Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya.
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ABSTRACT:
SUBMITTER: Ahmed IA
PROVIDER: S-EPMC10826929 | biostudies-literature | 2024
REPOSITORIES: biostudies-literature
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Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya.
Ahmed Ismail Adow IA Kariuki James J Mathu David D Onteri Stephen S Macharia Antony A Mwai Judy J Otambo Priscah P Wanjihia Violet V Mutai Joseph J Mokua Sharon S Nyandieka Lilian L Echoka Elizabeth E Njomo Doris D Bukania Zipporah Z
PloS one 20240130 1
<h4>Introduction</h4>Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the countr ...[more]
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Project description:Universal health coverage requires adequate and sustainable resourcing, which includes human capital, finance and infrastructure for its realization and sustainability. Well-functioning health systems enable health service delivery and therefore need to be either adequately or optimally geared-prepared and equipped-for service delivery to advance universal health coverage. Adequately geared health systems have sufficient capacity and capability per resourcing levels whereas optimally geared health systems achieve the best possible capacity and capability per resourcing levels. Adequately or optimally geared health systems help to mitigate health system constraints, challenges and inefficiencies. Effective, efficient, equitable, robust, resilient and responsive health systems are elements for implementing and realizing universal health coverage and are embedded and aligned to a global people-centric health strategy. These elements build, enhance and sustain health systems to advance universal health coverage. Effective and efficient health systems encompass continuous improvement and high performance for providing quality healthcare. Robust and resilient health systems provide a supportive and enabling environment for health service delivery. Responsive and equitable health systems prioritize people and access to healthcare. Efforts should be made to design, construct, re-define, refine and optimize health systems that are effective, efficient, equitable, robust, resilient and responsive to deliver decent quality healthcare for all.
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Project description:BACKGROUND:Kenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF's purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality. METHODS:We conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach. RESULTS:The new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery. CONCLUSION:While NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms' design and implementation limited NHIF's purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country's progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.
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Project description:The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.
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Project description:BackgroundPeople with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage.AimsTo propose context-relevant strategies for moving towards universal health coverage for people with mental disorders in Ethiopia.MethodsWe conducted a situational analysis to inform a SWOT analysis of coverage of mental health services and financial risk protection, health system characteristics and the macroeconomic and fiscal environment. In-depth interviews were conducted with five national experts on health financing and equity and analysed using a thematic approach. Findings from the situation analysis and qualitative study were used to develop recommended strategies for adequate, fair and sustainable financing of mental health care in Ethiopia.ResultsOpportunities for improved financing of mental health care identified from the situation analysis included: a significant mental health burden with evidence from strong local epidemiological data; political commitment to address that burden; a health system with mechanisms for integrating mental health into primary care; and a favourable macro-fiscal environment for investment in human capabilities. Balanced against this were constraints of low current general government health expenditure, low numbers of mental health specialists, weak capacity to plan and implement mental health programmes and low population demand for mental health care. All key informants referred to the under-investment in mental health care in Ethiopia. Respondents emphasised opportunities afforded by positive rates of economic growth in the country and the expansion of community-based health insurance, as well as the need to ensure full implementation of existing task-sharing programmes for mental health care, integrate mental health into other priority programmes and strengthen advocacy to ensure mental health is given due attention.ConclusionExpansion of public health insurance, leveraging resources from high-priority SDG-related programmes and implementing existing plans to support task-shared mental health care are key steps towards universal health coverage for mental disorders in Ethiopia. However, external donors also need to deliver on commitments to include mental health within development funding. Future researchers and planners can apply this approach to other countries of sub-Saharan Africa and identify common strategies for sustainable and equitable financing of mental health care.
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