title: Opportunities and challenges for implementing cost accounting systems in the Kenyan health system.
abstract: BACKGROUND
  Low- and middle-income countries need to sustain efficiency and equity in health financing on their way to universal health care coverage. However, systems meant to generate quality economic information are often deficient in such settings. We assessed the feasibility of streamlining cost accounting systems within the Kenyan health sector to illustrate the pragmatic challenges and opportunities.
  
  
  METHODS
  We reviewed policy documents, and conducted field observations and semi-structured interviews with key informants in the health sector. We used an adapted Human, Organization and Technology fit (HOT-fit) framework to analyze the components and standards of a cost accounting system.
  
  
  RESULTS
  Among the opportunities for a viable cost accounting system, we identified a supportive broad policy environment, political will, presence of a national data reporting architecture, good implementation experience with electronic medical records systems, and the availability of patient clinical and resource use data. However, several practical issues need to be considered in the design of the system, including the lack of a framework to guide the costing process, the lack of long-term investment, the lack of appropriate incentives for ground-level staff, and a risk of overburdening the current health management information system.
  
  
  CONCLUSIONS
  To facilitate the implementation of cost accounting into the health sector, the design of any proposed system needs to remain simple and attuned to the local context.
authors.affiliation: Wellcome Trust Research Program, Kenya Medical Research Institute, Nairobi, Kenya.|Ministry of Health, Nairobi, Kenya; Ekihuba@kemri-wellcome.org.
authors.forename: Elesban
authors.initials: E
authors.lastname: Kihuba
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gheorghe
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Fiammetta
authors.initials: F
authors.lastname: Bozzani
authors.affiliation: Wellcome Trust Research Program, Kenya Medical Research Institute, Nairobi, Kenya.|Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
keywords: Kenya; cost accounting; costing; health information systems; low- and middle-income countries; unit cost