Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya.

McCollum, Rosalind, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Otiso, Lilian, Mireku, Maryline, Muturi, Nelly, Martineau, Tim ORCID: https://orcid.org/0000-0003-4833-3149 and Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X (2019) 'Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya.'. International Journal for Equity in Health, Vol 18, Issue 1, p. 65.

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Abstract

BACKGROUND
Universal health coverage (UHC) is growing as a national political priority, within the context of recently devolved decision-making processes in Kenya. Increasingly voices within these discussions are highlighting the need for actions towards UHC to focus on quality of services, as well as improving coverage through expansion of national health insurance fund (NHIF) enrolment. Improving health equity is one of the most frequently described objectives for devolution of health services. Previous studies, however, highlight the complexity and unpredictability of devolution processes, potentially contributing to widening rather than reducing disparities. Our study applied Tanahashi's equity model (according to availability, accessibility, acceptability, contact with and quality) to review perceived equity of health services by actors across the health system and at community level, following changes to the priority-setting process at sub-national levels post devolution in Kenya.
METHODS
We carried out a qualitative study between March 2015 and April 2016, involving 269 key informant and in-depth interviews from different levels of the health system in ten counties and 14 focus group discussions with community members in two of these counties. Qualitative data were analysed using the framework approach.
RESULTS
Our findings reveal that devolution in Kenya has focused on improving the supply side of health services, by expanding the availability, geographic and financial accessibility of health services across many counties. However, there has been limited emphasis and investment in promoting the demand side, including restricted efforts to promote acceptability or use of services. Respondents perceived that the quality of health services has typically been neglected within priority-setting to date.
CONCLUSIONS
If Kenya is to achieve universal health coverage for all citizens, then county governments must address all aspects of equity, including quality. Through application of the Tanahashi framework, we find that community health services can play a crucial role towards achieving health equity.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Health Administration and Organization > WA 540 National and state health administration WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12939-019-0967-5
Depositing User:	Stacy Murtagh
Date Deposited:	16 May 2019 12:06
Last Modified:	17 Oct 2019 10:52
URI:	https://archive.lstmed.ac.uk/id/eprint/10781

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