Understanding the drivers of efficiency and inefficiency in the public healthcare sector; a qualitative investigation
Introduction The Government of Kenya developed Vision 2030, a long-term development plan which aims to have a country that is prosperous, globally competitive and has a high quality of life of its citizens by the year 2030. While seeking to improve the overall livelihoods of the people, the country aims to have a healthcare system that is efficient, integrated and affordable. The promulgation of the new constitution in the year 2010, brought major changes in the health sector. The responsibility to deliver essential health services was devolved to the 47 counties while the national government is responsible for policy making and the management ofthe national referral hospitals. While all these are notable strategies, the fact is that the available public health sector resources are limited and the challenge is to make sure they are used in an optimal manner to provide healthcare services to as many people as possible. The World Bank, whose goal is to end extreme poverty and promote shared prosperity, is constantly supporting countries especially the developing economies to find sustainable and efficient ways to manage the scarce resources. This study, through the support of the World Bank, sought to better understand factors influencing efficiency and inefficiency in the public health sector facilities in Kenya. Methodology This was a descriptive qualitative study using in-depth key informant interviews as the data collection tool. A total of 8 facilities were conveniently sampled from Nairobi, Nyeri, Kiambu and Kajiado Counties. Key informants were selected using purposive sampling technique. The data was analyzed using systematic and rigorous content analysis to identify themes and categories of the key drivers of efficiency and inefficiency and the interaction among them.Findings Several factors were identified to influence the output from the various facilities. This were summarized into ten themes and these were; Availability and welfare of the healthcare workers, procurement and use of medical commodities, availability and use of medical equipment, infrastructure development and use, leadership and supervision, governance and strategic planning, data management and performance evaluation, media and Communication, care coordination and community related factors. These factors affected the output from both the supply and demand sides of healthcare. Conclusion and recommendations To increase staff motivation for better performance, there is need to develop appropriate schemes of service, have competitive compensation packages and strategies for career growth. It would also be important to build the capacity of the facility managers on effective leadership and supervision to promote better implementation of governance policies and strategic plans for improved healthcare output. The governments should again ensure availability of adequate and timely medical commodities and reliable basic equipment in the facilities to enhance utilisation of healthcare. To promote proper performance evaluation of both the inputs and the outputs, there is need to improve the data management systems to generate accurate, timely and reliable data and ensure the workers are well trained on how to utilise this information to improve decision making. Traditional and emerging media can be used to improve demand for the services and enhance teamwork among the health workers. There is need to adopt effective management strategies in the facilities to constantly improve patient flow, save time and resources and improve patient satisfaction. Social economic and cultural factors that may affect demand for the services should be identified and managed appropriately. Finally, it would be important to analyse facilities on case by case basis as each has its unique factors that either promote or limit efficiency in the delivery of care.
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