Executive Summary
A grant proposal that will be presented to the World Bank is provided in this paper. The Grant will be instrumental in solving two problems in Kenya's healthcare system which include Health Information System and Service Delivery problems. The recommendations are based on the best practices that are implemented in India. The first part of the grant proposal compares the Indian and the Kenyan healthcare systems in terms of service delivery and health information systems. The second part of the proposal provides the best recommendations for Kenya's service delivery and health information system. The proposed budget is provided in the last section, and it incorporates the best practices provided in the second section. The approximate amount that will be required for the project is $14,870,000.
1.0 Introduction
This paper provides a grant proposal for health system strengthening in Kenya that will be presented to the World Bank. The grant proposal focuses on two health problems namely: Service Delivery and Health Information Systems in Kenya which is a developing country. The Indian healthcare system is used a benchmark for developing the grant proposal. The aim of the project will be to improve the delivery of healthcare services to the entire population of the country. More importantly, the funds will improve the functioning of the country's Health Information Systems.
Balabanova et al. (2013) explain that strengthening the delivery of healthcare services is essential in the realization of the Millennium Development Goals (MDGs) that are related to health. The goals include reduction of child mortality, malaria, maternal mortality, HIV/AIDs and maternal mortality (Kowal et al. 2012). The delivery of healthcare services is an output of the health system inputs such as financing, health workforce, supplies and procurement. Therefore, it is crucial for a health system to meet the minimum standards that guarantee efficient health service delivery (Thomas et al. 2015).
Schlein et al., 2013 note that the poor delivery of the healthcare services may slow down the phase at which a country realizes the Millennium development goals that relate to health. Furthermore, the health outcomes such as well-being, mortality, health status, and disease outbreaks may be affected adversely due to the poor service delivery. According to Obare et al. (2013), another implication of the poor delivery is health inequities. People from some geographical locations may be marginalized in the provision of health care services. In the same way, the social-economic statuses of individuals may act as barriers to the access of health services (Kitui, Lewis and Davey, 2013).
As noted by Balabanova et al. (2013), reliable and sound information lays a foundation for efficient decision making in a health care organization. The main functions of the health information system include generation of data, compilation of data, analysis of data, synthesis of the data and communication. The Health information system analyzes the patients' data to ensure that it is of good quality.
Kowal et al. (2012) explain that the health planners use the health information system to obtain data about the health determinants such as genetic, socioeconomic, behavioral and environmental factors. The inputs and processes in the healthcare system are obtained from the health information system, and they help in making decisions that affect the welfare of the patients. More importantly, the health information system determines the outputs or the performance of a healthcare organization such as accessibility, quality, and availability. The individual level data that is stored in the health information system offers the basis for providing personalized care to the patients. According to Thomas et al. (2015), the health organization level data helps the managers in the healthcare organizations to make the correct decisions regarding purchases of medicines and medical equipment. The population level data helps in formulating health intervention strategies that are appropriate for the specific populations. The public health surveillance data help in assessing the health conditions that are common in particular populations and guide the healthcare organizations to come up with relevant intervention measures (Schlein et al. 2013).
Therefore, if a healthcare organization does not have reliable health information system it may end up making decisions that affect the patients adversely. For example, the patients may end up being misdiagnosed as a result of poor records. The relevant healthcare partners may be hindered from accessing usable, comparative, reliable understandable and authoritative data as a result of poor record keeping by an organization (Obare et al. 2013).
2.0 A comparison of India's and Kenya's Health Care Systems
It is logical to compare India's healthcare system to Kenya's healthcare system because there was a time India healthcare system faced challenges in the delivery of services and the Health Information System. However, the government embraced methodologies that improved the performance of the system significantly. Therefore, it shows that if Kenya is granted the funds by the World Bank, it will improve the delivery of the healthcare service and the National Health Information system just like India. India and Kenya are similar in the demographic and economic criteria. Demographically, the two countries have diverse ethnic groups. Economically, the two countries face the challenge of high poverty levels (Kitui, Lewis and Davey 2013).
2.1 Comparison of the delivery systems
India has made a significant progress in the delivery of healthcare systems to its people. The government has implemented strategies to increase the efficiency and affordability of healthcare in the rural and semi-rural regions of the country (Kitui, Lewis, and Davey 2013). Specifically, the government has introduced a network of hospitals in the rural and semi-rural regions with the aim of integrating efficient healthcare delivery with the community-based healthcare plans. The ultimate goal of the government is to bring standardized, affordable and efficient medical services to the rural and semi-urban regions. Balabanova et al. (2013) add that the main beneficiaries of India's healthcare model are the low and middle-income individuals. The model emphasizes on the provision of childcare, mother care, preventive services and elderly care.
In comparison, Kenya faces serious issues in the delivery of high-quality healthcare services to the Kenyans due to the devolution of the health services to the counties. The devolution has strained the country’s healthcare system by causing inefficiency and overlapping in the processes of planning and implementing. Most counties do not have sophisticates health facilities (Thomas et al. 2015). The sophisticated facilities are found in big cities such as the Kenyatta Hospital in Nairobi and the Moi Teaching and Referral Hospital in Eldoret. The major healthcare facilities offer levels of healthcare that are contrasting, and this implies that the delivery of healthcare services in the country is inequitable (Schlein et al. 2013). For Example, the Kenyatta National Hospital has private and public wards in the same facility. The private wards are more expensive than the public wards and the doctors take a longer time to visit the patients in the public wards than the patients in the private wards. As noted by Obare et al. (2013), the patients in the public wards are crowded because they share beds. Also, the public wards are chaotic, open, and they do not offer privacy to the patients. There is a great disparity in the healthcare services that are provided at Kenyatta National Hospital and the county hospitals. Kitui, Lewis, and Davey (2013) note that the hospitals in the rural areas are not equipped well and on most occasions they miss essential supplies. It is imperative to note that the status of the healthcare system in Kenya forces many Kenyan patients to travel to India in a bid to get medical services there (Balabanova et al. 2013).
2.2 Comparison of the Health Information Systems
According to Kowal et al. (2012), India’s health information system is diversified because data is obtained from more than one source. The main source of health information is the population census. Also, the Civil Registration Systems in India offer useful information regarding the number of deaths, the number of births and the causes of death (Thomas et al. 2015). Besides, population-based surveys are conducted at the national level, and data is collected through interviews. There are service records that are generated and they focus on the mortality and morbidity of the patients. More importantly, the administrative records provide crucial information about the health infrastructure of the healthcare organizations (Thomas et al. 2015).
Comparatively, Kenya's National Health Information system is less diversified than the Indian system. The data is mainly derived from the national census which is conducted after every ten years. Most of the administrative records in Kenya are out of date and incomplete. Additionally, the service records have low-quality data, and they exclude the private sector (Schlein et al. 2013). Surveys of the health conditions are rarely conducted in Kenya due to the unavailability of funds. Markedly, the Civil Registration systems in Kenya do not provide accurate and reliable data because a large number of births are recorded (Obare et al. 2013). The implementation of the civil registration systems in the rural areas is poor. It is noteworthy that Kenya’s Health information is constrained due to the lack of financial resources, weakness in the legislation and information system, shortage of technical expertise and the inequitable distribution of health workers. As such, it is hard for the youth, the children and the women in the country to access high-quality healthcare services (Kitui, Lewis and Davey 2013).
3.0 Recommendations
3.1 Good Service Delivery Recommendations
3.1.1 Comprehensiveness
Kenya should be funded to provide a comprehensive range of health services to its populations. The health services should be appropriate to the requirements of the various target populations in the country, and this encompasses health promotion, preventive, rehabilitative, curative and palliative services (Balabanova et al. 2013).
3.1.2 Accessibility
The grants provided to Kenya should be used to increase the accessibility of the health services for all populations more especially those in the rural areas. Health services should be brought close to the people, and the barriers of cost should be eliminated. The services should be provided in the community, home, health facilities and work place settings (Balabanova et al. 2013).
3.1.3 Coverage
Kenya should be issued a grant to redesign the delivery of its healthcare services. The wide coverage will ensure that all the individuals in the target populations are covered. The coverage should cater for all social groups, income groups, the healthy people and the sick people in the country (Thomas et al. 2015).
3.1.4 Continuity
Kowal et al., 2012 recommend that Kenya should be funded to offer individuals with continuity of care over the lifecycle and in all levels of care.
3.1.5 Quality
Kenya needs grant funds to provide healthcare services of high quality. More importantly, the healthcare should be patient-centered, safe and effective to increase the life expectancy in Kenya (Thomas et al. 2015).
3.1.6 Coordination
The local area networks that provide healthcare services in Kenya ought to be coordinated actively across all the service delivery levels and care. The coordination between the social service providers and community organizations should be improved to enhance the delivery of efficient services in the country (Thomas et al. 2015).
3.1.7 Efficiency and accountability
The healthcare services in Kenya ought to be managed appropriately, and the wastage of healthcare resources should be minimal.
3.2 Recommendations for Health Information Systems
3.2.1 Health Surveys
Kenya should be funded to conduct health surveys that cover the priority health topics, and the relevance of the data sources should be upheld. The country should come up with reliable reports on child mortality and maternal mortality in the last five years. Further, the data should cover the major health interventions and the nutritional status in the country for the last five years (Schlein et al. 2013).
3.2.2 Death and Birth Registration
The national health information system should record at least 90% of the births and 90% of the deaths in the country every year. More importantly, the causes of death should be recorded at the national level (Schlein et al. 2013).
3.2.3 Census
Kenya should be funded adequately to conduct census after every ten years. The census should be used to conduct population projections for the country for the next ten years (Obare et al. 2013).
3.2.4 Health facility reports
The capacities of the healthcare institutions should be improved for them to offer accurate reports on the institutional deliveries, HIV/AIDs prevalence, health statistics, and notifiable diseases. More importantly, data quality assessments should be conducted in accordance with the internationally approved quality criteria. Furthermore, Kenya needs to implement the International Health Regulations as stipulated in the international standards (Obare et al. 2013).
3.2.5 Tracking of the health system resources
Kenya should complete national health accounts every year. Further, there should be a national database containing the private and public sector facilities which should be updated after every two years. The availability of the tracer commodities and medicine should be computed annually, and it should include the private and public health facilities (Kitui, Lewis and Davey 2013).
3.2.6 Institutional mechanism to handle health statistics
A functioning and designated institutional mechanism for analyzing health statistics in Kenya should be introduced. The mechanism should synthesize data from diverse sources and validate the facility-based and population –based data sources. A micro data archive data containing the census and health surveys in Kenya should be established, and its operation should be monitored closely. Studies on the burden of disease ought to be conducted after every three years, and the performance of the national health system should be assessed after every five years (Kitui, Lewis and Davey 2013).
3.2.7 Civil Registration
Kenya should improve the capacity of the existing civil registration system to ensure that all the events in the lifetimes of all citizens are recorded accurately. The events that ought to be captured by the civil registration authorities include birth, death and the changes in marital status. Accurate records will help the country to enhance the international comparability of the health data (Schlein et al. 2013).
4.0 Budget Proposal
The budget proposal for the project is provided in Table 1 below.
Source: Author
5.0 Conclusion
Reference List
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