Cost And Quality Of Healthcare Services Provided To Urban Refugees Through In-House And Outsourced Health Facilities In Nairobi, Kenya

ABSTRACT

More than half of the world’s refugees reside in non-camp settings, In Nairobi, approximately 55,000 refugees had been registered with United Nations High Commission for Refugees by end of 2012 (UNHCR, 2013).In recent years the UNHCR has documented a trend towards a growing number of refugees and asylum seekers residing in urban areas. Refugees in urban areas often face numerous problems limiting them from accessing the already overstretched government health services. Most urban refugees do not have a reliable source of income and hence cannot afford to pay for healthcare services. In Nairobi, healthcare for urban refugees is provided using donor funds through two main models: In-house health facility set up to provide healthcare services exclusively for urban refugees and through outsourcing from mainly existing faith based health facilities where refugees are treated and the costs passed to humanitarian organizations for settlement. Despite the increasing humanitarian crisis in Africa, there is shrinking humanitarian resources hence overstretching the already limited donor funds. There is need therefore to use the available donor funds in the most cost efficient way and ensure quality healthcare services. The main objective of this study is to determine and compare the cost and quality of healthcare services between in-house and outsourcing healthcare among urban refuges in Nairobi Kenya. The study employed a descriptive cross sectional design. Purposive sampling method was used to select the two facilities. Structured questionnaires were administered as exit interviews on refugee patients who were treated at the two facilities with the selected five common illnesses. The quality data was analysed using SPSS version 20 and cost data using excel 2007. The direct medical cost was at an average of Kshs 130.1per patient at the in-house facility and Kshs 588.02 per patient at the outsourced facility. The overhead costs were at an average of Kshs 800 pp and Kshs 349 pp respectively. Total average cost was Kshs 930.1per patient at in-house and kshs 937.02 per patient at outsourced facility. The quality of care indicators, clinician’s understanding of patients problems was statistically significant (χ2(1) =7.635, p=.006) patients being allowed to ask questions about their health was significant (χ2(1)=38.019,p=.000), patient being examined physically was statistically significant (χ2(1) =126.95,p=.000), drugs well utilized was also significant at( χ2(1)=36.837, p=.000).Laboratory utilization was higher at the outsourced facility compared to the in-house facility was significant (χ2(1)=23.214,p=.000). Comparing the cost at the two facilities, the direct medical cost was significantly different with in-house being the cheaper model (t-test=27.639, df 302.290 and p=.000) however with additional overhead costs, there was no significant difference in cost (t-test=-.346,df 302.290and p=0.729).Comparing quality of care, the results was subjected to a quality index measure. The in-house facility scored 87.53% while the outsourced facility scored 73.99% hence there was better quality of care at in-house facility compared to the outsourced centre. The study therefore recommends that the in-house model looks for ways of reducing their overhead costs (rent and salaries) since the direct average cost was significantly lower, with lower overhead costs, then the total average costs would be lower. The facility should also increase laboratory utilization (evidence based practices) since it scored high on all other quality measures apart from laboratory utilization.