ArticleHealth science reports2026
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.
Article in Health science reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Aims: Tertiary healthcare systems in low- and middle-income countries persistently suffer quality gaps due to inefficient financing and governance. Innovative healthcare financing mechanisms are increasingly promoted to improve service delivery in resource-constrained settings. This study examined the effects of these mechanisms-asset leasing financing (ALF), performance-based financing (PBF), and social impact bonds (SIB)-on the quality of tertiary healthcare in Kenya and assessed the moderating role of government stewardship. Methods: A cross-sectional quantitative study was conducted in three national referral hospitals in Kenya. Data were collected from hospital managers, clinical staff, and patients using structured questionnaires. Descriptive statistics, factor analysis, correlation analysis, and hierarchical multiple regression were applied. Results: Perceptions of tertiary healthcare quality were generally neutral to slightly negative across groups. All three financing mechanisms positively influenced the quality of tertiary healthcare. ALF ( Conclusion: Innovative healthcare financing mechanisms-ALF, ALF, PBF, and SIBs-are positively associated with the quality of tertiary healthcare in Kenya, with stronger effects observed under effective government stewardship. Strengthening stewardship and accountability frameworks may enhance the impact of financing reforms, offering evidence to inform health policy and managerial decision-making.
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