Kenya Ministry of Health, Department of Primary Health Care, Nairobi, Kenya.
Management Sciences for Health, Medford, MA, United States.
Front Public Health. 2023 Oct 12;11:1226163. doi: 10.3389/fpubh.2023.1226163. eCollection 2023.
For many Kenyans, high-quality primary health care (PHC) services remain unavailable, inaccessible, or unaffordable. To address these challenges, the Government of Kenya has committed to strengthening the country's PHC system by introducing a comprehensive package of PHC services and promoting the efficient use of existing resources through its primary care network approach. Our study estimated the costs of delivering PHC services in public sector facilities in seven sub-counties, comparing actual costs to normative costs of delivering Kenya's PHC package and determining the corresponding financial resource gap to achieving universal coverage.
We collected primary data from a sample of 71 facilities, including dispensaries, health centers, and sub-county hospitals. Data on facility-level recurrent costs were collected retrospectively for 1 year (2018-2019) to estimate economic costs from the public sector perspective. Total actual costs from the sampled facilities were extrapolated using service utilization data from the Kenya Health Information System for the universe of facilities to obtain sub-county and national PHC cost estimates. Normative costs were estimated based on standard treatment protocols and the populations in need of PHC in each sub-county.
The average actual PHC cost per capita ranged from US$ 9.3 in Ganze sub-county to US$ 47.2 in Mukurweini while the normative cost per capita ranged from US$ 31.8 in Ganze to US$ 42.4 in Kibwezi West. With the exception of Mukurweini (where there was no financial resource gap), closing the resource gap would require significant increases in PHC expenditures and/or improvements to increase the efficiency of PHC service delivery such as improved staff distribution, increased demand for services and patient loads per clinical staff, and reduced bypass to higher level facilities. This study offers valuable evidence on sub-national cost variations and resource requirements to guide the implementation of the government's PHC reforms and resource mobilization efforts.
对于许多肯尼亚人来说，高质量的初级卫生保健（PHC）服务仍然无法获得、无法获得或无法负担。为了应对这些挑战，肯尼亚政府承诺通过引入综合的 PHC 服务包并通过其初级保健网络方法促进现有资源的高效利用，来加强该国的 PHC 系统。我们的研究估计了在七个次级县的公共部门设施中提供 PHC 服务的成本，将实际成本与提供肯尼亚 PHC 服务包的规范成本进行了比较，并确定了实现全民覆盖的相应财政资源缺口。
我们从一个 71 个设施的样本中收集了主要数据，包括诊所、保健中心和县级医院。对 2018-2019 年的 1 年回溯性数据进行了设施层面的经常性成本收集，以便从公共部门角度估算经济成本。利用肯尼亚卫生信息系统的服务利用数据对抽样设施进行外推，以获得次级县和全国 PHC 成本估算，从而得出抽样设施的总实际成本。规范成本是根据标准治疗方案和每个次级县需要 PHC 的人口估算的。
人均平均实际 PHC 成本从甘泽县的 9.3 美元到穆库雷尼的 47.2 美元不等，而人均规范成本从甘泽的 31.8 美元到基布韦齐西部的 42.4 美元不等。除了穆库雷尼（那里没有资金缺口）之外，缩小资源差距将需要大幅增加 PHC 支出，和/或提高 PHC 服务提供效率，例如改善员工分配、增加服务需求和每临床员工的患者负担，以及减少对更高级别设施的绕过。本研究提供了关于国家以下一级成本差异和资源需求的宝贵证据，以指导政府实施 PHC 改革和资源调动工作。
