Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya

Efficiency gains is a potential strategy to expand Kenya’s fiscal space for health. We explored health sector stakeholders’ understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health are still relevant, emerging epidemiological trends such as an increase in the burden of non-communicable diseases should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency. County health system efficiency in Kenya could be enhanced by improving the timeliness of financial flows to counties and health facilities, giving health facilities financial autonomy, improving the number, skill mix, and motivation of healthcare staff, managing political interests, enhancing anticorruption strategies, strengthening management capacity and coordination in the health sector.

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Examining Health Sector Stakeholder Perceptions on the Efficiency of County Health Systems in Kenya

10.1101/2020.09.17.20196378 ◽

2020 ◽

Author(s):

Lizah Nyawira ◽

Rahab Mbau ◽

Julie Jemutai ◽

Kara Hanson ◽

Sassy Molyneux ◽

...

Keyword(s):

Public Finance ◽

Human Resources ◽

Health System ◽

Health Systems ◽

Human Resources For Health ◽

Health Sector ◽

System Efficiency ◽

Efficiency Gains ◽

Finance Management ◽

Health System Efficiency

Efficiency gains is a potential strategy to expand Kenyas fiscal space for health. We explored health sector stakeholders understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We collected data during a stakeholder engagement workshop. Workshop participants included health sector stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. We divided stakeholders into three groups and carried out facilitated group discussions followed by whole group feedback and discussion session. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health (RMNCH) are still relevant, emerging epidemiological trends characterized by an increase in the burden of non-communicable diseases (NCDs) should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency.

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Measuring the efficiency of health systems in Asia: a data envelopment analysis

BMJ Open ◽

10.1136/bmjopen-2018-022155 ◽

2019 ◽

Vol 9 (3) ◽

pp. e022155 ◽

Cited By ~ 11

Author(s):

Sayem Ahmed ◽

Md Zahid Hasan ◽

Mary MacLennan ◽

Farzana Dorin ◽

Mohammad Wahid Ahmed ◽

...

Keyword(s):

Data Envelopment Analysis ◽

Health System ◽

Technical Efficiency ◽

Health Systems ◽

Income Group ◽

Data Envelopment ◽

System Efficiency ◽

Asian Countries ◽

Middle Income ◽

Health System Efficiency

ObjectiveThis study aims to estimate the technical efficiency of health systems in Asia.SettingsThe study was conducted in Asian countries.MethodsWe applied an output-oriented data envelopment analysis (DEA) approach to estimate the technical efficiency of the health systems in Asian countries. The DEA model used per-capita health expenditure (all healthcare resources as a proxy) as input variable and cross-country comparable health outcome indicators (eg, healthy life expectancy at birth and infant mortality per 1000 live births) as output variables. Censored Tobit regression and smoothed bootstrap models were used to observe the associated factors with the efficiency scores. A sensitivity analysis was performed to assess the consistency of these efficiency scores.ResultsThe main findings of this paper demonstrate that about 91.3% (42 of 46 countries) of the studied Asian countries were inefficient with respect to using healthcare system resources. Most of the efficient countries belonged to the high-income group (Cyprus, Japan, and Singapore) and only one country belonged to the lower middle-income group (Bangladesh). Through improving health system efficiency, the studied high-income, upper middle-income, low-income and lower middle-income countries can improve health system outcomes by 6.6%, 8.6% and 8.7%, respectively, using the existing level of resources. Population density, bed density, and primary education completion rate significantly influenced the efficiency score.ConclusionThe results of this analysis showed inefficiency of the health systems in most of the Asian countries and imply that many countries may improve their health system efficiency using the current level of resources. The identified inefficient countries could pay attention to benchmarking their health systems within their income group or other within similar types of health systems.

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THE ANALYSIS OF INTERNATIONAL PRACTICE OF MODERNIZATION OF NATIONAL HEALTH SYSTEMS

Scientific bulletin of the Southern Institute of Management ◽

10.31775/2305-3100-2017-2-96-103 ◽

2017 ◽

pp. 96-103

Author(s):

A. A. Sokolov

Keyword(s):

Health System ◽

Medical Care ◽

Health Systems ◽

National Health ◽

Medical Science ◽

Health Sector ◽

National Health System ◽

Ecosystem Approach ◽

Advantages And Disadvantages ◽

Health System Efficiency

The article analyzes the main global health systems, their advantages and disadvantages. The evaluation of the introduction of each of them in reality. Recommendations for modernization of the national health system, which should be focused on the creation of effective national systems capable to provide the population with timely preventive measures, accessible and quality medical care, using medical science, rehabilitation and sanatorium-resort help. The task of providing free medical care to population throughout the Russian Federation in the conditions of insufficient financial support. Therefore, it is necessary to abandon single-payer systems to return to budgetary funding, to reinforce the insurance character of the OMC, to ensure the priority of quality indicators of health system efficiency, to ensure the continuity of the work of the modern Russian model of financing of the health sector of the country. The main conclusions of the study are the need to implement an alternative to the liberal-market approach to health reform ecosystem approach, to develop the ecosystem public health, involving its fuel economic modernization based on the achievements of the Semashko system. Applying this approach, it should abandon the mindless copying elements of Western health systems and to identify cooperative segments.

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The Use of Intersectional Analysis in Assessing Women’s Leadership Progress in the Health Workforce in LMICs: A Review

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.06 ◽

2021 ◽

Author(s):

Zahra Zeinali ◽

Kui Muraya ◽

Sassy Molyneux ◽

Rosemary Morgan

Keyword(s):

Human Resources ◽

Gender Equity ◽

Health Systems ◽

Health Workforce ◽

Human Resources For Health ◽

Health Sector ◽

Women's Leadership ◽

Social Identities ◽

Diverse Range ◽

Intersectional Analysis

Background: Human resources are at the heart of health systems, playing a central role in their functionality globally. It is estimated that up to 70% of the health workforce are women, however, this pattern is not reflected in the leadership of health systems where women are under-represented. Methods: This systematized review explored the existing literature around women’s progress towards leadership in the health sector in low- and middle-income countries (LMICs) which has used intersectional analysis. Results: While there are studies that have looked at the inequities and barriers women face in progressing towards leadership positions in health systems within LMICs, none explicitly used an intersectionality framework in their approach. These studies did nevertheless show recurring barriers to health systems leadership created at the intersection of gender and social identities such as professional cadre, race/ethnicity, financial status, and culture. These barriers limit women’s access to resources that improve career development, including mentorship and sponsorship opportunities, reduce value, recognition and respect at work for women, and increase the likelihood of women to take on dual burdens of professional work and childcare and domestic work, and, create biased views about effectiveness of men and women’s leadership styles. An intersectional lens helps to better understand how gender intersects with other social identities which results in upholding these persisting barriers to career progression and leadership. Conclusion: As efforts to reduce gender inequity in health systems are gaining momentum, it is important to look beyond gender and take into account other intersecting social identities that create unique positionalities of privilege and/or disadvantage. This approach should be adopted across a diverse range of health systems programs and policies in an effort to strengthen gender equity in health and specifically human resources for health (HRH), and improve health system governance, functioning and outcomes.

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Reinforcement and Maintenance of Human Resources for Health Systems during Long-Term Crises: A Systematic Review of Systematic Reviews

Emergency Medicine International ◽

10.1155/2021/9613443 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Amir Mohammad Salehi ◽

Salman Khazaei ◽

Motahareh Masumi ◽

Farnaz Shavandi ◽

Mostafa Kavand ◽

...

Keyword(s):

Human Resources ◽

Health System ◽

Health Systems ◽

Systematic Reviews ◽

Human Resources For Health ◽

Critical Factor ◽

Three Dimensions ◽

Hygiene Measures ◽

Wide Range

Background. Human resources are one of the most critical organizational resources, the reinforcement and maintenance of whom require much energy in health organizations, particularly in long-term crises. Many methods have been suggested in this regard; however, there is a need for their integration and clarification. Methods. We systematically searched the international databases, including PubMed, Scopus, and Web of Science, from 2003 to April 2021by using some relevant keywords. The quality of the included studies was assessed using the AMSTAR checklist. Results. The search resulted in 1613 papers, among which there were 16 systematic reviews. The studies addressed a wide range of problems and solutions. Twelve items and four items were classified with moderate quality (AMSTER score 5–8) and high quality (AMSTER score 9–11), respectively. Half of the studies (n = 8) dealt with mental and psychological problems resulting from crises as the most important factor in the decline of health system staff’s durability in organizations. They also provided different solutions such as mental health counselling during and after the crisis, flexible work schedule, promoted trust in the organization, support of staff’s family, and enhanced awareness to support employees. And the other articles addressed managerial problems as the most critical factor in the decline of health system staff’s durability in organizations and proposed solutions such as suitable planning before, during, and after the crisis and the use of material and spiritual incentives to increase the employees’ motivation and organizational resilience to maintain the staff. Conclusion. In the present review study, three dimensions (namely, resilience, motivation-hygiene measures, and development of manager’s soft skills) are considered as the main factors reinforcing and maintaining human resources in the health systems in long-term crises and disasters.

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Health system gaps in cardiovascular disease prevention and management in Nepal

BMC Health Services Research ◽

10.1186/s12913-021-06681-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Archana Shrestha ◽

Rashmi Maharjan ◽

Biraj Man Karmacharya ◽

Swornim Bajracharya ◽

Niharika Jha ◽

...

Keyword(s):

Human Resources ◽

Health System ◽

Health Systems ◽

National Health ◽

Task Force ◽

Health Spending ◽

Building Blocks ◽

Critical System ◽

Government Organizations ◽

The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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Cross-national comparisons of human resources for health – what can we learn?

Health Economics Policy and Law ◽

10.1017/s1744133105001027 ◽

2005 ◽

Vol 1 (1) ◽

pp. 59-78 ◽

Cited By ~ 12

Author(s):

CARL-ARDY DUBOIS ◽

MARTIN MCKEE

Keyword(s):

Human Resources ◽

Comparative Studies ◽

Human Resources For Health ◽

Health Sector ◽

International Health ◽

Comparative Approach ◽

Generative Capacity ◽

International Comparative ◽

Context Specific ◽

Cross National

After a long period of neglect, the issue of human resources for health (HRH) has recently emerged as a core component on the international health agenda, with policy makers increasingly eager to learn from experience elsewhere. This article investigates systematically the opportunities and challenges associated with the use of cross-national comparisons of HRH policies and practices. It reviews the evidence in favour of using international comparative studies on HRH, discusses emerging opportunities for developing a cross-national research agenda to guide HRH policies in Europe, and highlights obstacles which may hinder the implementation of comparative studies on HRH. While demonstrating many opportunities offered by the comparative approach to improve understanding of human resources processes in the health sector, this article also emphasizes the dangers of simplistic pleas for the transfer of human resource policies without taking into account the context-specific factors and the generative capacity of the social actors in the design and implementation of policy changes.

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