BackgroundThe Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap.MethodsBased on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007.ResultsThe total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals.ConclusionsThe results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies.

Despite the fact that state-recognized Indigenous persons in Canada are eligible for dental care benefits through the federally-funded Non-Insured Health Benefits (NIHB) program, Nunavut's Inuit suffer significant oral health disparities relative to the general Canadian population. This thesis explores how the administration of the NIHB program may contribute to the poor oral health outcomes for Nunavut's Inuit. It proposes that the program as it exists today is financially unsustainable, and is not conducive to public health objectives, identifying three possible areas of reform: the fee-for-service remuneration model, which creates financial incentives for providers to over-treat patients and is not well-suited for Nunavut's unique environment; the centralized administrative organization, which does not produce policies reflective of Inuit needs; and the provision of service days to communities, which does not follow any discernible formula. I conclude that increased devolution to an Inuit organization may offer solutions to each of these problems.