ArticleThe International journal of health planning and management2018
A critical analysis of health care purchasing arrangements in Kenya: A case study of the county departments of health.
Article in The International journal of health planning and management, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed.
- Understanding the role of 'software' in health system capacity for non-communicable disease response: hypertension care in rural Coastal Kenya.Health policy and planning · 2026Article
- Financial autonomy of facilities providing primary care services in low- and middle-income countries: assessing the evidence to inform the development of a typology and conceptual framework.BMC health services research · 2025Article
- Systematic Review of Financing Functions for Universal Health Coverage in Low- and Middle-Income Countries: Reforms, Challenges, and Lessons Learned.Public health reviews · 2025Review
- Health care provider payment reforms in African states of the Commonwealth-a scoping review.Frontiers in public health · 2025Article
- The path to universal health coverage in five African and Asian countries: examining the association between insurance status and health-care use.The Lancet. Global health · 2024Review
- Why Was the Policy Idea on the Health Benefits Package Advisory Panel Gazetted in Kenya? A Retrospective Policy Analysis.International journal of health policy and management · 2024Article
- How does Public Financial Management (PFM) influence health system efficiency: A scoping review.Wellcome open research · 2024Article
- Purchasing for high-quality care using National Health Insurance: evidence from Zambia.Health policy and planning · 2023Review
- Examining the influence of budget execution processes on the efficiency of county health systems in Kenya.Health policy and planning · 2023Review
- A qualitative evaluation of priority-setting by the Health Benefits Package Advisory Panel in Kenya.Health policy and planning · 2023Article
- Exploring the roles of players in strategic purchasing for healthcare in Africa-a scoping review.Health policy and planning · 2023Article
- Assessment of strategic healthcare purchasing and financial autonomy in Tanzania: the case of results-based financing and health basket fund.Frontiers in public health · 2023Article
- The impact of COVID-19 on health financing in Kenya.PLOS global public health · 2023Article
- Examining healthcare purchasing arrangements for strategic purchasing in Nigeria: a case study of the Imo state healthcare system.Health research policy and systems · 2022Review
- Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria.Health economics review · 2021Review
- Level and determinants of county health system technical efficiency in Kenya: two stage data envelopment analysis.Cost effectiveness and resource allocation : C/E · 2021Article
- Examining health facility financing in Kenya in the context of devolution.BMC health services research · 2021Article
- Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya.PLOS global public health · 2021Article
- Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya.International journal for equity in health · 2020Article
- Purchasing reforms and tracking health resources, Kenya.Bulletin of the World Health Organization · 2020Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundPurchasing in health care financing refers to the transfer of pooled funds to health care providers for the provision of health care services. There is limited empirical work on purchasing arrangements and what is required for strategic purchasing in low- and middle-income countries. We conducted this study to critically assess the purchasing arrangements of the county departments of health (CDOH) who are the largest purchasers of health care in Kenya.
methodsWe used a qualitative case study approach to assess the extent to which the purchasing actions of the CDOH in Kenya were strategic. We purposively sampled 10 counties and collected data using in-depth interviews (n = 81), focus group discussions (n = 4), and documents review. We analyzed data using a framework approach.
resultsCounty departments of health did not practice strategic purchasing. The government's (national and county) role as a steward for the purchasing function was characterized by poor accountability and inadequate budgetary allocations for service delivery. The absence of a purchaser-provider split between the CDOH and public health care providers undermined provider selection based on performance and quality. Poor public participation and ineffective complaints and feedback mechanisms limited public accountability and responsiveness to the needs of the people.
conclusionOur findings show that while there are frameworks that could promote strategic purchasing of the CDOH, strategic purchasing is impaired by poor implementation of these frameworks and the inherent weaknesses of a public integrated purchasing system that lacks purchaser-provider split.
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