What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms
Background Health facility regulation in low- and middle-income countries (LMICs) is generally weak, with potentially serious consequences for safety and quality. Innovative regulatory reforms were piloted in three Kenyan counties including: a Joint Health Inspection Checklist (JHIC) synthesizing r...
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| Format: | Article |
| Language: | English |
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Kerman University of Medical Sciences
2022-09-01
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| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | https://www.ijhpm.com/article_4103_f616d2ebef76d1f84db4e8a6b6208f9f.pdf |
| _version_ | 1811158740216315904 |
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| author | Eric Tama Irene Khayoni Catherine Goodman Dosila Ogira Timothy Chege Njeri Gitau Francis Wafula |
| author_facet | Eric Tama Irene Khayoni Catherine Goodman Dosila Ogira Timothy Chege Njeri Gitau Francis Wafula |
| author_sort | Eric Tama |
| collection | DOAJ |
| description | Background Health facility regulation in low- and middle-income countries (LMICs) is generally weak, with potentially serious consequences for safety and quality. Innovative regulatory reforms were piloted in three Kenyan counties including: a Joint Health Inspection Checklist (JHIC) synthesizing requirements across multiple regulatory agencies; increased inspection frequency; allocating facilities to compliance categories which determined warnings, sanctions and/or time to re-inspection; and public display of regulatory results. The reforms substantially increased inspection scores compared with control facilities. We developed lessons for future regulatory policy from this pilot by identifying key factors that facilitated or hindered its implementation. Methods We conducted a qualitative study to understand views and experiences of actors involved in the one-year pilot. We interviewed 77 purposively selected staff from the national, county and facility levels. Data were analyzed using the framework approach, identifying facilitating/hindering factors at the facility, inspection system, and health system levels. Results The joint health inspections (JHIs) were generally viewed as fair, objective and transparent, which enhanced their perceived legitimacy. Interactions with inspectors were described as friendly and supportive, in contrast to the punitive culture of previous inspections when bribery had been common. Inspector training and use of an electronic checklist were strongly praised. However, practical challenges with transport, route planning and budgets highlighted the critical nature of strong logistical management. The effectiveness of inspection in improving compliance was hampered by limitations in related systems, particularly facility licensing, enforcement of closures and, in the public sector, control of funds. However, an inclusive reform development process had led to high buy-in across regulatory agencies which was key to the system’s success. Conclusion Effective facility inspection involves more than “hardware” such as checklists, protocols and training. Cultural, relational and institutional “software” are also crucial for legitimacy, feasibility of implementation and enforceability, and should be carefully integrated into regulatory reforms. |
| first_indexed | 2024-04-10T05:29:17Z |
| format | Article |
| id | doaj.art-9c33edbbeecd46c28af5d49649ef9a41 |
| institution | Directory Open Access Journal |
| issn | 2322-5939 |
| language | English |
| last_indexed | 2024-04-10T05:29:17Z |
| publishDate | 2022-09-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-9c33edbbeecd46c28af5d49649ef9a412023-03-07T09:11:35ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392022-09-011191852186210.34172/ijhpm.2021.904103What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection ReformsEric Tama0Irene Khayoni1Catherine Goodman2Dosila Ogira3Timothy Chege4Njeri Gitau5Francis Wafula6Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, KenyaInstitute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, KenyaDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, University of London, London, UKInstitute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, KenyaInstitute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, KenyaWorld Bank Group, Nairobi, KenyaInstitute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, KenyaBackground Health facility regulation in low- and middle-income countries (LMICs) is generally weak, with potentially serious consequences for safety and quality. Innovative regulatory reforms were piloted in three Kenyan counties including: a Joint Health Inspection Checklist (JHIC) synthesizing requirements across multiple regulatory agencies; increased inspection frequency; allocating facilities to compliance categories which determined warnings, sanctions and/or time to re-inspection; and public display of regulatory results. The reforms substantially increased inspection scores compared with control facilities. We developed lessons for future regulatory policy from this pilot by identifying key factors that facilitated or hindered its implementation. Methods We conducted a qualitative study to understand views and experiences of actors involved in the one-year pilot. We interviewed 77 purposively selected staff from the national, county and facility levels. Data were analyzed using the framework approach, identifying facilitating/hindering factors at the facility, inspection system, and health system levels. Results The joint health inspections (JHIs) were generally viewed as fair, objective and transparent, which enhanced their perceived legitimacy. Interactions with inspectors were described as friendly and supportive, in contrast to the punitive culture of previous inspections when bribery had been common. Inspector training and use of an electronic checklist were strongly praised. However, practical challenges with transport, route planning and budgets highlighted the critical nature of strong logistical management. The effectiveness of inspection in improving compliance was hampered by limitations in related systems, particularly facility licensing, enforcement of closures and, in the public sector, control of funds. However, an inclusive reform development process had led to high buy-in across regulatory agencies which was key to the system’s success. Conclusion Effective facility inspection involves more than “hardware” such as checklists, protocols and training. Cultural, relational and institutional “software” are also crucial for legitimacy, feasibility of implementation and enforceability, and should be carefully integrated into regulatory reforms.https://www.ijhpm.com/article_4103_f616d2ebef76d1f84db4e8a6b6208f9f.pdfregulationinspectionpatient safetyprivate sectorkenya |
| spellingShingle | Eric Tama Irene Khayoni Catherine Goodman Dosila Ogira Timothy Chege Njeri Gitau Francis Wafula What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms International Journal of Health Policy and Management regulation inspection patient safety private sector kenya |
| title | What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms |
| title_full | What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms |
| title_fullStr | What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms |
| title_full_unstemmed | What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms |
| title_short | What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms |
| title_sort | what lies behind successful regulation a qualitative evaluation of pilot implementation of kenya s health facility inspection reforms |
| topic | regulation inspection patient safety private sector kenya |
| url | https://www.ijhpm.com/article_4103_f616d2ebef76d1f84db4e8a6b6208f9f.pdf |
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