Examining private sector engagement in provision of public health services towards universal health coverage: a case study of Kisii County
Mounde, Mokaya Isaiah
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For Kenya to achieve universal health coverage (UHC) by year 2022, the national and county governments must strengthen engagement with the private sector. Yet there is lack of clarity on private sector engagement across counties. This study sought to describe engagement and impact in Kisii County. Specifically, the study sought to describe the private sector engagement models in Kisii, examine achievements and challenges of engaging the sector in meeting public healthcare goals, and explore management views on the perceived impact of private sector engagement. A multiple methods approach was taken, with data collected from 62 employees of the Kisii county health department and the private sector. The quantitative component entailed collecting survey data from 52 participants (21 public, 31 private). The qualitative component entailed 10 in-depth interviews (five each for public and private). Findings indicated that whereas a myriad of private sector engagement models were employed, the public-private partnership model was most preferred. Engagement achievements included public sector getting human resources from the private sector; technical and capacity building support; and technological and financing support from the private sector. Engagement challenges included difficulty in regulating and holding the private actors accountable under the partnership arrangements; difficulty in engaging the private sector in non-profit initiatives; and county government inability to sustain programmes initiated by the private sector. Overall, private sector engagement was perceived to have had a positive impact on progress towards UHC in Kisii across all six-health system building blocks, namely, governance, health work force, financing, service delivery, healthcare technology and access to medicines. Among others, the study recommends that county governments should have a central role to play in targeting and identifying households for National Hospital Insurance Fund (NHIF) enrolment and that national governments ought to avail financial resources to facilitate increased population coverage through the NHIF in keeping with universal health coverage. The study also recommends that the Kenyan government should increase public financing of the health sector at the county level. By dedicating 15% of the national budget towards healthcare for instance, there will be an uplift in the healthcare system enough to realize the Universal Healthcare Coverage as per the Abuja declaration of 2001 to which Kenya is a signatory.