Perceptions and Attitudes of Health Professionals in Kenya on National Health Care Resource Allocation Mechanisms: A Structural Equation Modeling

BackgroundHealth care resource allocation is key towards attaining equity in the health system. However, health professionals’ perceived impact and attitude towards health care resource allocation in Sub-Saharan Africa is unknown; furthermore, they occupy a position which makes them notice the impact of different policies in their health system. This study explored perceptions and attitudes of health professionals in Kenya on health care resource allocation mechanism.MethodWe conducted a survey of a representative sample of 341 health professionals in Moi Teaching and Referral Hospital from February to April 2012, consisting of over 3000 employees. We assessed health professionals’ perceived impact and attitudes on health care resource allocation mechanism in Kenya. We used structural equation modeling and applied a Confirmatory Factor Analysis using Robust Maximum Likelihood estimation procedure to test the hypothesized model.ResultsWe found that the allocation mechanism was negatively associated with their perceived positive impact (-1.04, p p p p p p p ConclusionThe result suggests that health care resource allocation mechanism has a negative effect towards perceptions, attitudes and overall satisfaction of health professionals who are at the frontline in health care. These findings can serve as a crucial reference for policymakers as the Kenyan health system move towards devolving the system of governance.

背景：医疗资源配置是实现卫生体系公平的核心要义。然而，撒哈拉以南非洲（Sub-Saharan Africa）地区医护人员对医疗资源配置的感知影响与态度仍不明确；且这类人员身处卫生体系一线，能够直观体察各项政策对本国卫生系统的实际作用效果。本研究聚焦肯尼亚医护人员，探究其对本国医疗资源配置机制的感知与态度。
方法：本研究于2012年2月至4月期间，在拥有3000余名员工的莫伊教学转诊医院（Moi Teaching and Referral Hospital）中，针对341名具有代表性的医护人员开展了问卷调查。本研究评估了肯尼亚医护人员对本国医疗资源配置机制的感知影响与态度，并采用结构方程模型（Structural Equation Modeling），通过稳健极大似然估计（Robust Maximum Likelihood）程序开展验证性因子分析（Confirmatory Factor Analysis），以检验所预设的假设模型。
结果：研究发现，医疗资源配置机制与医护人员感知到的积极影响呈负相关关系（-1.04, p p p p p p p）。
结论：研究结论表明，医疗资源配置机制会对一线医护人员的感知、态度与整体满意度产生负面影响。在肯尼亚卫生体系推进治理分权化改革的进程中，本研究结果可为政策制定者提供关键参考依据。