Accessing health care in a cost sharing environment: a case study of Yathui Division in Mwala District
Muthoka, Justus D
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Easy access to health care is still a major challenge in many of the developing countries in general and Kenya in particular. This is inspite of the fact that access to adequate and quality health care is considered to be one of the fundamental rights of every individual. The role of safety nets and other social protection programs is often promoted as a solution to an ever rising cost of accessing basic community services like health care. This is especially so in the face of dwindling public resources. The focus of this study was to understand the performance of health care safety nets, namely; waivers and exemptions as currently administered in rural health facilities as perceived by potential users. Three hypotheses were tested, namely: a) Clarity of identification methods for waiver beneficiaries has an effect on access to health care services. b) There is a positive relationship between community sensitization on waiver and exemption schemes and their utilization and c) Enforcement of ministry of health waiver and exemption implementation guidelines has a positive effect on the implementation levels of the schemes The study was carried out in Yathui Division, Mwala District in Eastern Province. A survey research design was employed to collect data. A total of 96 household members who were potential users of safety nets were interviewed using standardized questionnaires. Two separate interview guides were used to collect data from 12 health facility staff and two key informants from ministry headquarters and the officer in charge of the only district hospital in the district respectively. Mwala district has four divisions, namely; Masii, Yathui, Kibauni and Mwala. Both the district and division were purposively sampled for the study because of: convenience and familiarity to the student, the research design used is a mixed one, that is, to a great extent quantitative and minimally qualitative. Yathui division which has three (3) locations was Similarly chosen for the same reasons except that its population characteristics are similar to that of the other two divisions in the district. This gave further credence for it to be sampled purposively. The key informants were also sampled purposively because of their expert knowledge in their fields. There are twenty two (22) public health facilities spread out in all the four (4) locations in the division and all have public health facilities. In total, there are seventeen (17) dispensaries and five (5) health centers and only one (1) district hospital. Stratified random sampling was used to draw samples from the two groups, that is, the stratum for dispensaries and the other for health centers respectively. From the stratum of health centers, three (3) health facilities were sampled randomly while in the dispensaries' stratum; nine (9) facilities were similarly picked. A sample size of 100 poor households was sampled through multl-staqe and random methods. However, only 96 of these were able to respond to the questions. The study established that clarity of the identification methods for would-be beneficiaries was key to accessing health care services. It was evident that the methods used were not clear and hence elicited apathy amongst the community members. On sensitization on the existence of the health safety nets, the finding was that even though the government initiated the health safety nets schemes, there was no much effort put to sensitize the local populations on their existence. It was established that the facilities were more interested in raising revenue for their operations than in extending waiver and exemptions to potential beneficiaries. It is no wonder that a good number of the community members felt it was a great privilege if one of them benefitted from the schemes. Further, it was established that even though some form of monitoring took place, this was not matched by increased implementation of the ministry guidelines on implementation of safety nets. It is recommended that a better and transparent system of identifying the needy for assistance be put in place and that the community be fully involved in the process. A program as important as this should also be backed by vigorous sensitization of the potential consumers. Monitoring should be geared towards better results and accountability. This was glaringly lacking. On further research, it is emphasized that other sources of flnanclnq health care for vulnerable groups be investigated and also research should be done on less conventional alternative health care that is cheaper to access.