Does Decentralization Deliver Health Services to vulnerable Groups in Kenya? A Case Study of Busia and Kakamega Counties -Kenya (original) (raw)
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One of the arguments in defense of local governments hinges on their ability to deliver public goods better because of their proximity to demand. Local governments operate on the basis of the concept of decentralization connoting the transfer of some level of formal responsibility, authority and/or resources to smaller, lower units of government in the form of counties, districts, regions or states. Decentralization takes different forms including deconcentration, devolution, delegation and privatization. The existing body of literature on decentralization and service delivery indicates that it can proffer considerable advantages although there is limited empirical evidence of positive outcomes. For example through increasing effectiveness in mobilization and allocative efficiency of resources, deepening citizen participation, and improving accountability mechanisms. This paper examines the framework for service delivery in the health sector in Kenya within the context of the country’s newly introduced devolved system of government. It examines three prerogatives of County Governments and their bearing on accountability for delivery of services in the health sector - i) resource mobilization, distribution and administration, ii) decision making, and iii) political accountability. The paper argues that devolution of the health function in Kenya faces challenges of coordination between the national and county governments which have left an amorphous sense of responsibility for service delivery. The paper concludes that devolution as is practiced in the health sector in Kenya involves a partial transfer of responsibility for service delivery to county governments that remits unbalanced accountability relations that potentially undermine the opportunities it creates or promises. It essentially splits up decision making capacity and resource management authority that makes it difficult for county governments to effectively deliver health care services but leaves accountability squarely on county governments.
Political Devolution and Health Service Delivery in Siaya County, Kenya
International journal of humanities & social studies, 2021
This study argues that health service is common good and a right to everyone and purposes to discuss political devolution and health service delivery in Siaya County of Kenya. The government has obligation to advance people's health and life expectancy (Abimbola, Negin & Martiniuk, 2014& Kieffer,2017). Working with the people of Ugunja Sub County of Siaya County this author understood that the citizens do not participate in health service delivery policy and implementation. On the other hand, Siaya County is credited to have led in enumerating community health workers. Nonetheless, this is because of the linear governance structure belief that the leaders (both political and administrative) know best what the citizens want. However, the 2010 Kenya Constitution is anchored on citizen participation to improve on services offered by the government. While devolution brought government services closer to the people, the county governments offer their services from the center. This raises the question of whether the devolved unit leadership were readied on the constitutional premise, 'the sovereign power of the state rests with the people', hence the requirement for public participation. Without such participation it is difficult to know citizen need yet within the communities' people have skills, knowledge and understanding of their problems with potential solutions (Vilka, 2004). Government of Kenya, The National Treasury and Planning (2017): Comprehensive public expenditure review (CPER), from evidence to policy reports that Siaya County has the highest infant mortality and lowest life expectancy at 47 years. This demonstrates a problem in health service delivery and prompted this researcher to explore effects of political devolution on health service delivery. In focus group discussions and interviews it came clear that systems of the county and national government politics affect policies that influence health service delivery. These service delivery challenges are anchored in systems theory (Bertalonffy, 1972; Faguet, 2014) and subsidiarity principle (Pope Pius, XI, 1931; Smoke 2015). The period covered by the CPER, 2017 also showed reduction in revenue allocation towards health from 8.6% to 7.6% as far below the Abuja Declaration of 1990 that each AU member state will raise their allocation for health to 15% of their GDP. Despite financial constraints, why did Siaya County not improve on the quality of health services as other counties? The answer may lie in political priorities influencing allocation of resources and lack of citizen participation in policy decisions that affect their daily lives. Engaging citizens and their participation is a democratic right. On the other hand, citizens are co-producers of health service among other services provided by the government. Therefore, their engagement, collaboration and partnership in the design, planning and implementation would provide a more effective outcome as citizens take
Strategic Journal of Business & Change Management
The constitution of Kenya (2010) introduced a devolved system of governance which entrenches health as a right for every citizen, to the highest attainable, standard of health. It Include the right to reproductive health. Further, it also designates the health services functions of the national and county governments as well as principles under which such services should be provided. Following the first general elections under the constitution of Kenya (2010) and creation of county governments, the need to address the administration, planning and management of health care services in response to the changes became imminent. The aim of this study was to establish the effects of devolution in strategy implementation of health care services. The specific objective was to establish the influence of devolution in strategy implementation of health care services. The study adopted a descriptive and explanatory research design since these tools allow the use of the gathered primary and secondary data. A simple random sampling was used for the study. Population can be defined as "any group of people, or observation, or test in which we happen to be interested (Bell 1997). Embu County has a total of 74 public health facilities; however for this study 24 health facilities were selected. The data obtained was analysed using descriptive and inferential, statistical analysis. The study established that devolution of health care services plays a significant role in implementing the primary health care strategy of increased responsiveness of health systems to local needs. It recommends that county governments should establish an enabling environment that is marked by the will and commitment of all health stakeholders, cogent strategy that addresses well articulated building blocks and a well thought out implementation process.
International Journal of Business and Management
The 2010 Constitution provides a legal framework that guarantees an all-inclusive rights-based approach to health service delivery to Kenyans. It provides that Kenyans are entitled to the highest attainable standards of health, which includes the right to healthcare services including reproductive health care (Article 43). The purpose of this study was to investigate the the extent to which management of devolved health services influence health-care service delivery in Arid and Semi-Arid Lands in Kenya. This study was guided by fiscal decentralization theory and theory of performance improvement, as well as sequential theory of decentralization. This study used a triangulation of both positivism and phenomenology. The population under this study constitute the Sub-Counties in ASAL in Kenya with a sample size of 89 Sub-Counties being sampled and 3 patients from each of the 89 sampled sub counties. This study found that, since the onset of devolution, there has been introduction of m...
DECENTRALIZATION OF HEALTH CARE SYSTEMS AND MORTALITY RATES IN KENYA
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Effect of Health Governance Structures on Provision of Health Care in Garissa County, Kenya
Journal of Humanities and Social Studies, 2020
Effect of Health Governance Structures on Provision of Health Care in Garissa County, Kenya 1. Introduction In recent years, governments and organizations are focused on improving governance through decentralization. The decentralization trend has been adopted in various countries in Latin America, Africa, and Asia (Rodríguez-Pose & Gill, 2003). Studies from these regions show that decentralization is an important aspect of improving governance and delivery of public service but it is faced with numerous complexities (Agrawal & Ostrom, 2001). According to Agrawal (1999) decentralization is achieved through various approaches that include, devolution, delegation, and privatization. This implies that there are different frameworks employed in decentralization of public functions based on the political, administrative, and fiscal aspects that are shared between the national and sub-national governance systems (Ahmad, Devarajan, Khemani, & Shah, 2005). The complexities emerging in the decentralization process are associated with the combinations that are executed in the sharing of political, administrative, and fiscal responsibilities. Additionally, major challenges emerge from the continuum required to facilitate the transformation from a highly centralized form of government to a decentralized and inclusive approach of governance (Musgrave, 1997). In Kenya, devolution has been adopted as a strategy of transferring authority and power from the central government through engaging a semiautonomous and sub-national structure of the county government. The 2010 constitution offers a legal framework that fosters an inclusive approach in rights-based health care delivery in the country. The law has entitled all Kenyans an opportunity to access the highest standards of health (Article 43). Additionally, Article 53 highlights the rights of all children to access basic nutrition, shelter, and healthcare. Article 56 implies that the state has the mandate to engage affirmative action that is focused on ensuring the needs of minorities and marginalized groups such as the people of Garissa county have reasonable access to water, health services, and infrastructure. In this light, the county government has to work in cooperation with the national government to increase efficiency in care delivery. The role of the county and national governments is presented in the Fourth Schedule of the constitution. The county government is in charge of basic health care, whereas the national government is in charge of health policy, county technical assistance and the management of national referral health facilities. The country's health sector consists of the
BMJ Global Health, 2018
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Health sector reforms in Kenya: an examination of district level planning
Health Policy, 2003
The paper examines health sector reforms in Kenya at the district level based on the Government of Kenya's Health Policy Framework of 1994. The authors present the context of and historical perspective to health sector reforms in Kenya and discuss the major reform policies including decentralization to the district level. The authors then review intended policy outcomes, investigating assumptions on which the implementation and effectiveness of the reform agenda at the local level are based. The authors argue that emphasis on outcomes rather than process have not supported sustainable reforms or achieved the government's goal of improving health and ensuring equity for the citizens of the country.
ABSTRACT The study was conducted in Kiryandongo District while limited to Mutunda Sub County and specifically in Karuma and Diima parishes respectively from November 2012- June 2013 and the major issue pertaining to decentralized health service delivery ranging from 2006-2013. The aims and objectives of this study was to analyze the implication of decentralized health service delivery, people’s perception on decentralized health service, the contributions of decentralized health service delivery, challenges of decentralized health service delivery, and come out with mitigation measures for addressing the challenges faced in decentralized health service delivery in Mutunda Sub County, Kiryandongo District. The study was conducted using cross sectional and descriptive design using both qualitative and quantitative methodology. The qualitative methods used included interviews that were guided by an interview guide. The quantitative methods of data collection employed mainly involved the use of close and open ended questionnaire, was filled in by the respondents. The findings show that most members of Mutunda Sub County were not aware about decentralized health service delivery in the Sub County while those who were aware said it was faced with a lot of challenges which hindered its performance in health service delivery. A lot of contribution was captured in the study by the researcher in Mutunda Sub County like bringing services near to the local people was the greatest contributions, for better health service delivery there is need for more funds to fasten proper service delivery, need to strengthen lower administrative units and continuous team building between health workers and the politicians.