"We are called the et cetera": experiences of the poor with health financing reforms that target them in Kenya.

摘要: Through a number of healthcare reforms, Kenya has demonstrated its intention to extend financial risk protection and service coverage for poor vulnerable groups. These reforms include the provision free maternity services, user-fee removal in public primary health facilities insurance subsidy programme (HISP) poor. However, available evidence points inequity likelihood that will still be left behind with regards coverage. This study examined experiences financing target them. We conducted qualitative cross-sectional two purposively selected counties Kenya. collected data through focus group discussions (n = 8) in-depth interviews (n = 30) people lowest wealth quintile residing demographic surveillance systems, HISP beneficiaries. analyzed using framework approach focusing on four access dimensions; geographical accessibility, affordability, availability, acceptability. Health reduced barriers improved services counties. various limited extent which they benefited from these reforms. Long distances, lack transport, condition roads high transport costs especially rural areas facilities. Continued charging user fees despite their abolition, delayed reimbursements beneficiaries were seeking care from, informal exposed out pocket payments. Stock-outs medicine other medical supplies, dysfunctional equipment, shortage workers, frequent strikes adversely affected availability services. Acceptability was further by discrimination workers ineffective grievance redress mechanisms led feeling disempowerment among Pro-poor some extent. enhance effectiveness pro-poor ensure benefit fully them, there is need address across all dimensions.