Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2019

Open Access 01-12-2019 | Research

Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya

Authors: Rosalind McCollum, Miriam Taegtmeyer, Lilian Otiso, Maryline Mireku, Nelly Muturi, Tim Martineau, Sally Theobald

Published in: International Journal for Equity in Health | Issue 1/2019

Login to get access

Abstract

Background

Universal health coverage (UHC) is growing as a national political priority, within the context of recently devolved decision-making processes in Kenya. Increasingly voices within these discussions are highlighting the need for actions towards UHC to focus on quality of services, as well as improving coverage through expansion of national health insurance fund (NHIF) enrolment. Improving health equity is one of the most frequently described objectives for devolution of health services. Previous studies, however, highlight the complexity and unpredictability of devolution processes, potentially contributing to widening rather than reducing disparities. Our study applied Tanahashi’s equity model (according to availability, accessibility, acceptability, contact with and quality) to review perceived equity of health services by actors across the health system and at community level, following changes to the priority-setting process at sub-national levels post devolution in Kenya.

Methods

We carried out a qualitative study between March 2015 and April 2016, involving 269 key informant and in-depth interviews from different levels of the health system in ten counties and 14 focus group discussions with community members in two of these counties. Qualitative data were analysed using the framework approach.

Results

Our findings reveal that devolution in Kenya has focused on improving the supply side of health services, by expanding the availability, geographic and financial accessibility of health services across many counties. However, there has been limited emphasis and investment in promoting the demand side, including restricted efforts to promote acceptability or use of services. Respondents perceived that the quality of health services has typically been neglected within priority-setting to date.

Conclusions

If Kenya is to achieve universal health coverage for all citizens, then county governments must address all aspects of equity, including quality. Through application of the Tanahashi framework, we find that community health services can play a crucial role towards achieving health equity.
Footnotes
1
Services should be grouped into priority classes using criteria such as cost-effectiveness, priority to the worse off and financial risk protection [16].
 
2
REACHOUT is an ambitious five year international research consortium aiming to generate knowledge to strengthen the performance of CHWs and other close-to-community (CTC) providers in promotional, preventive and curative primary health services in six low- and middle-income countries in rural and urban areas in Africa and Asia, including Kenya.
 
Literature
1.
Solar O, Irwin A. Commission on Social Determinants of Health. A Conceptual Framework for Action on the Social Determinants of Health, no. April. World Health Organisation: Geneva; 2007.
2.
World Health Organisation, “Closing the health equity gap: Policy options and opportunities for action. TT -,” Geneva, WHO, 2013, 2013.
3.
Kenya National Bureau of Statistics and ICF Macro. Kenya demographic and Health survey. Nairobi: ICF Macro; 2014.
4.
Lang’at P. How Uhuru hopes to achieve big four agenda. Nairobi: Daily Nation; 2018.
5.
Eaton K, Kaiser K, Smoke P. The political economy of decentralization reforms - implications for aid effectiveness: Washington DC; 2010.
6.
Prud’homme R. The dangers of decentralisation. World Bank Obs. 1995;10(2):201–20.CrossRef
7.
Yilmaz S, Beris Y, Serrano-Berthet R. Local government discretion and accountability: a diagnostic framework for local governance. Washington, DC; 2008.
8.
McCollum R, et al. Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care. Health Policy Plan. 2018;66(6):729–42.CrossRef
9.
D. Waithaka, B. Tsofa, E. Kabia, and E. Barasa, “Describing and evaluating healthcare priority setting practices at the county level in Kenya,” Int. J. Health Plann. Manage., no. March, pp. 1–18, 2018.
10.
Tsofa B, Molyneux S, Gilson L, Goodman C. How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya. Int. J. Equity Health. 2017;16(1):151.CrossRef
11.
Boerma T, Eozenou P, Evans D, Evans T, Kieny MP, Wagstaff A. Monitoring Progress towards Universal Health Coverage at Country and Global Levels. PLoS Med. 2014;11:9.
12.
Rodney AM, Hill PS. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. Int J Equity Health. 2014;13:1–8.CrossRef
13.
Kazungu JS, Barasa EW. Examining levels, distribution and correlates of health insurance coverage in Kenya. Trop Med Int Heal. 2017;22(9):1175–85.CrossRef
14.
T. O’Connell and A. Sharkey, “Reaching Universal Health Coverage through District Health System Strengthening: Using a modified Tanahashi model sub-nationally to attain equitable and effective coverage,” Matern. Newborn Child Heal. Work. Pap. UNICEF Heal. Sect., no. 2013.
15.
World Health Assembly. World Health Assembly Resolution 58.33 Sustainable health financing , universal coverage and social health Insurance: Resolutions and Decision of the 58th World Health Assembly, no. 4; 2005. p. 139–40.
16.
WHO Consultative Group on Equity and Universal Health Coverage. Making fair choices on the path to universal health coverage: final report of the WHO consultative group on equity and universal Health coverage. Geneva: World Health Organisation; 2014.
17.
Tulenko K, et al. Community health workers for universal health-care coverage: from fragmentation to synergy. Bull World Health Organ. Nov. 2013;91(11):847–52.CrossRef
18.
Haines A, et al. Achieving child survival goals: potential contribution of community health workers. Lancet. Jun. 2007;369(9579):2121–31.CrossRef
19.
20.
Henriksson DK, Fredriksson M, Waiswa P, Selling K, Peterson SS. Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda. Glob. Health Action. 2017;10:1.
21.
Conyers D. Decentralization and service delivery: lessons from sub-Saharan Africa. IDS Bull. 2007;38(1):18–32.CrossRef
22.
Pope C, Mays N. Qualitative research: reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. Jul. 1995;311:42–5.CrossRef
23.
Kuper A, Reeves S, Levinson W. An introduction to reading and appraising qualitative research. BMJ Br Med J. 2008;337:404–9.
24.
Ritchie J, Lewis J. The foundations of qualitative research. London: SAGE Publications; 2003.
25.
Chuma J, Maina T, Ataguba J. Does the distribution of health care benefits in Kenya meet the principles of universal coverage? BMC Public Health. 2012;12(1):20.CrossRef
26.
McCollum R, Gomez W, Theobald S, Taegtmeyer M. How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review. BMC Public Health. 2016;16(1).
27.
Ministry of Medical Services and Ministry of Public Health and Sanitation, “Kenya Health Policy 2012–2030,” Nairobi, Kenya, 2012.
28.
Halabi SF. Participation and the right to Health: lesson from Indonesia. Health Hum Rights. 2009;11(1):49–59.CrossRef
29.
Kristiansen S, Santoso P. Surviving decentralisation?. Impacts of regional autonomy on health service provision in Indonesia. Health Policy (New York). 2006;77(3):247–59.CrossRef
30.
Masanyiwa ZS, Niehof A, Termeer CJ. A gendered users’ perspective on decentralized primary health services in rural Tanzania. Int J Heal. Plann Manag. 2013;30:285–306.CrossRef
31.
Utomo B, Sucahya PK, Utami FR. Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia. Int. J. Equity Health. 2011;10(1):47.CrossRef
32.
Gitobu CM, Gichangi PB, Mwanda WO. The effect of Kenya ’ s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities; 2018. p. 1–11.
33.
Pyone T, Smith H, van den Broek N. Implementation of the free maternity services policy and its implications for health system governance in Kenya. BMJ Glob. Heal. 2017;2(4):e000249.CrossRef
34.
Nyikuri M, Tsofa B, Barasa E, Okoth P, Molyneux S. Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the kenyan coast. PLoS One. 2015;10(12):1–18.CrossRef
35.
Tsofa B, Goodman C, Gilson L, Molyneux S. Devolution and its effects on health workforce and commodities management - early implementation experiences in Kilifi County, Kenya Lucy Gilson. Int J Equity Health. 2017;16(1):1–13.CrossRef
36.
O’Connell TS, Bedford KJA, Thiede M, McIntyre D. Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level. Int J Equity Health. 2015;14:54.CrossRef
37.
L. Gilson, J. Doherty, R. Loewenson, and V. Francis, “Challenging Inequity Through Heath Systems - Final Report. Knowledge Network on Health Systems.,” no. June, pp. 1–146, 2007.
38.
R. Mccollum et al., “Applying an intersectionality lens to examine health for vulnerable individuals following devolution in Kenya,” vol. 2, pp. 1–15, 2019.
39.
Kane S, et al. Limits and opportunities to community health worker empowerment: a multi-country comparative study. Soc Sci Med. 2016;164:27–34.CrossRef
40.
M. C. Kok et al., “Optimising the benefits of community health workers’ unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries,” Glob. Public Health, vol. 1692, no. April, pp. 1–29, 2016.
41.
LVCT Health, Liverpool School of Tropical Medicine, and Kenya community health and development unit, “Quality Improvement for community health services: Learning Event Report,” Nairobi, Kenya, 2017.
42.
McCollum R, et al. Exploring perceptions of community health policy in Kenya and identifying implications for policy change. Health Policy Plan. 2015;31(1):10–20.CrossRef
43.
Frenz P, Vega J. Universal health coverage with equity: what we know, don’t know and need to know. In: First Global Symposium on Health Systems Research; 2010. p. 1–56.
44.
De Andrade LOM, et al. Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. Lancet. 2015;385(9975):1343–51.CrossRef
Metadata
Title
Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya
Authors
Rosalind McCollum
Miriam Taegtmeyer
Lilian Otiso
Maryline Mireku
Nelly Muturi
Tim Martineau
Sally Theobald
Publication date
01-12-2019
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-0967-5

Other articles of this Issue 1/2019

International Journal for Equity in Health 1/2019 Go to the issue

Research

Healthcare-seeking behavior among pregnant women in the Chinese hierarchical medical system: a cross-sectional study

Systematic review

Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review

Research

“We are called the et cetera”: experiences of the poor with health financing reforms that target them in Kenya

Research

Does public service motivation matter in Moroccan public hospitals? A multiple embedded case study

Research

The respective parts of incidence and lethality in socioeconomic differences in cancer mortality. An analysis of the French network Cancer registries (FRANCIM) data

Research

Trends and predictors of inequality in childhood stunting in Nepal from 1996 to 2016