Publication: Performance Evaluation of Public Health Laboratories in Kenya
Loading...
Published
2018-02
ISSN
Date
2018-05-03
Editor(s)
Abstract
This paper presents findings from a performance evaluation of laboratories in Kenya supported under the East Africa Public Health Laboratory Networking Project (EAPHLNP). The aim of the evaluation was to document progress and lessons learned, to enhance performance and foster sustainability.
Link to Data Set
Citation
“Lehmann, Joel; Muture, Bernard; Matu, Martin; Schneidman, Miriam. 2018. Performance Evaluation of Public Health Laboratories in Kenya. Health, Nutrition and Population Discussion Paper;. © World Bank. http://hdl.handle.net/10986/29781 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication East Africa Public Health Laboratory Networking Project(World Bank, Washington, DC, 2016-04)This report summarizes the main findings from the application of performance based incentives linked to progress on a standardized, globally recognized metric - the stepwise laboratory improvement process towards accreditation (SLIPTA) checklist - under the East Africa Public Health Laboratory Networking Project (EAPHLNP) in Rwanda. The lab performance-based financing (PBF) pilot was introduced in the context of a well-established national PBF program dating back to the early 2000s. The flexible nature of the EAPHLNP and the favorable context in Rwanda provided an ideal backdrop to introduce PBF incentive payments to accelerate progress of five project supported labs towards accreditation. The evaluation found improved laboratory performance at all project-supported laboratories in Rwanda as measured by the SLIPTA scores. For the first time, laboratories were bringing in PBF revenues, instilling a culture of continuous quality improvements, and focusing management attention on accreditation. PBF appears to have contributed to an accelerated change, with PBF laboratories experiencing an overall greater increase in SLIPTA scores compared to project-supported laboratories in the other countries. No clear patterns were found in terms of improved test volumes or test accuracy, which were not part of the pilot scheme. While it was difficult to disentangle the effects of different interventions, the evaluation found a system-strengthening value to combining investments in modernizing laboratories, and strengthening human resources with PBF. Relationships between laboratory staff and clinicians improved, with laboratory managers having a greater voice in hospital management and lab staff increasingly valued and respected by clinicians. A spirit of teamwork prevailed at participating sites. Other countries considering PBF mechanisms for public health laboratories need to take into account lessons learned and assess the features which may be relevant to their own contexts. PBF schemes for laboratories need to be viewed as an integral part of a package of interventions that contribute to enhanced performance.Publication Laboratory Professionals in Africa : The Backbone of Quality Diagnostics(World Bank, Washington, DC, 2014-11)Laboratories have historically been under supported in developing country health systems resulting in poor quality diagnosis and inadequate disease surveillance. Laboratory professionals are predominantly male with relatively limited female labor participation, with potential gender based barriers to advancement. The focus on communicable diseases has meant that funding for broader public health laboratory services has been relatively neglected. In this paper the authors present a number of strategies to address these problems based on the outcomes from a literature review and case studies conducted in four African countries. Improved registration and human resource planning are required to establish the scale of the problem and to develop country specific strategies to address skills shortages. More high quality pre-service training is needed to supply the service with suitably skilled professional staff to address the current deficit. Innovative in-service training is essential to maintain competence and collaboration is required with the private sector to utilize their expertise. A clear career structure with transparent promotional opportunities is required to recruit and retain staff in the public sector. The establishment of suitable work environments and regulatory and representative bodies will also support recruitment and retention as well as enhance quality. It is also clear that this cadre has been underrepresented in human resources for health research and more activity in this area will lead to greater understanding of the problems and provide more potential solutions.Publication Evaluating the Economic and Health Impacts of Investing in Laboratories in East Africa(World Bank, Washington, DC, 2015-05)Laboratories provide essential services to the health sector on the monitoring and treatment of disease. Routine implementation of new diagnostic techniques may be costly; therefore, understanding their clinical utility, impact, and cost-effectiveness are necessary to guide decisions as to whether and how such techniques should be implemented. In this study, the authors design a conceptual framework for examining the following: (1) optimal mix of laboratory services at different levels of the health system; (2) combination of resources required within laboratories to promote efficiency; and (3) potential for outsourcing to promote cost containment. The framework considers both the health and economic rationale for laboratory investments. The authors then use the conceptual framework to inform a decision analytics model that maps out the health and economic impact of laboratory investments, and to illustrate the model by investigating the best placement of a new technology (GeneXpert) for detecting multi-drug-resistant tuberculosis (MDR-TB). The illustrative application of the model shows that investment in a new diagnostic technology for MDR-TB is cost-effective regardless of placement in a district-level (satellite) or national-level (reference) laboratory. Placement of the GeneXpert system at the satellite laboratory results in patients tested for MDR-TB or TB at lower costs than the reference laboratory. Furthermore, if testing occurs at the satellite laboratory, more primary and secondary cases are treated and cured than if testing was conducted at the reference laboratory, leading to better outcomes. Overall, testing at the satellite laboratory results in more deaths averted and more disability life-adjusted years (DALYs) saved. Both facilities have average costs per DALY well below the World Health Organization (WHO) - suggested threshold for the per capita gross domestic product (GDP). However, the satellite laboratory saves more DALYs at a lower additional cost per DALY.Publication Hospital Performance in Brazil : The Search for Excellence(Washington, DC : World Bank, 2008)This book combines a comprehensive overview of the Brazilian hospital sector with in-depth analyses of the key elements of interest in promoting and ensuring excellence in hospital performance. It does so in an accessible manner and within the organizational and financial context of Brazil. Thus, the book can offer specific recommendations that go to the heart of the problem, as well as suggest what kinds of approaches work in that context. The recommendations themselves are based on what works in Brazil while drawing on international experiences relevant to the Brazilian context to broaden the policy options. But the authors go a step further by providing recommendations on implementation, specifically highlighting the need to strengthen governance arrangements, improve accountability, and sharpen resource management.Publication Performance-Based Contracting in Health : The Experience of Three Projects in Africa(World Bank, Washington, DC, 2008-04)Performance-based contracting in health is an example of a results-based financing approach to improving health service delivery. In 2003 and 2004 the Global Partnership on Output-Based Aid (GPOBA) supported the design of three schemes using performance-based contracting in Uganda, the Democratic Republic of Congo, and Rwanda. GPOBA's technical assistance has led to three innovative projects funded by the World Bank and the Canadian International Development Agency (CIDA). This note reviews early lessons from these schemes.
Users also downloaded
Showing related downloaded files
Publication What to Do When Foreign Direct Investment Is Not Direct or Foreign(World Bank, Washington, DC, 2017-04)As globalization has intensified, multinational enterprises' investments have become a sophisticated set of financial transactions that are difficult to monitor and classify by the home and host countries. In some cases, what is classified as foreign direct investment is rather "indirect foreign direct investment," channeled through a third country. Indirect flows have increased significantly in recent years, now accounting for almost 30 percent of global foreign direct investment flows. Indirect foreign direct investment flows also capture the flow of domestic funds channeled through offshore centers back to the local economy in the form of direct investment, also known as "foreign direct investment round tripping." These investments do not offer the benefits of typical foreign direct investment, and may lead to tax revenue and welfare losses. Round tripping is mostly channeled through offshore financial or transshipping centers. In most cases, domestic companies round trip their investments to benefit from preferential treatments reserved for certain countries and their firms. The most important policy measure to reduce round tripping activity and mitigate its impact is to improve the business environment for all firms; this can foster domestic and foreign investment, and may, to some extent, also curb foreign direct investment round tripping. Nevertheless, countries also need to adapt to the new playing field for foreign direct investment, and recognize the trade-offs of their national policies on capital flows. National policy measures must be complemented by international actions. At the same time, all indirect foreign direct investment flows should be closely monitored, something that is best conducted in coordination with international partners.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Factors Explaining Child Work and Education in Myanmar(World Bank, Washington, DC, 2022-12)Child workers constitute a significant share of the Myanmar labor force, which has translated into an unprotected child labor market. Given the prevalence of issues surrounding school enrollment and dropout rates, this paper investigates the relationship between child work and education. Using data from the 2015 Labor Force survey, it studies what factors explain child work and how this can in turn affect schooling outcomes. The study differentiates between children’s household chores and wage work. To understand if these two types of activities affect schooling differently, the paper explores if and how work intensity (number of hours worked) plays a role. The findings show that child work has a negative correlation with school enrollment and attendance, to differing degrees depending on the type of work and work intensity, regardless of gender. Overall, wage work is negatively correlated with enrollment and attendance disproportionately more than household chores. Work intensity seems to play a smaller role, but it still matters when looking at girls’ participation in household chores. Working long hours does not seem to have a link with the likelihood of being enrolled and attending school, although it could affect learning outcomes as it reduces the amount of time dedicated to homework and study. However, the data source being some years old, the analysis may not fully reflect the most recent economic and social developments and conditions in Myanmar.Publication Measuring Empowerment in Practice : Structuring Analysis and Framing Indicators(World Bank, Washington, DC, 2005-02)This paper presents an analytic framework that can be used to measure and monitor empowerment processes and outcomes. The measuring empowerment (ME) framework, rooted in both conceptual discourse and measurement practice, illustrates how to gather data on empowerment and structure its analysis. The framework can be used to measure empowerment at both the intervention level and the country level, as a part of poverty or governance monitoring. The paper first provides a definition of empowerment and then explains how the concept can be reduced to measurable components. Empowerment is defined as a person's capacity to make effective choices; that is, as the capacity to transform choices into desired actions and outcomes. The extent or degree to which a person is empowered is influenced by personal agency (the capacity to make purposive choice) and opportunity structure (the institutional context in which choice is made). Asset endowments are used as indicators of agency. These assets may be psychological, informational, organizational, material, social, financial, or human. Opportunity structure is measured by the presence and operation of formal and informal institutions, including the laws, regulatory frameworks, and norms governing behavior. Degrees of empowerment are measured by the existence of choice, the use of choice, and the achievement of choice. Following the conceptual discussion and the presentation of the analytic framework, this paper illustrates how the ME framework can be applied, using examples from four development interventions. Each example discusses how the framework guided analysis and development of empowerment indicators. The paper also presents a draft module for measuring empowerment at the country level. The module can be used alone or be integrated into country-level poverty or governance monitoring systems that seek to add an empowerment dimension to their analysis.Publication Building Systems for Universal Health Coverage in South Korea(World Bank, Washington, DC, 2015-03)This paper broadly examines the development process of Korea’s health care system toward the achievement of Universal Health Coverage. Korea implemented a series of health care reforms after a rapid expansion of population coverage to improve efficiency and equity in financing and delivery of health care. The authors also investigate changes in the governance structure of Korea’s national health Insurance, which is now represented by two agencies: National Health Insurance Service (NHIS) and Health Insurance Review and Assessment Service (HIRA). Health insurance agencies have improved the accountability and transparency of the health insurance system, thanks to the ICT-based centralized claim review and assessment. Lessons and challenges from Korea’s experiences and achievements on the road to UHC could provide valuable policy implications to low- and middle-income countries.