Journal article
A critical analysis of health care purchasing arrangements in Kenya: A case study of the county departments of health
- Abstract:
- BACKGROUND:Purchasing in health care financing refers to the transfer of pooled funds to health care providers for the provision of health care services. There is limited empirical work on purchasing arrangements and what is required for strategic purchasing in low- and middle-income countries. We conducted this study to critically assess the purchasing arrangements of the county departments of health (CDOH) who are the largest purchasers of health care in Kenya. METHODS:We used a qualitative case study approach to assess the extent to which the purchasing actions of the CDOH in Kenya were strategic. We purposively sampled 10 counties and collected data using in-depth interviews (n = 81), focus group discussions (n = 4), and documents review. We analyzed data using a framework approach. RESULTS:County departments of health did not practice strategic purchasing. The government's (national and county) role as a steward for the purchasing function was characterized by poor accountability and inadequate budgetary allocations for service delivery. The absence of a purchaser-provider split between the CDOH and public health care providers undermined provider selection based on performance and quality. Poor public participation and ineffective complaints and feedback mechanisms limited public accountability and responsiveness to the needs of the people. CONCLUSION:Our findings show that while there are frameworks that could promote strategic purchasing of the CDOH, strategic purchasing is impaired by poor implementation of these frameworks and the inherent weaknesses of a public integrated purchasing system that lacks purchaser-provider split.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 565.0KB, Terms of use)
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- Publisher copy:
- 10.1002/hpm.2604
Authors
- Publisher:
- Wiley
- Journal:
- International Journal of Health Planning and Management More from this journal
- Volume:
- 33
- Issue:
- 4
- Pages:
- 1159-1177
- Place of publication:
- England
- Publication date:
- 2018-08-03
- Acceptance date:
- 2018-07-05
- DOI:
- EISSN:
-
1099-1751
- ISSN:
-
0749-6753
- Pmid:
-
30074642
- Language:
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English
- Keywords:
- Pubs id:
-
908779
- Local pid:
-
pubs:908779
- Deposit date:
-
2020-11-18
- ARK identifier:
Terms of use
- Copyright holder:
- Mbau et al.
- Copyright date:
- 2018
- Rights statement:
- © 2018 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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