Influence of healthcare reforms on quality of healthcare in Samburu County, Kenya

Abstract

Delivering consistent, high-quality healthcare that eliminates socioeconomic and geographic disparities is crucial for a reformed healthcare system. This study explored the influence of healthcare reforms on the quality of healthcare in Samburu County, Kenya, employing an exploratory sequential mixed-method design. Initial qualitative findings guided subsequent quantitative analysis across five reform dimensions: health equity, insurance expansion, financing, technology integration, and incentive programs. A stratified random sampling technique was applied in drawing 219 respondents, and self-administered structured questionnaires were employed to collect primary data from public healthcare workers. An interview guide was applied in key informant survey interaction. Using NVivo version 10 and SPSS version 26, the data was analysed. The thematic analysis led to the derivation of five themes. The study found that health financing reforms had the strongest positive impact on healthcare quality, attributed to improved infrastructure and enhanced health-seeking behaviors. Technology integration reforms, especially health information exchange and digital records, also significantly improved service delivery. Health equity reforms positively influenced care access, affordability, and community participation. However, health insurance expansion showed a significant but negative impact on healthcare quality. Incentive programs demonstrated no significant effect, with findings indicating low awareness and uptake among providers and patients. The study supports the theoretical frameworks of Health Systems, Health Equity, and Policy Implementation theories, affirming the integral role of reforms in improving healthcare quality. It concludes that targeted, context-specific reforms can enhance healthcare delivery in marginalized regions.