Swiss Center for International Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland.
University of Basel, Basel, Switzerland.
BMC Health Serv Res. 2020 Mar 6;20(1):182. doi: 10.1186/s12913-020-5041-x.
Competing priorities in health systems necessitate difficult choices on which health actions and investments to fund: decisions that are complex, value-based, and highly political. In light of the centrality of universal health coverage (UHC) in driving current health policy, we sought to examine the value interests that influence agenda setting in the country's health financing space. Given the plurality of Kenya's health policy levers, we aimed to examine how the perspectives of stakeholders involved in policy decision-making and implementation shape discussions on health financing within the UHC framework.
A series of in-depth key informant interviews were conducted at national and county level (n = 13) between April and May 2018. Final thematic analysis using the Framework Method was conducted to identify similarities and differences amongst stakeholders on the challenges hindering Kenya's achievement of UHC in terms of its the optimisation of health service coverage; expansion of the population that benefits from essential healthcare services; and the minimisation of out-of-pocket costs associated with health-seeking behaviour.
Our findings indicate that the perceived lack of strategic leadership from Kenya's national government has led to a lack of agreement on stakeholders' interpretation of what is to be understood by UHC, its contextual values and priorities. We observe material differences between and within policy networks on the country's priorities for population coverage, healthcare service provision, and cost-sharing under the UHC dispensation. In spite of this, we note that progressive universalism is considered as the preferred approach towards UHC in Kenya, with most interviewees prioritising an equity-based approach that prioritises better access to healthcare services and financial risk protection. However, the conflicting priorities of key stakeholders risk derailing progress towards the expansion of access to health services and financial risk protection.
This study adds to existing knowledge of UHC in Kenya by contextualising the competing and evolving priorities that should be taken into consideration as the country strategises over its UHC process. We suggest that clear policy action is required from national government and county governments in order to develop a logical and consistent approach towards UHC in Kenya.
医疗体系中存在相互竞争的优先事项，这使得人们必须艰难地决定为哪些卫生行动和投资提供资金：这些决策既复杂，又具有价值导向，且高度政治化。鉴于全民健康覆盖（UHC）在推动当前卫生政策方面的核心地位，我们试图研究影响国家卫生筹资领域议程设置的价值利益。鉴于肯尼亚卫生政策杠杆的多样性，我们旨在研究参与政策决策和实施的利益相关者的观点如何在 UHC 框架内塑造卫生筹资的讨论。
2018 年 4 月至 5 月期间，在国家和县级层面（n=13）进行了一系列深入的关键知情人访谈。使用框架方法进行最终主题分析，以确定利益相关者在肯尼亚实现 UHC 方面的挑战、其优化卫生服务覆盖范围、扩大受益于基本医疗保健服务的人口、以及最小化与寻求医疗服务相关的自付费用方面的困难的看法存在的异同。
我们的研究结果表明，肯尼亚国家政府缺乏战略领导力，导致利益相关者对 UHC 的理解、其背景价值和优先事项存在分歧。我们观察到，在国家的人口覆盖、医疗服务提供和 UHC 规定下的成本分担等优先事项上，政策网络之间以及内部存在实质性差异。尽管如此，我们注意到，渐进式普遍主义被认为是肯尼亚 UHC 的首选方法，大多数受访者优先考虑基于公平的方法，即优先考虑更好地获得医疗服务和财务风险保护。然而，关键利益相关者的相互冲突的优先事项可能会破坏扩大获得卫生服务和财务风险保护的进展。
本研究通过将肯尼亚 UHC 相互竞争和不断演变的优先事项置于上下文中，增加了对肯尼亚 UHC 的现有知识。我们建议，国家政府和县政府需要采取明确的政策行动，以便在肯尼亚制定关于 UHC 的合理和一致的方法。
