Browsing by Author "Chuma, Jane"
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- ItemOpen AccessDoes the distribution of health care benefits in Kenya meet the principles of universal coverage?(BioMed Central Ltd, 2012) Chuma, Jane; Maina, Thomas; Ataguba, JohnBACKGROUND:The 58th World Health Assembly called for all health systems to move towards universal coverage where everyone has access to key promotive, preventive, curative and rehabilitative health interventions at an affordable cost. Universal coverage involves ensuring that health care benefits are distributed on the basis of need for care and not on ability to pay. The distribution of health care benefits is therefore an important policy question, which health systems should address. The aim of this study is to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage. METHODS: Two nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system is conducted including the public sector, private-not-for-profit and private-for-profit sectors. Standard benefit incidence analysis techniques were applied and adopted to allow application to private sector services. RESULTS: The three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care. CONCLUSIONS: The principles of universal coverage require that all should benefit from health care according to need. The Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need. Deliberate efforts should be directed to restructuring the Kenyan health system to address access barriers and ensure that all Kenyans benefit from health care when they need it.
- ItemOpen AccessExtending coverage to informal sector populations in Kenya: design preferences and implications for financing policy(BioMed Central, 2018-01-09) Okungu, Vincent; Chuma, Jane; Mulupi, Stephen; McIntyre, DianeBackground: Universal health coverage (UHC) is important in terms of improving access to quality health care while protecting households from the risk of catastrophic health spending and impoverishment. However, progress to UHC has been hampered by the measures to increase mandatory prepaid funds especially in low- and middleincome countries where there are large populations in the informal sector. Important considerations in expanding coverage to the informal sector should include an exploration of the type of prepayment system that is acceptable to the informal sector and the features of such a design that would encourage prepayment for health care among this population group. The objective of the study was to document the views of informal sector workers regarding different prepayment mechanisms, and critically analyze key design features of a future health system and the policy implications of financing UHC in Kenya. Methods: This was part of larger study which involved a mixed-methods approach. The following tools were used to collect data from informal sector workers: focus group discussions [N = 16 (rural = 7; urban = 9)], individual in-depth interviews [N = 26 (rural = 14; urban = 12)] and a questionnaire survey [N = 455(rural = 129; urban = 326)]. Thematic approach was used to analyze qualitative data while Stata v.11 involving mainly descriptive analysis was used in quantitative data. The tools mentioned were used to collect data to meet various objectives of a larger study and what is presented here constitutes a small section of the data generated by these tools. Results: The findings show that informal sector workers in rural and urban areas prefer different prepayment systems for financing UHC. Preference for a non-contributory system of financing UHC was particularly strong in the urban study site (58%). Over 70% in the rural area preferred a contributory mechanism in financing UHC. The main concern for informal sector workers regardless of the overall design of the financing approach to UHC included a poor governance culture especially one that does not punish corruption. Other reasons especially with regard to the contributory financing approach included high premium costs and inability to enforce contributions from informal sector. Conclusion: On average 47% of all study participants, the largest single majority, are in favor of a noncontributory financing mechanism. Strong evidence from existing literature indicates difficulties in implementing social contributions as the primary financing mechanism for UHC in contexts with large informal sector populations. Noncontributory financing should be strongly recommended to policymakers to be the primary financing mechanism and supplemented by social contributions.
- ItemOpen AccessThe impact of malaria among the poor and vulnerable : the role of livelihoods and coping strategies in rural Kenya(2005) Chuma, Jane; Thiede, MichaelThe thesis set out to explore how households cope with the costs of malaria and the implications of malaria cost burdens for household livelihoods and vulnerability. It uses a conceptual framework that takes a holistic approach to understand vulnerability and the link between malaria and livelihood change. In order to investigate these issues, the study was designed to meet five main objectives: to improve the understanding on the economic burden of malaria; to identify factors that make households vulnerable to the costs of malaria; to identify and explore coping strategies; to understand the role of health care providers in aggravating cost burdens and; to inform policy debates on how to improve access to effective malaria treatment and protect households from high illness costs.
- ItemOpen AccessResource allocation in the Kenyan health sector : a question of equity(2001) Chuma, Jane; McIntyre, DiThis study examined the current resource allocation decision-making processes, and the distribution of both financial and non-financial resources in the health sector. The study explored how the current resource allocation process has impacted on equity between provinces (equity being defined as equal resources for equal need). It went further to look at possible alternatives that could lead the Kenyan health sector towards geographical equity. The study focused on the public health sector because it is the largest provider of health care services in Kenya. The basic argument underlying the study was that, raising additional funds for health care (e.g. through user fees) might not lead to equity, if the additional resources were to be allocated within the current resource allocation process. Instead, the study argues that the first step towards equity in health care in Kenya is to distribute the current resources in a more equitable manner. This can only be done through the development and implementation of a better resource allocation process.
- ItemOpen AccessRethinking the economic costs of malaria at the household level: Evidence from applying a new analytical framework in rural Kenya(BioMed Central Ltd, 2006) Chuma, Jane; Thiede, Michael; Molyneux, CatherineBACKGROUND:Malaria imposes significant costs on households and the poor are disproportionately affected. However, cost data are often from quantitative surveys with a fixed recall period. They do not capture costs that unfold slowly over time, or seasonal variations. Few studies investigate the different pathways through which malaria contributes towards poverty. In this paper, a framework indicating the complex links between malaria, poverty and vulnerability at the household level is developed and applied using data from rural Kenya. METHODS: Cross-sectional surveys in a wet and dry season provide data on treatment-seeking, cost-burdens and coping strategies (n = 294 and n = 285 households respectively). 15 case study households purposively selected from the survey and followed for one year provide in-depth qualitative information on the links between malaria, vulnerability and poverty. RESULTS: Mean direct cost burdens were 7.1% and 5.9% of total household expenditure in the wet and dry seasons respectively. Case study data revealed no clear relationship between cost burdens and vulnerability status at the end of the year. Most important was household vulnerability status at the outset. Households reporting major malaria episodes and other shocks prior to the study descended further into poverty over the year. Wealthier households were better able to cope. CONCLUSION: The impacts of malaria on household economic status unfold slowly over time. Coping strategies adopted can have negative implications, influencing household ability to withstand malaria and other contingencies in future. To protect the poor and vulnerable, malaria control policies need to be integrated into development and poverty reduction programmes.
- ItemOpen AccessThe cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms(BioMed Central, 2017-02-27) Okungu, Vincent; Chuma, Jane; McIntyre, DiBackground: The need to provide quality and equitable health services and protect populations from impoverishing health care costs has pushed universal health coverage (UHC) to the top of global health policy agenda. In many developing countries where the majority of the population works in the informal sector, there are critical debates over the best financing mechanisms to progress towards UHC. In Kenya, government health policy has prioritized contributory financing strategy (social health insurance) as the main financing mechanism for UHC. However, there are currently no studies that have assessed the cost of either social health insurance (SHI) as the contributory approach or an alternative financing mechanism involving non-contributory (general tax funding) approaches to UHC in Kenya. The aim of this study was to critically assess the financial requirements of both contributory and non-contributory mechanisms to financing UHC in Kenya in the context of large informal sector populations. Methods: SimIns Basic® model, Version 2.1, 2008 (WHO/GTZ), was used to assess the feasibility of UHC in Kenya and provide estimates of financial resource needs for UHC over a 17-year period (2013–2030). Data sources included review of national and international literature on inflation, demography, macro-economy, health insurance, health services unit costs and utilization rates. The data were triangulated across geographic regions for accuracy and integrity of the simulation. SimIns models for 10 years only so data from the final year of the model was used to project for another 7 years. The 17-year period was necessary because the Government of Kenya aims to achieve UHC by 2030. Results and conclusions: The results show that SHI is financially sustainable (Sustainability in this study is used to mean that expenditure does not outstrip revenue.) (revenues and expenditure match) within the first five years of implementation, but it becomes less sustainable with time. Modelling for a non-contributory scenario, on the other hand, showed greater sustainability both in the short- and long-term. The financial resource requirements for universal access to health care through general government revenue are compared with a contributory health insurance scheme approach. Although both funding options would require considerable government subsidies, given the magnitude of the informal sector in Kenya and their limited financial capacity, a tax-funded system would be less costly and more sustainable in the long-term than an insurance scheme approach. However, more innovative financing for health care as well as giving the health sector higher priority in government expenditure will be required to make the non-contributory financing mechanism more sustainable.
- ItemOpen AccessTowards universal health coverage: Exploring healthcare-related financial risk protection for the informal sector in Kenya(2015) Okungu, Vincent Okongo; McIntyre, Di; Chuma, JaneThere is a global emphasis to move towards universal health coverage (UHC) with the goal of making health services more equitable and accessible for all, without the risk of financial catastrophe when paying for the services. A key element of UHC reforms is to move away from out-of-pocket payments for health services towards a greater emphasis on mandatory prepayment health financing. The main challenge for low- and middle-income countries is how to extend coverage for informal sector populations, which in most cases are disproportionately exposed to catastrophic and impoverishing healthcare costs. This study explored the nature of the informal sector in Kenya, the experience of members of the informal sector with the health system, their views on different prepayment mechanisms for health services and compares the resource requirements for UHC through a system that requires contributions from the informal sector and a system that is non-contributory.