Can a private sector engagement intervention that prioritizes pro-poor strategies improve healthcare access and quality? A randomized field experiment in Kenya

• DOI: 10.1093/heapol/czad076
• Publication Date: 2023-08-21T14:37:53Z
• Authors: Claire E Boone; Paul J Gertler; Grace Makana Barasa; Joshua Gruber; Ada Kwan
• Keywords: Kenya; Equity

Abstract Private sector engagement in health reform has been suggested to help reduce healthcare inequities sub-Saharan Africa, where populations with the most need seek least care. We study effects of African Health Markets for Equity (AHME), a cluster randomized controlled trial carried out Kenya from 2012 2020 at 199 private clinics. AHME included four clinic-level interventions: social insurance, franchising, SafeCare quality-of-care certification programme and business support. This paper evaluates whether increased capacity clinics serve poor clients while maintaining or enhancing quality care provided. At endline, that received were 14.5 percentage points (pp) more likely be empanelled National Insurance Fund (NHIF), served 51% NHIF middle three quintiles wealth distribution compared control Comparing individuals living households near treatment (N = 8241), led 6.7-pp increase probability holding any insurance on average. did not find additional effect among households. measured using standardized patient (SP) experiment 596 SP–provider interactions) recruited trained SPs present as either ‘not poor’, able afford all services provided, ‘poor’ by telling provider they could only ∼300 Kenyan Shillings (US$3) fees. found lower levels both correct unnecessary services, affect this. More work must done ensure receive high-quality