Centre for Health Solutions

In Sub-Saharan Africa, female entrepreneurs are well represented in healthcare but struggle to access financial services. Digital financing technologies could help close this gap. This study assessed the readiness, perspectives and gender disparities in (digital) loan characteristics among Kenyan health Small and Medium Enterprises (SMEs). We interviewed 24 and surveyed 410 health SME owners and retrieved loan-history data for 850 health SMEs. Appropriate parametric and non-parametric tests were used to compare key variables across groups, focusing on gender disparities. In addition, multiple regression analyses were employed to explore how different factors, particularly gender, influence uptake and characteristics of traditional and digital loans taken. In-depth interviews (IDIs) identified low trust in digital lenders, while survey results indicated a strong demand for loans, regardless of gender. SME owners willing to take risks (OR = 2.32, p = 0.052), with monthly financial needs (OR = 4.22, p = 0.001), and positive perceptions of digital loans (OR = 3.14, p = 0.004) were more likely to take a digital loan, compared to the low risk takers, those who never or rarely experience acute financial needs, and those with negative perception of digital loans, respectively. Loan-history data showed a gender difference in the initial traditional loan amount, with women-owned businesses receiving an estimated 47.7% less than the male counterparts (p = 0.022) however, this gap disappeared for digital loans. Over 50% of women-led businesses using digital loans experienced significant growth, suggesting increased digital revenues linked to these loans. This study underscores the financing gap faced by Kenyan health SMEs and demonstrates the potential of digital loans to improve financial inclusion, particularly for female entrepreneurs. It addresses a gap in the literature by providing new evidence on how digital financial products can reduce gender-based barriers in the health sector. Low trust in digital lenders, especially among non-users, highlights the need for improved information and transparency to foster confidence in these tools.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-23045-4.

BackgroundRoutine program data indicates positivity rates under 2% from HIV testing services (HTS) at sites supported by Centre for Health Solutions-Kenya in Central Kenya. Achieving the UNAIDS 95:95:95 goals requires continuous identification of people living with HIV in an environment of diminishing resources. We assessed non-clinical and clinical characteristics of persons who tested HIV-positive aimed at improving the process of HTS through Provider-Initiated HIV Testing & Counseling (PITC).MethodsWe conducted a retrospective analysis of routine PITC program data collected between October 2018 and September 2019 from six health facilities located in three counties in central Kenya. Stratification was based on county and facility volume. A multivariable logistic regression model, clustered adjusted for facility using robust standard errors, was used to determine predictors of a positive HIV result.ResultsThe total sample was 80,693 with an overall positivity rate of 1.2%. Most, (65.5%), were female and 6.1% were < 15 years. Most clients, 55,464 (68.7%), had previously tested for HIV. Client characteristics associated with a higher odds of positivity on multivariable analysis included: being female (adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI] (1.03–1.57); adults 15 years and above compared to children < 15 years, divorced and married polygamous compared to married monogamous [aOR 3.98, 95% CI (2.12–7.29) and aOR 2.41 95% CI (1.48–3.94) respectively]; clients testing for the first time compared to repeat testers in less than 12 months [aOR 1.39, 95% CI (1.27–1.51)]. Similarly, repeat testers in more than 12 months compared to repeat testers in less than 12 months [aOR 1.90, 95% CI (1.55–2.32)]; presumptive TB clients compared to those without signs of TB [aOR 16.25, 95% CI (10.63–24.84)]. Clients tested at inpatient departments (IPD) were more likely to get a positive HIV result compared to those tested at outpatient departments (OPD), and other departments.ConclusionsThe study findings highlight client characteristics such as age, marital status, HIV test entry point, first-time test, repeat test after 12 months, and TB status as factors that could influence PITC results and could be used to develop a screening tool to target eligible clients for HTS in low HIV prevalence settings.

Expanded access to HIV treatment services has improved outcomes for children and adolescents living with HIV in Kenya. Minimal data are available on these outcomes. We describe temporal trends in outcomes for children and adolescents initiating antiretroviral therapy (ART) from 2004 to 2014 at sites supported by Centre for Health Solutions—Kenya, in central Kenya. We retrospectively analyzed data from children 0–9 years of age (n = 3,519) and adolescents 10–19 years of age (n = 1,663) living with HIV, who newly initiated ART at 47 health facilities in central Kenya. Year cohorts were analyzed from the Comprehensive Patient Application Database (CPAD) and International Quality Care (IQCare) electronic medical databases, including temporal trends in outcomes and associated factors using multivariable competing risk regression analysis. There were more girls (2,453 [52.7%]) than boys, with most enrolled at World Health Organization (WHO) stage II (1,813 [37.7%]) or III disease (1,694 [35.1%]). Most of the children and adolescents (4,431 [96.4%]) did not have tuberculosis (TB) symptoms. Cumulative lost to follow-up (LTFU) incidence at 6, 12, 24, and 36 months were 5.0%, 9.9%, 22.9%, and 33.1%, respectively. Cumulative mortality incidence at 6, 12, 24, and 36 months were 0.7%, 1.0%, 1.2%, and 1.5%, respectively. The incidence of LTFU was higher among female children and adolescents, those initiated on tenofovir-based regimens, and those with presumptive TB symptoms. Mortality risk was higher among those with WHO stage III or IV disease, and children and adolescents on TB treatment or who had presumptive TB. Enrollment occurred at a young age and pediatric-friendly ART regimens were initiated at earlier WHO stages implying effective early infant diagnosis and treatment for all strategies, resulting in improved treatment outcomes. The higher retention rates in recent years as well as the lower retention after many years of follow-up underscore the importance of implementing longitudinal follow-up strategies targeting this population.

Background: Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid and lower-level cadres limit access to effective contraceptive methods in many settings. Task sharing and task shifting are strategies that can be adopted to increase uptake of health services including family planning. Methods: We collected data through online survey, key informant interviews and focused grouped discussions with an intervention group and that implemented the task sharing and task shifting policy guidelines and a control group that did not implement the policy. A total of 434 questionnaires were filled by health workers’ in primary health care facilities to assess effectiveness of task sharing and task shifting on the uptake of family planning services including its strengths and challenges. The questionnaire was designed with the aim of getting data on services provided by the cadres on effectiveness (number of clients, increase in use of methods, access to services), how they perceive these tasks, the bottlenecks and facilitating factors associated with the practice of task sharing and task shifting. Results: We found out that the task sharing and task shifting can expand and increase access to services as stated by 95% of the respondents. Most community health workers provided more of the family planning services at 45% with only 5% of the services of family planning being provided by medical officers. 98% of family planning services were integrated with other services. Task shifting was beneficial to the health care providers as well as the clients and the success of task sharing and task shifting depended on training, supportive supervision and a regulated environment through policies. Conclusion: The study shows that formalized task sharing and task shifting can increase health service uptake especially when community health workers are involved to provide services in the community. This leads to increased service provision, equivalent health professional performance across cadres and patient outcomes in the provision of family planning services.

Building capacity in implementation science within health programs is dependent on training in theory and practice of epidemiology, statistics, and research in addition to high self-efficacy toward application of training. This article describes a training program providing technical assistance to more than 300 health facilities in Kenya and Tanzania, its evaluation results, and its ability to improve participants' knowledge, competencies, and self-efficacy on data management, analysis, and dissemination among health care professionals. Two months prior to the training, participants (n = 98) were emailed a pre-course survey including 19 questions using a Likert-type response for planning the content of the workshop. Six to 12 weeks after the training, a post-course survey was emailed to all participants. Five different trainings were conducted indicating 5 participant cohorts. The questions posed involved course satisfaction, course impact on knowledge and skills, and self-efficacy in data analysis and utilization. Post-course survey results revealed that the participants had confidence in data analysis, which was significantly different from the pre-test results (0.05 α). Qualitative commentary complemented the findings of the impact of the workshop. Four manuscripts and 13 abstracts have been submitted post training. Results suggest that a short-term training program can achieve immediate gains in data and research self-efficacy among health care professionals. Although increasing self-efficacy is a necessary first step in developing skills, educators should engage in continuing education for sustainable dissemination practices. There is an urgent need to determine the current infrastructure to promote scientific dissemination. This will assist countries to produce better evidence to support their programs, policies, and overall health programs.