Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya
Abstract Background Kenya aims to achieve universal health coverage (UHC) by 2030 and has selected the National Health Insurance Fund (NHIF) as the ‘vehicle’ to drive the UHC agenda. While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12939-024-02171-x |
| _version_ | 1797199551785861120 |
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| author | Jacob Kazungu Angela K. Moturi Samson Kuhora Julia Ouko Matthew Quaife Justice Nonvignon Edwine Barasa |
| author_facet | Jacob Kazungu Angela K. Moturi Samson Kuhora Julia Ouko Matthew Quaife Justice Nonvignon Edwine Barasa |
| author_sort | Jacob Kazungu |
| collection | DOAJ |
| description | Abstract Background Kenya aims to achieve universal health coverage (UHC) by 2030 and has selected the National Health Insurance Fund (NHIF) as the ‘vehicle’ to drive the UHC agenda. While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted facilities may be a barrier to equitable access to care. We estimated the spatial access to NHIF-contracted facilities in Kenya to provide information to advance the UHC agenda in Kenya. Methods We merged NHIF-contracted facility data to the geocoded inventory of health facilities in Kenya to assign facility geospatial locations. We combined this database with covariates data including road network, elevation, land use, and travel barriers. We estimated the proportion of the population living within 60- and 120-minute travel time to an NHIF-contracted facility at a 1-x1-kilometer spatial resolution nationally and at county levels using the WHO AccessMod tool. Results We included a total of 3,858 NHIF-contracted facilities. Nationally, 81.4% and 89.6% of the population lived within 60- and 120-minute travel time to an NHIF-contracted facility respectively. At the county level, the proportion of the population living within 1-hour of travel time to an NHIF-contracted facility ranged from as low as 28.1% in Wajir county to 100% in Nyamira and Kisii counties. Overall, only four counties (Kiambu, Kisii, Nairobi and Nyamira) had met the target of having 100% of their population living within 1-hour (60 min) travel time to an NHIF-contracted facility. On average, it takes 209, 210 and 216 min to travel to an NHIF-contracted facility, outpatient and inpatient facilities respectively. At the county level, travel time to an NHIF-contracted facility ranged from 10 min in Vihiga County to 333 min in Garissa. Conclusion Our study offers evidence of the spatial access estimates to NHIF-contracted facilities in Kenya that can inform contracting decisions by the social health insurer, especially focussing on marginalised counties where more facilities need to be contracted. Besides, this evidence will be crucial as the country gears towards accelerating progress towards achieving UHC using social health insurance as the strategy to drive the UHC agenda in Kenya. |
| first_indexed | 2024-04-24T07:17:33Z |
| format | Article |
| id | doaj.art-81fdd4be961546c9b913dcec6e26b8e8 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-04-24T07:17:33Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-81fdd4be961546c9b913dcec6e26b8e82024-04-21T11:12:26ZengBMCInternational Journal for Equity in Health1475-92762024-04-0123111010.1186/s12939-024-02171-xExamining inequalities in spatial access to national health insurance fund contracted facilities in KenyaJacob Kazungu0Angela K. Moturi1Samson Kuhora2Julia Ouko3Matthew Quaife4Justice Nonvignon5Edwine Barasa6Health Economics Research Unit, KEMRI Wellcome Trust Research ProgrammePopulation & Health Surveillance Group, KEMRI Wellcome Trust Research ProgrammeNational Health Insurance FundNational Health Insurance FundDepartment of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Health Policy, Planning and Management, School of Public Health, University of GhanaHealth Economics Research Unit, KEMRI Wellcome Trust Research ProgrammeAbstract Background Kenya aims to achieve universal health coverage (UHC) by 2030 and has selected the National Health Insurance Fund (NHIF) as the ‘vehicle’ to drive the UHC agenda. While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted facilities may be a barrier to equitable access to care. We estimated the spatial access to NHIF-contracted facilities in Kenya to provide information to advance the UHC agenda in Kenya. Methods We merged NHIF-contracted facility data to the geocoded inventory of health facilities in Kenya to assign facility geospatial locations. We combined this database with covariates data including road network, elevation, land use, and travel barriers. We estimated the proportion of the population living within 60- and 120-minute travel time to an NHIF-contracted facility at a 1-x1-kilometer spatial resolution nationally and at county levels using the WHO AccessMod tool. Results We included a total of 3,858 NHIF-contracted facilities. Nationally, 81.4% and 89.6% of the population lived within 60- and 120-minute travel time to an NHIF-contracted facility respectively. At the county level, the proportion of the population living within 1-hour of travel time to an NHIF-contracted facility ranged from as low as 28.1% in Wajir county to 100% in Nyamira and Kisii counties. Overall, only four counties (Kiambu, Kisii, Nairobi and Nyamira) had met the target of having 100% of their population living within 1-hour (60 min) travel time to an NHIF-contracted facility. On average, it takes 209, 210 and 216 min to travel to an NHIF-contracted facility, outpatient and inpatient facilities respectively. At the county level, travel time to an NHIF-contracted facility ranged from 10 min in Vihiga County to 333 min in Garissa. Conclusion Our study offers evidence of the spatial access estimates to NHIF-contracted facilities in Kenya that can inform contracting decisions by the social health insurer, especially focussing on marginalised counties where more facilities need to be contracted. Besides, this evidence will be crucial as the country gears towards accelerating progress towards achieving UHC using social health insurance as the strategy to drive the UHC agenda in Kenya.https://doi.org/10.1186/s12939-024-02171-xSpatial accessInequalitiesHealth facilityNational Health Insurance FundTravel timeUniversal health coverage |
| spellingShingle | Jacob Kazungu Angela K. Moturi Samson Kuhora Julia Ouko Matthew Quaife Justice Nonvignon Edwine Barasa Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya International Journal for Equity in Health Spatial access Inequalities Health facility National Health Insurance Fund Travel time Universal health coverage |
| title | Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya |
| title_full | Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya |
| title_fullStr | Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya |
| title_full_unstemmed | Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya |
| title_short | Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya |
| title_sort | examining inequalities in spatial access to national health insurance fund contracted facilities in kenya |
| topic | Spatial access Inequalities Health facility National Health Insurance Fund Travel time Universal health coverage |
| url | https://doi.org/10.1186/s12939-024-02171-x |
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