Department of International Health, School of Nursing & Health Studies, Georgetown University, 3700 Reservoir Rd NW, Washington, DC 20007, USA.
Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, 197 Lenana Place, Lenana Road, Nairobi, Kenya.
Health Policy Plan. 2022 Feb 8;37(2):189-199. doi: 10.1093/heapol/czab129.
To better understand the wide variation of performance among county health systems in Kenya, this study investigated their performance determinants. We selected five counties with varied performance and examined their performance across five domains containing 10 thematic areas. We conducted a stakeholder analysis, consisting of focus group discussions and key informant interviews, and administered a quantitative survey to quantify the magnitude of inefficiency. The study found that a shortage of funding was one of the most common complaints from counties, leading to inefficiency in the health system. Another major reason for inefficiencies was the delay in disbursing funding to health facilities, which affected the procurement of medical supplies and commodities essential for delivering healthcare to the population. In addition, lack of autonomy in procuring commodities and equipment was repeatedly mentioned as a barrier to delivering quality health services. Other reported common concerns contributing to the performance of county health systems were the lack of lab tests and equipment, low willingness to join health insurance, rigid procurement policies and lengthy procurement process, lack of motivation and incentives for service delivery, and poor economic status. Despite the common concerns among the five counties, they differed in some schematic areas, such as the county's commitment to health and community mobilization. In summary, this study suggests various factors that determine county health system performance. Given the multifaceted nature of inefficiency drivers, it is necessary to adopt a holistic approach to address the causes of inefficiencies and improve the county health systems.
为了更好地理解肯尼亚县级卫生系统之间绩效的广泛差异，本研究调查了它们的绩效决定因素。我们选择了五个绩效不同的县，检查了它们在包含 10 个主题领域的五个领域中的绩效。我们进行了利益攸关方分析，包括焦点小组讨论和关键意见领袖访谈，并进行了定量调查，以量化效率低下的程度。研究发现，资金短缺是各县最常见的抱怨之一，导致卫生系统效率低下。效率低下的另一个主要原因是资金向卫生设施的拨付延迟，这影响了医疗用品和商品的采购，而这些是向民众提供医疗保健的必要条件。此外，在采购商品和设备方面缺乏自主权，这被反复提到是提供优质医疗服务的障碍。其他报道的常见问题也会影响县级卫生系统的绩效，包括缺乏实验室检测和设备、加入医疗保险的意愿低、采购政策僵化和采购流程冗长、提供服务的动力和激励不足以及经济状况不佳。尽管这五个县存在共同关注的问题，但它们在一些方案领域存在差异，例如该县对卫生和社区动员的承诺。总之，本研究提出了决定县级卫生系统绩效的各种因素。鉴于效率低下驱动因素的多面性，有必要采取整体方法来解决效率低下的原因，改善县级卫生系统。
