Our ‘Dual Focus PhD’ series tracks the working lives of our part-time PhD fellows. Many work at the highest of levels, both nationally and internationally — and in normal times they come to Maastricht in person for our unique PhD Dual Career Training Programme in Governance and Policy Analysis (GPAC²). This time we catch up virtually with Purity Njagi who will shortly defend her thesis on “Financial risk, vulnerability and equity of access to health care services in Kenya”.
Your thesis is finished at a time where health care is on the top of our agenda. The whole world is struggling with the pandemic, and the title of your thesis reflects precisely the issues that we consider pressing these days. Yet, you did not study COVID-19 but looked at the health care system in Kenya more generally. Tell us more about your work.
My dissertation was motivated by the call to achieve universal health coverage, which means people should receive quality healthcare without suffering financial hardships. However, this has been a daunting task for many governments in Sub-Saharan Africa (SSA) countries such as Kenya, where mechanisms for financial risk protection are limited. Therefore, healthcare systems rely on out-of-pocket payments, which can often turn catastrophic and push some households into poverty.
My study, therefore, focused on the impact of the lack of financial risk protection. I started by assessing the extent of financial risk protection in SSA countries. Then using Kenya as a case study, I explored the socioeconomic inequalities in financial risk protection, the cost-related barriers to access healthcare services, and the impact of household shocks on access to healthcare services.
The findings of my thesis stress the pervasiveness of the financial risk burden in many SSA countries due to the lack of financial protection. In addition, it points to the existence of inequalities and variations in access to healthcare services across social-economic groups, rural-urban strata, and regions. The COVID-19 pandemic has not only exposed these inequalities within and across countries but has also exacerbated these disparities.
My study further provides insights on the effect of Idiosyncratic shocks in limiting the ability of households to invest in healthcare. These points to the role of social protection in building the financial resilience of families. For instance, COVID-19 has triggered adverse economic shocks on many households through the loss of livelihoods. Thus, it is almost like a cycle, which puts the household in a , problematic decision-making dilemma on spending their limited resources on healthcare.
Still, some of your findings may be very useful in the current global setting. What were the main policy recommendations contemporary achieve from your research that may help current policymakers achieve sound decisions?
The main policy recommendation emanating from my research is increased healthcare investment to improve the supply of quality healthcare services to meet all populations’ healthcare needs, especially the vulnerable people. This is underscored by the current COVID-19 pandemic, which has exposed the fragility of the healthcare systems and overstretched the existing healthcare resources. This creates the urgency to increase financing for healthcare, especially in resource-limited settings.
Another key recommendation is the need for a multi-sector approach and coordination across all sectors, given their interconnectedness and the drivers of equity extend beyond the healthcare sector. The coordination across sectors during the COVID-19 response is an excellent example of how collaboration with key sectors can help to catalyse achievements towards equity of healthcare.
Also, I recommend optimising the decentralised healthcare systems to improve access to the underserved and, more importantly, strengthen primary healthcare systems. We have seen the critical role of primary healthcare in early and timely diagnosis for not only COVID cases but also other ailments. This reduces the need for secondary healthcare services and reduces the strain on higher levels of healthcare so they can deal with more advanced cases. In the end, this could reduce the overall cost of healthcare.
You chose to engage in a part-time PhD programme, combining your job with family and work. Why did you choose to do your PhD? In addition, how did you manage to complete it within the average time of 5 years whilst being employed?
My work experience has been in monitoring and evaluating population and health programmes which essentially involves generating and synthesising evidence to inform better programming and policy decisions. I, therefore, considered taking a PhD as part of advancing my skills and gaining more expertise in evidence-based research. More so, having interacted with various healthcare systems in several East and Southern African countries, I was exposed to the contextual gaps and barriers in access to healthcare. Therefore, my motivation to take this PhD was coupled with my interest in health equity and contextual understanding.
I preferred a part-time PhD because it allowed me to keep learning through my day-to-day work while complementing my skills to perform better in my job. I had hoped that transitioning from full-time employment to consulting could offer me some more flexibility. However, the uncertainty of the work schedule that comes with consulting, including too much travelling outside my country, was very challenging. To manage this, I set aside specific time for my research, even if it meant just reading one article not to lose the momentum. I also committed to not missing any calls with my supervisors irrespective of my travels unless it was utterly impossible. My supervisors encouraged me to publish, and I used the publications as the “Prize” and worked to complete each chapter for submission. As a result, I managed to publish three papers, with the fourth one under final review.
If all goes well, your thesis defence will be one of the first activities that the GPAC2 programme hosts in person again. What would you recommend our first-year candidates to do during the workshop weeks, and how would you advise them to stay connected during the times they are home with their academic support team in the Netherlands?
I am very excited about the possibility to defend in person. It is a good way to have a final visit and goodbye to the place I have connected with for the last five years. Since the programme’s start, I never missed any workshop, and I stayed in until the last day. This was an opportunity to interact with the many skill sessions offered, some of which formed the basis of the methodological approaches I applied in my dissertation. Furthermore, you get to interact with the experts in these subjects who are very willing to offer additional advice. Importantly, I used the workshops to set my progress milestones. Every workshop, I purposed to present an advanced version of my research to optimise on the feedback from more people.
Remotely, my supervisors were supportive. From the get-go, we set up a working arrangement that I committed to abiding by. We had check-ins every two weeks. I used one touch-base to share my plan for the month and the other to share my monthly progress. This kept me on track, I never ‘lost touch’ with my research, and I consistently made progress. Even the smallest progress continues.
The opinions expressed here are the author’s own; they do not necessarily reflect the views of UNU.
UNU / H. Pijpers