DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20194171

Citizen engagement in social health insurance purchasing, in selected counties in Kenya

Eunice M. Mwangi, Wanja M. Tenambergen, Job O. Mapesa, Isaac K. Mutai

Abstract


Background: National hospital insurance fund (NHIF) uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study sought information on citizen knowledge of PCHS benefit package, NHIF communication to citizens, determination of citizen views and values, NHIF accountability to citizens, citizen choice of PCHS provider and how these factors influence citizen access to NHIF, PCHS.

Methods: This was a cross sectional research conducted between March 2017 to March 2018. 426 patients were sampled from Nyandarua and Nakuru Counties.

Results: 366 (93%) patients knew the PCHS benefit package, 226 (57%) said NHIF communication to them was adequate, 280 (71%) said NHIF does not take into account their view and values, 272 (69%) said NHIF is not accountable to them, 269 (68%) knew how to select an outpatient facility, 111 (28%) said they did not receive NHIF, PCHS. Multivariate logistics regression analysis of citizen engagement factors and access to PCHS, indicate that NHIF communication to citizens (p<0.05, OR=2.358, 95% CI [1.399-3.975]), purchaser accountability (p<0.05, OR=2.073, 95% CI [1.017-4.226]) and provider choice (p<0.05, OR=2.990, 95% CI [1.817-4.920]) added significantly to the regression model.

Conclusions: There is inadequate engagement of citizens in NHIF decision making which may hinder access to NHIF PCHS, therefore NHIF should establish citizens’ needs and preference through public forums, elicit citizens’ feedback, act on complains when raised, inform citizens on how the capitation system works and NHIF should visit health facilities regularly to establish if patients are accessing PCHS.


Keywords


Universal health coverage, Social insurance, Primary care health services, National scheme, Citizens, Kenya

Full Text:

PDF

References


Gorji HA, Mousavi SMSP, Shojaei A, Keshavarzi A, Zare H. The challenges of strategic purchasing of healthcare services in Iran Health Insurance Organization: a qualitative study. Electron Physician. 2008;10(2):6299-306.

Munge K, Mulupi S, Barasa EW, Chuma J. A Critical Analysis of Purchasing Arrangements in Kenya: The Case of the National Hospital Insurance Fund. Int J Health Policy Manag. 2017;7(3):244-54.

World Health Organization. In: Etienne C, Asamoa-Baah A, Evans DB, eds. The World health report: health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010.

Figueras J, Robinson R, Jakubowski E, eds. Purchasing to improve health systems performance. Maidenhead: Open University Press; 2005.

Resilient and Responsive Health Systems, 2014. What is Strategic Purchasing? RESYST and Asia-Pacific Observatory on Health Systems and Policies. Available at: http://resyst.lshtm.ac.uk/sites/resyst .lshtm.ac.Uk/files/docs/reseources/Purchasing%20 brief.pdf. Accessed on 18 November 2016.

Government of Kenya, and Kenya National Beureau of Statistics, 2012. 2009 Kenya Population and Housing Census;Analytical Report on Urbanization (“Counting Our People for Implementation of Vision 2030”. Available at: https://www.google.com/search?q=Urbanisation+ by+County+in+Central+Kenya&ie=utf-8&oe=utf-8&client=firefox-b. Accessed on 18 November 2016.

Mbau R, Barasa E, Munge K, Mulupi S, Nguhiu PK, Chuma J. A critical analysis of health care purchasing arrangements in Kenya: A case study of the county departments of health. International J Health Planning Management. 2018;33(4):1159–77.

Gathu B, Mwangi ME, Oluoch M, 2016. Factors influencing uptake of social health insurance in Kenya: a case of Nyeri County. Research Gate. Available at: https://www.researchgate.net/publica tion/330542225_Factors _Influencing_Uptake_Of_Social_Health_Insurance_In_Kenya_A_Case_Of_Nyeri_County. Accessed on 18 November 2016.

Busse R, Figueras J, Robinson R, Jakubowski E. Strategic purchasing to improve health system performance: Key Issues And International Trends. Healthcare Papers. 2007;8:62-76.

Sieverding M, Onyango C, Suchman L. Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya. Plos One. 2018;13(2):e0192973.

Carrin G, Chris J. Reaching universal coverage via social health insurance: key design features in the transition period. Geneva: Eldis, World Health Organization. 2004; 54.

Joint Learning Network for UHC, Universal Health Coverage, Health Finance and Governance, and Project, Abt Associates, Results for Development. Strategic Communication for Universal Health Coverage: Practical Guide; 2018.

Honda A, McIntyre D, Hanson K, Tangcharoensathien V, eds. Strategic Purchasing in China, Indonesia and the Philippines. Comparative Countries Studies; 2016:2(1).

Obadha M, Chuma J, Kazungu J, Barasa E. Health care purchasing in Kenya: Experiences of health care providers with capitation and fee-for-service provider payment mechanisms. Int J Health Planning Manag. 2019;34(1):917-33.

National Hospital Insurance Fund, 2015. NHIF: Afya Yetu. Bima Yetu. Available at: http://www.nhif.or.ke/healthinsurance/. Accessed on 18 November 2016.