A critical analysis of the purchasing arrangements in Kenya

Abstract

Over the past 15 years, the Universal Health Coverage (UHC) agenda has gained power at both the policy formulation and implementation level in Kenya. Purchasing - the way by which financial resources are linked to the provision of health services - can facilitate progress towards UHC if undertaken strategically by using mechanisms that optimise quality, efficiency, equity and responsiveness of health care services. This report provides a critical assessment of the performance of health care purchasers in Kenya and identifies factors influencing their performance. It focuses on three purchasing mechanisms: the National Hospital Insurance Fund, low-cost Private Health Insurance and Community-Based Health Insurance. Data collected from document reviews and in-depth interviews with key informants revealed that all three purchasing mechanisms fall short of ideal strategic purchasing. Gaps were identified in both design and implementation, which undermines the goal of UHC in Kenya. The policy implications of the findings include a need for stewardship, a coherent policy platform for strategic purchasing practice, needs assessment and service entitlement design to protect against financial catastrophe, and greater consideration for health system efficiency and quality by purchasers. This research is supported by the Department for International Development’s RESYST (Resilient and Responsive Health Systems) programme which is led by the London School of Hygiene & Tropical Medicine