Changing the game in purchasing health services: findings from a provider-purchaser engagement in Kenya

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Abstract Background: Kenya has committed to achieving universal health coverage (UHC) by 2030 and has prioritized purchasing reforms. Enhancing effective provider-purchaser engagements is quintessential to transitioning to strategic purchasing reforms on provider selection or empanelment, benefits package design and provider payments mechanism. This study assessed the challenges hindering effective provider-purchaser engagement in Kenya and proposed actionable solutions to policymakers and actors. Methods: The study applied a cross-sectional qualitative study design. Data was collected using interviews – incorporating both focus group discussions (FGDs), in-depth interviews (IDIs) and a consensus-building workshop with stakeholders representing healthcare providers, medical professional bodies, the National Hospital Insurance Fund (NHIF – at county/branch and national level), health insurance beneficiaries, the Council of Governors (COG) and the ministry of health (MOH). Purposive sampling was employed to select stakeholder representatives for each of the stakeholder clusters. Results: Provider-purchaser challenges were identified to result from 1) human resource gaps (understaffing and staff turnover), 2) infrastructure gaps (both hardware and software), 3) knowledge and skill gaps, and 4) governance issues attributed to bureaucratic processes, poor accountability mechanisms and poor mechanisms of communication between providers and purchasers. Providers and purchasers emphasized the need for 1) automation of processes, 2) review of provider payment mechanisms (PPMs), 3) regular capacity building of providers, 4) effective communication and accountability and 5) development of public-private contracting frameworks as key actionable solutions for implementation. Conclusion: Challenges hindering effective provider-purchaser engagements result largely from human resources, infrastructure, capacity, communication and accountability gaps. Reforms aimed at addressing these gaps must focus on building staff capacity in the payment process , employment or prioritization of staff to the payment process, adoption of information systems or technology to automate processes (both on empanelment and payment) and establishment of working communication channels (both automated and in-person processes) that are regular. Such reforms should be tailored to the stakeholders' actions and monitored to ensure adequate implementation to enhance provider-purchaser engagements.

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