Assessing the progress and gaps in strategic health purchasing in Kenya

Background: Kenya has committed to achieve universal health coverage (UHC) and prioritised purchasing reforms. Existing evidence indicates that purchasing can be leveraged to achieve health system objectives when done strategically. However, no single study has collated evidence on the progress and bottlenecks on strategic health purchasing (SHP) in Kenya to inform requisite SHP reforms in moving towards UHC. Against this backdrop, we assessed the progress and gaps in SHP in Kenya. Methods: We used a cross-sectional qualitative study design and collected data using document reviews, key informant interviews, and a stakeholder engagement workshop focussing on the three main purchasers in Kenya: the National Hospital Insurance Fund (NHIF), county departments of health (CDOH) and the Ministry of Health (purchaser for vertical programmes). Data was analysed following a framework analysis approach. Results: Kenya is making progress towards developing, implementing and institutionalising SHP practices that should lead to the attainment of health system goals. Progress has been made in 1) strengthening the process of defining a health benefits package available for the population, 2) engaging in selective contracting and integrated care contracting, 3) implementing multiple provider payment mechanisms, 4) designing legal and regulatory frameworks that provide direction for purchasing, and 5) increasingly utilising information systems. However, several gaps remain. First, there remain inadequate linkages between MOH policies and the NHIF that can facilitate adequate stewardship/oversight. Second, the purchasers lack adequate capacity to ensure quality assurance and enforce contracts. Third, provider payment methods (PPM) remain poorly designed, implemented, and are not adequately linked to health system goals. Finally, purchasers have weak or unclearly defined communications strategies to patients and providers. Conclusions: Although Kenya is making progress in SHP, key gaps remain. Consequently, there is a need to implement reforms that will align the purchasers’ actions and decisions to the ideals of strategic health purchasing.

An Efficient Delay Tolerant Networks Routing Protocol for Information-Centric Networking

Delay tolerant networks (DTN) is a good candidate for delivering information-centric networking (ICN) messages in fragmented networks due to disaster. In order to efficiently deliver ICN messages in DTN, the characteristics of multiple requester nodes for the same content and multiple provider nodes for the same request should be used efficiently. In this paper, we propose an efficient DTN routing protocol for ICN. In the proposed protocol, requester information for request packet, which is called an Interest in ICN, is shared by exchanging status table with requested Data ID, requester ID, and satisfaction flag, where satisfaction flag is defined to show the delivery status of Data, so that unnecessary forwarding of Data is avoided. Data is forwarded to a more probable node by comparing average delivery predictability to a set of requesters. Performance of the proposed protocol was evaluated using simulation from the aspect of Data delivery probability and Data overhead, for varying buffer sizes, number of relay nodes, and time-to-live (TTL) of Data. The results show that the proposed protocol has better Data delivery probability, compared to content distribution and retrieval framework in disaster networks for public protection (CIDOR) and opportunistic forwarding (OF) protocols, although there is a tradeoff from the aspect of Data overhead for varying buffer sizes and number of relay nodes.

An Observation Tool for Studying Patient-oriented Workflow in Hospital Emergency Departments

SummaryBackground: Studying workflow is a critical step in designing, implementing and evalu -ating informatics interventions in complex sociotechnical settings, such as hospital emergency departments (EDs). Known approaches to studying workflow in clinical settings attend to the activities of individual clinicians, thus being inadequate to characterize patient care as a cooperative work.Objectives: The purpose of this paper is twofold. First, we introduce a novel, theory-driven patient-oriented workflow method -ology, which better addresses the complex, multiple-provider nature of patient care.Second, we report the development of an observational tool and protocol for use in studies of this type, and the results of an evaluation study.Methods: We created a tablet computer implementation of an instrument to efficiently capture patient-oriented workflow, and evaluated it through a field study in three EDs. We focused on activities occurring over time during a single patient care episode as well as the roles of the ED staff members who conducted the activities.Results: The evidence generated supports the validity, viability, and reliability of the tool. The coverage of the tool in terms of ac -tivities and roles was satisfactory. The tool was able to capture the sequence of activity-role pairs for 108 patient care episodes. The inter-rater reliability assessment yielded a high kappa value (0.79).Discussion: The patient-oriented workflow methodology has the potential to facilitate modeling patient care in EDs by character -izing both roles and activities in sequence. The methodology also provides researchers and practitioners a more realistic and comprehensive workflow perspective that can inform the design, implementation and evaluation of health information technology interventions.