- Title
- Evaluating the Kenya health policy 2014-2030: towards equity and financial protection
- Creator
- Ngala, Consolata
- Subject
- Medical policy -- Economic Aspects -- Kenya
- Subject
- Medical policy -- Social aspects -- Kenya
- Subject
- Health insurance -- Kenya
- Date Issued
- 2025-04
- Date
- 2025-04
- Type
- Doctoral theses
- Type
- text
- Identifier
- http://hdl.handle.net/10948/73331
- Identifier
- vital:79412
- Description
- The government of Kenya in 2014 developed and implemented the Kenya Health Policy 2014-2030 to improve the welfare of its citizens. This was done through Universal Health Coverage (UHC) that was piloted from December, 2018 to December 2019 in Nyeri, Kisumu, Isiolo and Machakos Counties in Kenya. These were the counties with a high prevalence of non-communicable diseases (NCDs), communicable diseases (CDs), poverty rates and accidents and injuries respectively. In February 2022 the government rolled out UHC targeting the elderly, as well as infants which was only 3.9 % and 12.8 % of the total population respectively. This was done without first evaluating the impact of the pilot. Literature shows that the achievement of UHC is quite elusive in Kenya. The study evaluated the design, implementation and impact of the Policy on equity and financial protection in piloted (Machakos and Kisumu) and non-piloted counties (Nakuru and Busia). The study also a baseline comparative analysis of the equity and financial protection in the sampled counties, establish the impact of the policy on the equity and financial protection in 2018-2019 (post analysis) and finally determined the cost effectiveness of equity and financial protection by comparing the cost of the health outcomes in the study counties. Exploratory and cross-sectional designs using both qualitative and quantitative data guided by the theory of change and logic model were used. The study used both secondary data from the Kenya Health Expenditure and Utilisation Survey (KHHEUS) (2018) and from primary survey data of 591 households in both piloted and non-piloted counties. Purposive, cluster and simple random sampling techniques were used to select the study Counties. The qualitative data collected was analysed thematically through content analysis. The quantitative data was analysed descriptively and through the use of inferential statistics (logistic regression and zero truncated model). Health outcomes measured by number of visits (Access) and catastrophic health expenditures were subjected to propensity score matching and incremental cost effectiveness ratio computed. The findings indicated that the life expectancy increased from 60 to 63 years in 2021-2022. There was a reduction in the prevalence of CDs such as Malaria from 4.3% in 2021 to 3.7% in 2023, and HIV from 11.4% in 2021 to 5.8% in 2023. Injuries reduced by 1.9%, maternal mortality as well as infant and under five mortality rates reduced with an increased uptake of antenatal care services. However, prevalence of NCDs increased from 39% in 2020 to 44% in 2023. Baseline analysis revealed that households in the piloted Counties had relatively more hospital visits and a reported lower percentage of catastrophic health expenditure (CHE). Propensity score matching revealed that the treated Counties had a statistically significant greater number of hospital visits as compared to the control Counties. There was statistically significant difference in the number of households in the control Counties that suffered CHE as compared to the treatment Counties. Lastly, the incremental cost effectiveness ratio revealed that to improve on the number of visits by 1%, the government should invest an additional of Ksh 1,225.87 million in Kisumu. Equally, to reduce the number of households likely to suffer CHE by 1%, the government should invest additional Ksh 80.775 and 165.82 million in Kisumu and Machakos respectively. The study revealed that UHC played a vital role in influencing hospital utilisation and cushioned households against CHE. The study recommends that 100% inclusivity in any government social heath insurance is necessary in order to reduce CHE among households. In addition, to enhance equity, the government should invest more in healthcare human resource and infrastructure across the Counties.
- Description
- Thesis (PhD) -- Faculty of Business and Economic Sciences, School of Economics, Development and Tourism, 2025
- Format
- computer
- Format
- online resource
- Format
- application/pdf
- Format
- 1 online resource (411 pages)
- Format
- Publisher
- Nelson Mandela University
- Publisher
- Faculty of Business and Economic Sciences
- Language
- English
- Rights
- Nelson Mandela University
- Rights
- All Rights Reserved
- Rights
- Open Access
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- Downloads: 3
Collections
NMU School for Economics, Development and Tourism
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE1 | NGALA, C.pdf | 7 MB | Adobe Acrobat PDF | View Details Download |