DRIVERS INFLUENCING DELIVERY OF DECENTRALIZED HEALTH SERVICES IN KENYA: A CASE OF WAJIR COUNTY

ABDIRAHMAN ALI BULLE

Abstract


In Kenya, the promulgation of the Constitution on August 27th 2010 ushered in a new era in the country’s governance system: devolution. The health sector is one of the functions devolved as clearly stipulated in the fourth schedule of the Constitution. The objective of this study therefore, was to investigate the drivers influencing delivery of decentralized health services in Wajir County. The specific objectives of the study include; establishing the influence of leadership and governance, county health policy, public participation and resources distribution on delivery of decentralized health services in Kenya. The target population was 661,941 according to the 2009 National Population and Housing Census. The sample size composed of 150 stakeholders in the health sector randomly selected across the County. Both quantitative and qualitative methods of data analysis were used. The tools used for data collection include: interview schedule and the use of questionnaire .The study established that all study variables (leadership and governance, resources distribution, public participation and accountability) had a significant influence on quality of health services delivery as shown by Beta coefficients of (0.461) (0.497) (0.486) and (0.446) respectively. The study also revealed a strong positive correlation between all study variables. The study revealed that devolution led to better resource utilization and operational efficiency in delivery of health services compared with a centralized system.

Key Words: Delivery, Decentralized ,  Health Services

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References


Ahmad, J. K., Devarajan, S., Khemani, S., & Shah, S. (2005). Decentralization and service delivery. World Bank Policy Research Working Paper, (3603).

Akin, J. S., Hutchinson, P., & Strumpf, K. S. (2001). Decentralization and government provision of public goods: the public health sector in Uganda. USAID.

Alfred Boateng Poku.(1993).Decentralization and Health Services Delivery, Uganda Case Study. University of Ghana, Legon, Ghana.

Anders Jeppsson.(2004). Decentralization and National Health Policy Implementation in Uganda-a problematic process. Lund University, Sweden.

B. C. Smith. (1997). The Decentralization of Healthcare in Developing Countries: Organizational Options. University of Dundee.

Blas, E., & Limbambala, M. E. (2001). User-payment, decentralization and health service utilization in Zambia. Health policy and planning, 16(suppl 2), 19-28.

Bossert, T. J., & Mitchell, A. D. (2011). Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan. Social Science & Medicine, 72(1), 39-48.

Brinkerhoff, D. W. (2004). Accountability and health systems: toward conceptual clarity and policy relevance. Health policy and planning, 19(6), 371-379.

Commission on Revenue Allocation. (2011). KENYA: County Fact Sheets 2011.

Conyers, D. (2007). Decentralisation and Service Delivery: Lessons from Sub‐Saharan Africa. IDS bulletin, 38(1), 18-32.

Dillinger, W. (1994). Decentralization and its implications for urban service delivery (Vol. 16). World Bank Publications.

Gilson, L., & Mills, A. (1995). Health sector reforms in sub-Saharan Africa: lessons of the last 10 years. Health policy, 32(1), 215-243.

Gilson, L., Kilima, P., & Tanner, M. (1994). Local government decentralization and the health sector in Tanzania. Public Administration and Development, 14(5), 451-477.

González-Block, M., Leyva, R., ATA, O. Z., Loewe, R., & Alagón, J. (1989). Health services decentralization in Mexico: Formulation, implementation and results of policy. Health Policy and Planning, 4(4), 301-315.

Grundy J, Healy V, Gorgolon L. (2003). Overview of Devolution of Health Services in the Philippines. Provincial Health Department, SthCotabato Province, the Philippines.

Jose Ignacio Anton and Rafael Munoc de Bustillo.(2012). Effects of Healthcare Decentralization in Spain from a citizens’ perspective. Munich Personal RePEc Archive, University of Salamanca.

Kalungu Michael, (2012). Decentralization Policy and Effective Health Service Delivery in Local Governments in Uganda, a case study of Igonga District Local Government.Makerere University, Uganda.

Kibua, T. N., & Mwabu, G. M. (Eds.). (2008). Decentralization and devolution in Kenya: New approaches. University of Nairobi Press.

KPMG. Devolution of Healthcare Services in Kenya.

Krishna Regmi, (2008).The effect of Decentralization on Health Services: the Nepalese experience. University of East London, London, UK.

Litvack, J. I., Ahmad, J., & Bird, R. M. (1998). Rethinking decentralization in developing countries. World Bank Publications.

Miguel Gonzalez-Block, Rene Leyva, Oscar Zapata, Ricardo Loewe and Javier Alagon. Health Services Decentralization in Mexico: Formulation, Implementation and Results of Policy. Institution National de Salud Publica, Mexico.

Mills, A., Vaughan, J. P., Smith, D. L., & Tabibzadeh, I. (1990). Health system decentralization: concepts, issues and country experience.

Ministry of Health.(2013). Kenya Service Availability and Readiness Assessment Mapping (SARAM) Report.

Nafula, N. N., Manda, D. K., Bedi, A., Mwabu, G., & Kimenyi, M. S. (2004). A review of the health sector in Kenya (No. 11). Kenya Institute for Public Policy Research and Analysis.

Nirvikar Singh. (2008). Decentralization and Delivery of Healthcare Services in India.University of Carlifonia, Santa Cruz.

Nyanjom, O. (2006). Inequality in Kenya’s Health sector. Reading on Inequality in Kenya, 1, 97-156.

Oyaya, C. O., & Rifkin, S. B. (2003). Health sector reforms in Kenya: an examination of district level planning. Health Policy, 64(1), 113-127.

Peters, D. H. (Ed.). (2009). Improving health service delivery in developing countries: from evidence to action. World Bank Publications.

P. M. Ndavi, S. Ogola, P.M. Kizito and K. Johnson. (2009). Decentralizing Kenya’s Health Management System: An Evaluation. University of Nairobi.

Pongpisut Jongudomsak, Jaruayporn Srisasalux. A decade of Decentralization in Thailand: What Lessons can be drawn?

Republic of Kenya.(2010).Kenya Health System Assessment 2010.

Richard B. Saltman, VaidaBankauskaite and KarstenVrangbaeic.(2009). Decentralization in Healthcare. Open University Press, New York.

Robalino, D. A., Picazo, O., & Voetberg, A. (2001). Does fiscal decentralization improve health outcomes? Evidence from a cross-country analysis. Evidence from a Cross-Country Analysis (March 2001). World Bank Policy Research Working Paper, (2565).

Saltman, R., Bankauskaite, V., & Vrangbaek, K. (2006). Decentralization in health care: strategies and outcomes. McGraw-Hill International.

Silverman, J. (1992). Decentralization: Economic policy and sector investment programs. Washington DC; WB.

Thomas J Bossert and Joel C Beauvais.(2002). Decentralization of Health Systems in Ghana, Zambia, Uganda and the Philippines; a comparative analysis of decision space. Oxford University Press.New York USA.

Von Braun, J., & Grote, U. (2000, November). Does decentralization serve the poor?. In International Monetary Fund Conference on Fiscal Decentralization, Washington, DC, November (pp. 20-21).

World Bank, (1997). World Development Report: The State in a Changing World. New York: Oxford University Press.

World Health Organization. Health System Decentralization; Concept, Issues and Country Experience. World Health Organization, Geneva.


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