ArticleBMC health services research2021
Examining health facility financing in Kenya in the context of devolution.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers and facilitators to the implementation of integrated disease surveillance and response (IDSR) in Africa: a systematic review using the consolidated framework for implementation research (CFIR).Frontiers in public health · 2026Pooled it
- Economic burden of typhoid among hospitalised children in Kenya.BMJ global health · 2026Article
- Transforming hemodialysis access in Kenya: a national assessment of the Managed Equipment Services model.BMC health services research · 2026Article
- Understanding what factors influence community health worker involvement in hypertension service delivery in Kenya: applying a community health system lens.Health policy and planning · 2026Article
- 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 determinants of effective hypertension and diabetes care in rural primary health facilities in Kisumu, Kenya: a mixed-methods study.BMC public health · 2026Article
- Examining Tertiary Healthcare Quality Under Asset Leasing, Performance-Based Financing, and Social Impact Bonds: The Role of Government Stewardship in a Cross-Sectional Quantitative Study in Kenya.Health science reports · 2026Article
- The feasibility of social impact bonds in financing tertiary health care quality: qualitative stakeholders' perspectives in Kenya.Health economics review · 2026Article
- Challenges of healthcare quality in Kenya's tertiary hospitals: assessing the contribution and constraints of asset leasing financing mechanism.BMC health services research · 2025Article
- Examining the emergence and implementation experience of Primary Health Care Networks (PCNs) in Kenya: a qualitative process evaluation.BMC health services research · 2025Article
- Sustainability starts with spending: public financial management lessons from Kenya's universal health care pilot.BMC health services research · 2025Article
- Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania.Health research policy and systems · 2025Article
- Missed opportunities for digital health data use in healthcare decision-making: A cross-sectional digital health landscape assessment in Homa Bay county, Kenya.PLOS digital health · 2025Article
- Approaches to implementing and financing primary health care in Kenya: a case of seven counties.Frontiers in health services · 2025Review
- Article
- The cost of care for children hospitalized with respiratory syncytial virus (RSV) associated lower respiratory infection in Kenya.BMC public health · 2024Article
- Evaluating the effects, implementation experience and political economy of primary healthcare facility autonomy reforms within counties in Kenya: a mixed methods study protocol.BMJ public health · 2024Article
- A mixed methods study examining the impact of primary health care financing transitions on facility functioning and service delivery in Kenya: a study protocol.Wellcome open research · 2024Article
- Factors Influencing Progressive Utilization of Palliative Care Services among Cancer Patients in Kenya: The Case of Nairobi Hospice.International journal of environmental research and public health · 2023Article
- Community engagement to inform development of strategies to improve referral for hypertension: perspectives of patients, providers and local community members in western Kenya.BMC health services research · 2023Article
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Authors and funding
6 authors.
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Abstract
backgroundHow health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system.
methodsWe carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data.
resultsPlanning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as "wish lists" since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities.
conclusionThe national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.