Perspectives of Healthcare Managers, Policymakers, and Financial Experts on the Effectiveness of Asset Leasing in Enhancing Tertiary Healthcare Quality in Kenya

Background: Kenya’s public health sector is facing a crisis of poor quality of healthcare, as evidenced by an acute shortage of healthcare workers, frequent industrial unrest, broken-down healthcare facilities, and erratic supply of essential commodities. In a bid to enhance the quality of healthcare through the availability of modern medical equipment and technologies, the government, since 2015, rolled out asset leasing financing for national referral healthcare facilities. Methods: We conducted a study with the objective of exploring stakeholders’ perspectives on the effectiveness of asset lease financing in enhancing the quality of tertiary healthcare in Kenya. The study used qualitative data, utilizing a case study design and an interpretivism approach. A total of 32 stakeholders participated. These include 7 Ministry of Health policymakers, 7 National Treasury policymakers, 10 tertiary hospitals managers, and 8 social health investors’ financial experts. We used semi-structured interviews to collect qualitative data, which was transcribed and analyzed using a thematic approach. Results: The results showed that though Asset Leasing Financing mechanism has addressed structural inequities by redistributing high-end medical infrastructure across tertiary hospitals geographies and contributed to improved timeliness and reach of care, stakeholders felt that it has not fully achieved its transformative potential in Kenya’s healthcare due to a convergence of governance weaknesses, implementation inefficiencies, and institutional misalignments. Conclusions: We recommend the need for a contextualized, accountable, policy-backed but possibly an asset leasing model decentralized to the tertiary hospitals governance. This could enhance the entire delivery of the financing model to improve tertiary healthcare quality. We also demonstrated the theoretical contribution and local policy implication of the study.