Journal Article

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

Mbau, Rahab, Bigogo, Godfrey, Kabia, Evelyn, Oduor, Clement, Khagayi, Sammy, Oyando, Robinson, Barasa, Edwine

2019

Overview

Background Through a number of healthcare reforms, Kenya has demonstrated its intention to extend financial risk protection and service coverage for poor and vulnerable groups. These reforms include the provision of free maternity services, user-fee removal in public primary health facilities and a health insurance subsidy programme (HISP) for the poor. However, the available evidence points to inequity and the likelihood that the poor will still be left behind with regards to financial risk protection and service coverage. This study examined the experiences of the poor with health financing reforms that target them. Methods We conducted a qualitative cross-sectional study in two purposively selected counties in Kenya. We collected data through focus group discussions ( n  = 8) and in-depth interviews ( n  = 30) with people in the lowest wealth quintile residing in the health and demographic surveillance systems, and HISP beneficiaries. We analyzed the data using a framework approach focusing on four healthcare access dimensions; geographical accessibility, affordability, availability, and acceptability. Results Health financing reforms reduced financial barriers and improved access to health services for the poor in the study counties. However, various access barriers limited the extent to which they benefited from these reforms. Long distances, lack of public transport, poor condition of the roads and high transport costs especially in rural areas limited access to health facilities. Continued charging of user fees despite their abolition, delayed insurance reimbursements to health facilities that HISP beneficiaries were seeking care from, and informal fees exposed the poor to out of pocket payments. Stock-outs of medicine and other medical supplies, dysfunctional medical equipment, shortage of healthcare workers, and frequent strikes adversely affected the availability of health services. Acceptability of care was further limited by discrimination by healthcare workers and ineffective grievance redress mechanisms which led to a feeling of disempowerment among the poor. Conclusions Pro-poor health financing reforms improved access to care for the poor to some extent. However, to enhance the effectiveness of pro-poor reforms and to ensure that the poor in Kenya benefit fully from them, there is a need to address barriers to healthcare seeking across all access dimensions.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acceptability / Adult / Affordability / Analysis / At risk populations / Availability / Barriers / Beneficiaries / Counties / Cross-Sectional Studies / Delayed / Demographics / Discrimination / Empowerment / Equality and Human Rights / Experiences / Fees / Fees & charges / Female / Financial risk / Financing / Focus Groups / Health care / Health care access / Health care expenditures / Health care facilities / Health care industry / Health care policy / Health Care Reform / Health Expenditures - statistics & numerical data / Health facilities / Health Facilities - statistics & numerical data / Health financing reforms / Health insurance / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services - statistics & numerical data / Health Services Accessibility - economics / Health Services Accessibility - statistics & numerical data / Health Services Research / Health status / Healthcare Financing / Help seeking behavior / Humans / Inequality / Informal care / Insurance / Insurance coverage / Insurance, Health - economics / Insurance, Health - statistics & numerical data / Kenya / Legal fees / Local transit / Male / Maternity services / Medical care discrimination / Medical equipment / Medical personnel / Medical supplies / Medicine / Medicine & Public Health / Methods / Middle Aged / Motivation / Patient Acceptance of Health Care - statistics & numerical data / Payments / Planning / Poverty - statistics & numerical data / Protection / Public Health / Public transportation / Reforms / Risk management / Rural areas / Rural roads / Shortages / Social Justice / Social Policy / Strikes / Surveillance / Surveillance equipment / Surveillance systems / The poor / Transport costs / Vulnerable Populations - statistics & numerical data / Wealth / Workers / Young Adult