DRIVERS OF PERFOMANCE OF DEVOLVED HEALTH PROJECTS IN KENYA: A CASE OF BOMET COUNTY
In August 2010, Kenya adopted a new constitution that introduced a new governance framework with a national government and 47 counties . Kenya in an effort to improve resource allocation and regional development has pursued devolved governance and decentralized health services subsequently followed under the new framework, the responsibility for health service delivery is to the counties while policy, national referral hospitals, and capacity building are the national government’s responsibility. However, the perfomance of the helath projects since they were devolved has not met the expetrations of the stakeholders.The objective of this study therefore, was to establish the drivers of perfomance of health projects in Kenya with a case of Bomet County. The specific objectives of the study included; establishing the influence of leadership and governance, monitoring and evaluation, budgetary allocation and development partners on perfomance of devolved health projects in Kenya. The target population was health pojects in the county. The secondary data was obtained from published documents such as journals, periodicals, magazines and reports to supplement the primary data. A pilot study was conducted to pretest the validity and reliability of instruments for data collection. The primary data was collected by use census survey. The quantitative data was analyzed with help of SPSS version 21 and Excel. The study adopted correlation and regression analysis at 5% level of significance to determine strength and direction of the relationship of the variables under study. The analysis showed that leadership and governance had the strongest positive (Pearson correlation coefficient =.792; p-value= .011< .05) influence on performance of devolved health projects in Bomet county. In addition, budgetary allocation, monitoring and evaluation and development partners are positively correlated performance of devolved health projects (Pearson correlation coefficient =.577, .545 and .539; p- value= .022<.05; .036<.05; .048< .05) respectively.The study established that the independent variables influenced performance of devolved health projects in the study area. The study also recommends that there is need to have leadership,enough budgetary allocation effective monitoring and evaluation and the supportive development partners to enhance performance of the devolved health projects in the study area.Finally, very little has been undertaken to explore drivers of performance of health projects in Kenya reason why the study recommends for similar studies to be undertaken in other counties in Kenya for generalization of the findings of this study.
Key Words: Devolved Health Projects, Leadership & governance, Budgetary Allocation, Monitoring & Evaluation, Development Patners
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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