largely missing in low-resource settings such as Kenya. We examined provider and purchaser perceptions about whether patient choice and provider competition influenced provider behaviour and enhanced access and quality of outpatient care in Kenya. Methods: We conducted a qualitative study to explore this across two purposefully selected counties. We conducted 15 in-depth interviews (IDIs) with health facility managers and National Health Insurance Fund (NHIF) staff across the two counties. We examined these across five areas summarised as either local market conditions or patient feedback following the Vengberg framework. Results: NHIF members’ choice of outpatient facilities compelled private and faith-based providers to compete for members while public providers did not view choice as a way of spurring competition. Besides, all providers did not receive any information regarding the exit of NHIF members from their facilities. Providers felt that that information would be crucial for their planning, especially in enhancing service accessibility and quality of care. Most providers ensured the availability of drugs, provided a wider range of services and leveraged on marketing to attract and retain NHIF members. Finally, providers highlighted their redesign of service delivery to meet NHIF members’ needs whilst enhancing the quality-of-care aspects such as waiting time and having qualified health workers. Conclusion: There is a need for NHIF to share NHIF members’ exit information with providers to support their service delivery arrangements in response to NHIF members’ needs. Besides, this study contributes evidence on patient choice and provider competition and their influence on access and quality of care from a low-resource setting country which is crucial as NHIF transitioned to the Social Health Authority
Assessing the choice of National Health Insurance Fund contracted outpatient facilities in Kenya: A qualitative study
No full textObjective
To assess National Health Insurance Fund (NHIF) members' level of understanding, experiences, and factors influencing their choice of NHIF-contracted outpatient facilities in Kenya.
Methods
We conducted a cross-sectional qualitative study with NHIF members in two purposefully selected counties (Nyeri and Makueni counties) in Kenya. We collected data through 15 focus group discussions with NHIF members. Data were analysed using a framework analysis approach.
Results
Urban-based NHIF members had a good understanding of the NHIF-contracted outpatient facility selection process and the approaches for choosing and changing providers, unlike their rural counterparts. While NHIF members were required to choose a provider before accessing care, the number of available alternative facilities was perceived to be inadequate. Finally, NHIF members identified seven factors they considered important when choosing an NHIF-contracted outpatient provider. Of these factors, the availability of drugs, distance from the household to the facility and waiting time at the facility until consultation were considered the most important.
Conclusion
There is a need for the NHIF to prioritise awareness-raising approaches tailored to rural settings. Further, there is a need for the NHIF to contract more providers to both spur competition among providers and provide alternatives for members to choose from. Besides, NHIF members revealed the important factors they consider when selecting outpatient facilities. Consequently, NHIF should leverage the preferred factors when contracting healthcare providers. Similarly, healthcare providers should enhance the availability of drugs, reduce waiting times whilst improving their staff's attitudes which would improve user satisfaction and the quality of care provided
Examining national health insurance fund members’ preferences and trade-offs for the attributes of contracted outpatient facilities in Kenya: A discrete choice experiment
No full textPatient choice of health facilities is increasingly gaining recognition for potentially enhancing the attainment of health system goals globally. In Kenya, National Health Insurance Fund (NHIF) members are required to choose an NHIF-contracted outpatient facility before accessing care. Understanding their preferences could support resource allocation decisions, enhance the provision of patient-centered care, and deepen NHIF’s purchasing decisions. We employed a discrete choice experiment to examine NHIF members’ preferences for attributes of NHIF-contracted outpatient facilities in Kenya. We developed a d-efficient experimental design with six attributes, namely availability of drugs, distance from household to facility, waiting time at the facility until consultation, cleanliness of the facility, attitude of health worker, and cadre of health workers seen during consultation. Data were then collected from 402 NHIF members in six out of 47 counties. Choice data were analysed using panel mixed multinomial logit and latent class models. NHIF members preferred NHIF-contracted outpatient facilities that always had drugs [β=1.572], were closer to their households [β=-0.082], had shorter waiting times [β=-0.195], had respectful staff [β=1.249] and had either clinical officers [β=0.478] or medical doctors [β=1.525] for consultation. NHIF members indicated a willingness to accept travel 17.8km if drugs were always available, 17.7km to see a medical doctor for consultation, and 14.6km to see respectful health workers. Furthermore, NHIF members indicated a willingness to wait at a facility for 8.9 hours to ensure the availability of drugs, 8.8 hours to see a doctor for consultation, and 7.2 hours to see respectful health workers. Understanding NHIF member preferences and trade-offs can inform resource allocation at counties, service provision across providers, and purchasing decisions of purchasers such as the recently formed social health insurance authority in Kenya as a move towards UHC
