Understanding the performance of county health service delivery in Kenya: a mixed-method analysis.

To better understand the wide variation of performance among county health systems in Kenya, this study investigated their performance determinants. We selected five counties with varied performance and examined their performance across five domains containing 10 thematic areas. We conducted a stakeholder analysis, consisting of focus group discussions and key informant interviews, and administered a quantitative survey to quantify the magnitude of inefficiency. The study found that a shortage of funding was one of the most common complaints from counties, leading to inefficiency in the health system. Another major reason for inefficiencies was the delay in disbursing funding to health facilities, which affected the procurement of medical supplies and commodities essential for delivering healthcare to the population. In addition, lack of autonomy in procuring commodities and equipment was repeatedly mentioned as a barrier to delivering quality health services. Other reported common concerns contributing to the performance of county health systems were the lack of lab tests and equipment, low willingness to join health insurance, rigid procurement policies and lengthy procurement process, lack of motivation and incentives for service delivery, and poor economic status. Despite the common concerns among the five counties, they differed in some schematic areas, such as the county's commitment to health and community mobilization. In summary, this study suggests various factors that determine county health system performance. Given the multifaceted nature of inefficiency drivers, it is necessary to adopt a holistic approach to address the causes of inefficiencies and improve the county health systems.

Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis.

INTRODUCTION: A well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system is critical to progress towards UHC. We aimed to measure and compare the performance of Kenya's public healthcare system at the county level and explore remediable drivers of poor healthcare system performance. METHODS: Using administrative data from fiscal year 2014/2015 through fiscal year 2017/2018, we measured the technical efficiency of 47 county-level public healthcare systems in Kenya using stochastic frontier analysis. We then regressed the technical efficiency measure against a set of explanatory variables to examine drivers of efficiency. Additionally, in selected counties, we analysed surveys and focus group discussions to qualitatively understand factors affecting performance. RESULTS: The median technical efficiency of county public healthcare systems was 84% in fiscal year 2017/2018 (with an IQR of 79% to 90%). Across the four fiscal years of data, 27 out of the 47 Kenyan counties had a declining technical efficiency score. Our regression analysis indicated that impediments to the flow of funding-measured by the budget absorption rate which is the ratio between funds spent and funds released-were significantly related to poor healthcare system performance. Our analysis of interviews and surveys yielded a similar conclusion as nearly 50% of respondents indicated issues stemming from poor budget absorption were significant drivers of poor healthcare system performance. CONCLUSION: Public healthcare systems at the county-level in Kenya general performed well; however, addressing delays in the flow of funding is a concrete step to improve healthcare system performance. As Kenya-and other countries-provides additional funding to meet their UHC goals, establishing a strong and robust public financial management system is critical to ensure that the benefits of UHC are realised.

Exploring Factors Associated with Self-Management Compliance among Rural Elders with Diabetes.

The purpose of the study was to examine the social-ecological factors associated with diabetic self-management compliance among elders with diabetes in China. A total of 2,586 rural elderly residents who were 60-years-old or above participated in the survey. Socio-demographic factors, social support, healthcare accessibility and health risk factors were measured, along with self-reported medication and blood glucose monitoring data. Among the 117 individuals with diabetes, the medication compliance rate was 79.49%. The elderly who had high economic status were more likely to meet medication treatment compliance. Only 58.97% of study participants monitored blood glucose once a month. Younger age (<70-year-old), higher economic status, more social support and better healthcare accessibility were associated with higher blood glucose monitoring compliance odds. Diabetic medication and blood glucose testing tools should be more comprehensively covered by the national insurance program. Healthcare accessibility should be increased through transportation support, building more local facilities, such as mobile labs, and promoting affordable home-visit care. Self-management education programs about diabetes for rural elders should be promoted.

Exploring the Risk Factors for Depressive Symptoms Among Chinese Rural Older Adults.

The purpose of the current study was to examine risk factors for depressive symptoms among older adults in rural China. Data were derived from the National Health Services Survey in China. A total of 2,586 rural adults age ≥60 were included in the study. Sociodemographic factors, health risk factors, and behavioral factors were measured, along with self-rated depressive symptoms. Older age (>70 years), lower education level, and living without a partner were associated with depressive symptoms. After adjusting for socioeconomic status and social support, individuals who had at least one chronic disease, experienced pain, and were unable to take care of themselves or perform household chores were more likely to report depressive symptoms (all p < 0.001). Community health care and nursing services should focus on pain control, improvement of daily physical function, and social support for older adults in rural China. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 41-47.].