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The impact of COVID-19 on health financing in Kenya

Sudden shocks to health systems, such as the COVID-19 pandemic may disrupt health system functions. Health system functions may also influence the health system’s ability to deliver in the face of sudden shocks such as the COVID-19 pandemic. We examined the impact of COVID-19 on the health financing...

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Autores principales: Kairu, Angela, Orangi, Stacey, Mbuthia, Boniface, Arwah, Brian, Guleid, Fatuma, Keru, Janet, Vilcu, Ileana, Musuva, Anne, Ravishankar, Nirmala, Barasa, Edwine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610457/
https://www.ncbi.nlm.nih.gov/pubmed/37889878
http://dx.doi.org/10.1371/journal.pgph.0001852
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author Kairu, Angela
Orangi, Stacey
Mbuthia, Boniface
Arwah, Brian
Guleid, Fatuma
Keru, Janet
Vilcu, Ileana
Musuva, Anne
Ravishankar, Nirmala
Barasa, Edwine
author_facet Kairu, Angela
Orangi, Stacey
Mbuthia, Boniface
Arwah, Brian
Guleid, Fatuma
Keru, Janet
Vilcu, Ileana
Musuva, Anne
Ravishankar, Nirmala
Barasa, Edwine
author_sort Kairu, Angela
collection PubMed
description Sudden shocks to health systems, such as the COVID-19 pandemic may disrupt health system functions. Health system functions may also influence the health system’s ability to deliver in the face of sudden shocks such as the COVID-19 pandemic. We examined the impact of COVID-19 on the health financing function in Kenya, and how specific health financing arrangements influenced the health systems capacity to deliver services during the COVID-19 pandemic.We conducted a cross-sectional study in three purposively selected counties in Kenya using a qualitative approach. We collected data using in-depth interviews (n = 56) and relevant document reviews. We interviewed national level health financing stakeholders, county department of health managers, health facility managers and COVID-19 healthcare workers. We analysed data using a framework approach. Purchasing arrangements: COVID-19 services were partially subsidized by the national government, exposing individuals to out-of-pocket costs given the high costs of these services. The National Health Insurance Fund (NHIF) adapted its enhanced scheme’s benefit package targeting formal sector groups to include COVID-19 services but did not make any adaptations to its general scheme targeting the less well-off in society. This had potential equity implications. Public Finance Management (PFM) systems: Nationally, PFM processes were adaptable and partly flexible allowing shorter timelines for budget and procurement processes. At county level, PFM systems were partially flexible with some resource reallocation but maintained centralized purchasing arrangements. The flow of funds to counties and health facilities was delayed and the procurement processes were lengthy. Reproductive and child health services: Domestic and donor funds were reallocated towards the pandemic response resulting in postponement of program activities and affected family planning service delivery. Universal Health Coverage (UHC) plans: Prioritization of UHC related activities was negatively impacted due the shift of focus to the pandemic response. Contrarily the strategic investments in the health sector were found to be a beneficial approach in strengthening the health system. Strengthening health systems to improve their resilience to cope with public health emergencies requires substantial investment of financial and non-financial resources. Health financing arrangements are integral in determining the extent of adaptability, flexibility, and responsiveness of health system to COVID-19 and future pandemics.
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spelling pubmed-106104572023-10-28 The impact of COVID-19 on health financing in Kenya Kairu, Angela Orangi, Stacey Mbuthia, Boniface Arwah, Brian Guleid, Fatuma Keru, Janet Vilcu, Ileana Musuva, Anne Ravishankar, Nirmala Barasa, Edwine PLOS Glob Public Health Research Article Sudden shocks to health systems, such as the COVID-19 pandemic may disrupt health system functions. Health system functions may also influence the health system’s ability to deliver in the face of sudden shocks such as the COVID-19 pandemic. We examined the impact of COVID-19 on the health financing function in Kenya, and how specific health financing arrangements influenced the health systems capacity to deliver services during the COVID-19 pandemic.We conducted a cross-sectional study in three purposively selected counties in Kenya using a qualitative approach. We collected data using in-depth interviews (n = 56) and relevant document reviews. We interviewed national level health financing stakeholders, county department of health managers, health facility managers and COVID-19 healthcare workers. We analysed data using a framework approach. Purchasing arrangements: COVID-19 services were partially subsidized by the national government, exposing individuals to out-of-pocket costs given the high costs of these services. The National Health Insurance Fund (NHIF) adapted its enhanced scheme’s benefit package targeting formal sector groups to include COVID-19 services but did not make any adaptations to its general scheme targeting the less well-off in society. This had potential equity implications. Public Finance Management (PFM) systems: Nationally, PFM processes were adaptable and partly flexible allowing shorter timelines for budget and procurement processes. At county level, PFM systems were partially flexible with some resource reallocation but maintained centralized purchasing arrangements. The flow of funds to counties and health facilities was delayed and the procurement processes were lengthy. Reproductive and child health services: Domestic and donor funds were reallocated towards the pandemic response resulting in postponement of program activities and affected family planning service delivery. Universal Health Coverage (UHC) plans: Prioritization of UHC related activities was negatively impacted due the shift of focus to the pandemic response. Contrarily the strategic investments in the health sector were found to be a beneficial approach in strengthening the health system. Strengthening health systems to improve their resilience to cope with public health emergencies requires substantial investment of financial and non-financial resources. Health financing arrangements are integral in determining the extent of adaptability, flexibility, and responsiveness of health system to COVID-19 and future pandemics. Public Library of Science 2023-10-27 /pmc/articles/PMC10610457/ /pubmed/37889878 http://dx.doi.org/10.1371/journal.pgph.0001852 Text en © 2023 Kairu et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kairu, Angela
Orangi, Stacey
Mbuthia, Boniface
Arwah, Brian
Guleid, Fatuma
Keru, Janet
Vilcu, Ileana
Musuva, Anne
Ravishankar, Nirmala
Barasa, Edwine
The impact of COVID-19 on health financing in Kenya
title The impact of COVID-19 on health financing in Kenya
title_full The impact of COVID-19 on health financing in Kenya
title_fullStr The impact of COVID-19 on health financing in Kenya
title_full_unstemmed The impact of COVID-19 on health financing in Kenya
title_short The impact of COVID-19 on health financing in Kenya
title_sort impact of covid-19 on health financing in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610457/
https://www.ncbi.nlm.nih.gov/pubmed/37889878
http://dx.doi.org/10.1371/journal.pgph.0001852
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