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.

TMPRSS2 As an Influential Human Gene for COVID-19

: In December 2019, the new virus, COVID-19, emerged and led to a pandemic respiratory acute disease. Almost all countries have experienced different rates of morbidity and mortality. These differences can be attributed to factors such as a diagnostic test capacity for COVID-19 and the health system efficiency. Besides the differences between countries related to the COVID-19 management, different patients represent a diverse range of clinical symptoms, from outpatient to patients admitted to the intensive care unit (ICU) due to the severity of symptoms. To gain deeper insights into such disparities in the severity of COVID-19 clinical presentations, epidemiological studies have reported risk factors such as old age, male sex, underlying chronic diseases such as diabetes, inflammatory and cardiovascular diseases, which have a bearing on susceptibility to COVID-19. In addition to these risk factors, the molecular mechanism involved in the virus entry process has been under investigation. Apart from a well-known protein called ACE2 (angiotensin-converting enzyme 2), which plays the receptor role for COVID-19, another essential protein in this pathway is TMPRSS2 (transmembrane protease, serine 2). This protease has a crucial role in effective membrane integration between the virus and the target cell. This process can affect the severity of the infection and the mortality rate of the disease. Thus, it seems that understanding the role of TMPRSS2 in COVID-19 infection can help better management by designing TMPRSS2 inhibitors drugs. Given the variants of the TMPRSS2 gene, which are associated with the severity of symptoms, people exposed to severe forms of this disease can be identified before the deterioration of the disease to adopt appropriate therapeutic approaches. Therefore, this study focused on the different levels of the TMPRSS2 interactions with COVID-19 virus and disease severity.

Mobile devices and wearable technology for measuring patient outcomes after surgery: a systematic review

Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of high-quality evidence is often cited as a barrier to DHI implementation. This review captures and appraises the current use, evidence base and reporting quality of mobile and wearable DHI following surgery. Keyword searches were performed within Embase, Cochrane Library, Web of Science and WHO Global Index Medicus databases, together with clinical trial registries and Google scholar. Studies involving patients undergoing any surgery requiring skin incision where postoperative outcomes were measured using a DHI following hospital discharge were included, with DHI defined as mobile and wireless technologies for health to improve health system efficiency and health outcomes. Methodological reporting quality was determined using the validated mobile health evidence reporting and assessment (mERA) guidelines. Bias was assessed using the Cochrane Collaboration tool for randomised studies or MINORS depending on study type. Overall, 6969 articles were screened, with 44 articles included. The majority (n = 34) described small prospective study designs, with a high risk of bias demonstrated. Reporting standards were suboptimal across all domains, particularly in relation to data security, prior patient engagement and cost analysis. Despite the potential of DHI to improve postoperative patient care, current progress is severely restricted by limitations in methodological reporting. There is an urgent need to improve reporting for DHI following surgery to identify patient benefit, promote reproducibility and encourage sustainability.

Health system efficiency and democracy: A public choice perspective

Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the role of the political regime has been neglected. In addition, there is a lack of formal theoretical work on this specific topic, which ensures transparency and logical consistency of arguments and implications. Using a public choice approach, this paper provides a rigorous theoretical and empirical investigation of the relationships between health system efficiency and political institutions. We develop a simple principal-agent model describing the behavior of a government with respect to investments in population health under different political regimes. The main implication of the theoretical model is that governments under more democratic regimes put more effort in reducing embezzlement of health expenditure than non-democratic regimes. Accordingly, democratic countries are predicted to have more efficient health systems than non-democratic countries. We test this hypothesis based on a broad dataset including 158 countries over the period 1995-2015. The empirical results clearly support the implications of the theoretical model and withstand several robustness checks, including the use of alternative indicators for population health and democracy and estimations accounting for endogeneity. The empirical results also indicate that the effect of democracy on health system efficiency is more pronounced in countries with higher income levels. From a policy perspective, we discuss the implications of our findings in the context of health development assistance.

Access of older people to primary healthcare services in low- and middle-income countries: a systematic scoping review protocol

Background: People across the world are living longer. This advantageous trend is escorted by an increased prevalence of chronic diseases, making healthcare needs more complex. Non-communicable diseases induce a sharply rising economic and societal cost, particularly in low- and middle-income countries (LMIC), where most older people reside. In this context, the access of older people to primary health care (PHC) is vital because it brings solutions to the aforementioned issues. Furthermore, evidence strongly suggests that this approach to health ensures universal health coverage and enables health systems to adapt to rapid economic, technologic, and demographic changes. PHC improves health outcomes, health system efficiency, and health equity. Given their distinctive needs, older people face financial, geographical, social, cultural, structural, and organisational barriers, affecting their equitable access to PHC services. Therefore, many interventions have been implemented to maximise their access to PHC. This paper outlines the protocol for a scoping review that addresses the central question: What is the scope and nature of available evidence on older peoples’ access to PHC in LMICs? This includes the experience of older people having access to PHC, enabling and hindering access, outcomes of the lack of access, interventions implemented to improve access, and related theoretical frameworks. Methods: This scoping review will follow the theoretical framework proposed by Arksey and O’Malley. The five databases that will be searched are CINAHL, PubMed, LILACS, Embase, and Cochrane Libraries. Studies will be selected according to a set of inclusion/exclusion criteria. Data will then be mapped, extracted, and presented graphically along with a narrative report. Conclusions: The scoping review is a first step to synthesise and disseminate the literature on older people’s access to PHC. This will provide information for researchers to reorient their studies, and intel for decision-makers, enabling them to enact policies that meet older people’s needs.

A cross-sectional study on the pursuit of happiness among healthcare workers in the context of health systems strengthening: The case of Meru County, Kenya.

Background: Happiness is one of the ultimate goals of every human being. Happiness is a significant factor of health system efficiency. Healthcare workers are at the core of every health system. However, up-to-date literature on happiness among healthcare workers is limited. The purpose of this study is to investigate the factors influencing the self-assessed happiness among healthcare workers in public and mission hospitals, Meru County, Kenya. Methods: Using a cross-sectional design, a total of 553 healthcare workers in 24 hospitals completed the Orientations to Happiness questionnaire between June and July 2020. Results: Healthcare workers’ overall happiness was significantly different between hospitals of public and mission ownership (p<0.05). The orientations to happiness mean scores of both pursuits of pleasure and meaning were significantly different between public and mission hospitals (p<0.05). However, there were no statistically significant differences in the pursuit of engagement among the healthcare workers between public and mission hospitals (p<0.05). Conclusion: Our results may have policy and practical implications related to healthcare workers’ happiness policies and programs in future, aimed at health workforce strengthening. Future studies should replicate this study across the remaining 46 counties in Kenya.

Evaluating Health System Efficiency using Data Envelopment Analysis: A case of Indian Healthcare System

Purpose-With increased demand and restricted healthcare resources, it becomes important to take a step back and evaluate the efficiency of healthcare delivery. The present study aims to evaluate the health system efficiency of India by benchmarking it against its peers in BRICS countries and against OECD countries. Design/Methodology/Approach: The input and output variables required for measuring the efficiency of healthcare system were identified. A Data Envelopment Analysis (DEA) approach was used and efficiency frontier identified with the rankings of the BRICS and OECD countries. India is thus benchmarked against its peers (BRICS) and against OECD countries. Finding: India was found to operate at the efficiency frontier along with China, Russia, Brazil, and South Africa, however it ranked fourth. When benchmarked against OECD countries, India operates on the efficiency frontier along with Canada, Greece, Japan, Korea, Mexico, Spain, Sweden, Switzerland, Turkey, Great Britain, Chile and Israel. Countries like Germany, United States of America, Czech Republic, Slovakia and Lithuania operate at a lower healthcare efficiency and need to use their resources wisely. Practical/Research Implications: Developing countries like India can look to improve its healthcare system delivery by replicating best practices of healthcare systems from its peers and the top 10 OECD countries. Majority of the OECD countries in the top 10 have implemented universal health coverage, have higher physician and nurse density and higher hospital bed ratios. They are inclined towards branded drugs vis-à-vis generics and have follow evidence based medicine. From a theoretical perspective, it adds to the body of literature of DEA and health system efficiency. Originality/Value: This is a pioneer study that benchmarks India against its peers and against OECD countries drawing unique insights about healthcare efficiency