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Risk-based support and compliance reform for the Kenyan health sector

Innovations in Investment Climate Reforms An Impact Evaluation Workshop Paris, November 2012. KENYA. Risk-based support and compliance reform for the Kenyan health sector. Impact Evaluation Concept Note. JAMBO!. Motivation: Health Facility Inspections Reform. Objective:

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Risk-based support and compliance reform for the Kenyan health sector

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  1. Innovations in Investment Climate Reforms An Impact Evaluation Workshop Paris, November 2012 KENYA Risk-based support and compliance reform for the Kenyan health sector Impact Evaluation Concept Note

  2. JAMBO!

  3. Motivation: Health Facility Inspections Reform Objective: • To provide transparent and cost-effective inspection and support for improving compliance with Joint Health Inspections Checklist • To reduce discretion of inspection through randomization and thereby provide a more uniform basis for a risk-based inspections regime, and increase efficiency in the process. Motivation • Kenya Constitution 2010: The right to the highest attainable level of healthcare • Fragmented inspections systems lacking a mechanism for joint inspections for regulatory groups • Official Gazettment of the IFC supported Joint Health Inspections Checklist and the drafting of the Health Bill & Health Professionals Council Bill, 2012. • The results of the IFC-WHO/ PharmAccess/ MOH Minimum Patient Safety Compliance Survey indicate a strong need to take action to improve patient safety

  4. Evaluation Question

  5. Evaluation Design 1:

  6. Evaluation Design 2: Randomization 8,000 registered health institutions in Kenya (sample size n=1000) BASELINE DATA COLLECTION Sample of Low-risk health institutions Sample of High-risk health institutions Control Group High-frequency inspections M-health M-health + SWAT

  7. Evaluation Design 3: Randomization 8,000 registered health institutions in Kenya (sample size n=1000) BASELINE DATA COLLECTION Sample of Low-risk health institutions Sample of High-risk health institutions Control Group High-frequency inspections Medium-frequency inspections

  8. Sampling and Data • Use of Service Provision Assessment/ Master Facility List raw data to inform sample size calculations. • Sample size approx n=1000 • Sampling and randomization at institution (clinic/hospital/etc) out of 8,000 institutions in Kenya keeping up National Representative Sample. Current Background Data availability: • Existing data and records from health inspections on selected facilities using the previous separate checklists • Data from the IFC-WHO joint Minimum Patient Safety Standards Survey conducted by IPSOS and with the technical assistance of PharmAccess and MOH on a sample of 500 private and public facilities in Kenya

  9. Sampling and Data Diagnostic Tools/ Data Collection: Joint Health Inspections (JHI) Checklist Tool • Data collection on JHI Tool completed at facility at Baseline and at End-line • Tool used to identify high risk facilities (HRF) and low risk facilities (LRF) through a set of risk-based Guidelines. • Facilities self-assess every year on the JHI checklist and submit to the regulatory authorities; penalties for inaccurate reporting. • Mid-Line Rapid Assessment Tool (RAT) administration: Administration of a shortened tool developed by factor analysis  RAT varied yearly on a random blinded basis Patient Exit Survey (mobile enabled) • Conducted at Base-line and End-line on all groups to determine movement in standard of service level as a result of interventions

  10. Project Team Core Government Team: Policy, Implementation, Coordination Permanent Secretary Ministry of Medical Services Director of Medical Services Dr. Judith Bwonya Ministry of Medical Services Mrs. Elizabeth Oywer Registrar, Nursing Council of Kenya Mr. Daniel Yumbya CEO, Medical Practitioners and Dentists Board Mr. PepelaWanjala Ministries of Health, M&E coordinator CEOs/ Registrars of the four other regulatory Boards and Councils Researchers: Research Design and Oversight Dr. Tomomi Tanaka Arizona State University Dr. Jeffery Tanner IEG – World Bank Francisco Campos World Bank, Africa FPD IFC personnel: In-Country Coordination and Research Input Ms. ShakirahHudani IFC-Health in Africa Mr. SyedEstem Islam IFC- IC M&E

  11. Timeline

  12. Innovations in Investment Climate Reforms An Impact Evaluation Workshop Paris, November 2012 KENYA Asante Sana!!Thank you!Merci. Impact Evaluation Concept Note

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