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Background: National Health Insurance Fund (NHIF) outpatient services operate under capitation, and are strategically designed to enhance quality, equity, and affordability. However, despite this strategy, providers often demand out-of-pocket payments. This study investigates provider participation in strategic purchasing and its impact on NHIF’s outpatient service delivery.

Methods: A cross-sectional analytical study was conducted among 66 healthcare managers from facilities accredited to provide NHIF outpatient services in two counties in Kenya. The data were collected using structured questionnaires. Logistic regression analysis was performed to assess the association between study variables.

Results: Most respondents were male (36, 55%). The provision of NHIF outpatient services was significantly correlated with the monitoring provider performance by NHIF and the county department of health (Pmultivariate=0.024). There was a 31-fold increase in the likelihood of provision for monitored facilities. A significant difference (p=0.005**) was observed in monitoring health facilities. Monitoring was more common among private healthcare providers than public and faith-based health facilities.

Conclusion: The involvement of healthcare providers in strategic purchasing has not yet been achieved. County and NHIF quality assurance departments should regularly monitor providers’ performance to ensure the delivery of equitable and high-quality healthcare.


Strategic purchasing capitation national health scheme health financing Kenya

Article Details

Author Biographies

Eunice Mwangi, Aga Khan University, Kenya

Eunice Muthoni Mwangi serves is an Assistant Professor at the Aga Khan University's Department of Population Health in Nairobi. She holds a Ph.D. in health systems management and a Master’s in Public Health. Mwangi is a Health Systems Management scientist and a Trainer of Trainers (ToT) in Leadership Management and Governance in Health. Her research interests lie in enhancing health systems and public health, with a focus on improving access to health while minimizing financial burdens.

Wanja Mwaura-Tenambergen, Riara University, Kenya

Wanja Mwaura-Tenambergen is an Associate Professor of Health Systems Management with a focus on improving access to primary care health services, especially in rural areas of developing countries. She holds a PhD and a Master of Public Health (MPH) from Chulalongkorn University, Thailand. Wanja is dedicated to building partnerships to enhance education quality and research, with extensive experience in teaching, research, and project implementation.

How to Cite
Mwangi, E., & Tenambergen, W. (2024). Healthcare Providers’ Engagement in Strategic Purchasing of Outpatient Services: A Cross-sectional Analysis of the National Health Scheme in Kenya. Pan-African Journal of Health and Environmental Science, 3(1), 137–158.


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