Challenges of Implanting Devolved Health Care in the Counties in Kenya
Kenya’s health care system has remained largely centralised with decisions taken at MOH headquarters from where they are conveyed top-down through the provincial medical officers to the district level. Centralised functions at the headquarters include policy formulation, coordinating activities of all health players (government and non-governmental organizations), initiating and managing implementation of policy changes on various issues including charging of user fees, and undertaking monitoring and evaluation of impact of policy changes at the district level.nb
MOH through the various health sector strategic plans has expressed commitment to decentralisation intended to provide increased authority for decision making, resource allocation, and management of health care to the district and facility levels. For example, in 1992 the MOH established the District Health Management Teams (DHMTs) and the District Health Management Boards (DHMBs), which were charged with managing public health services at the district level. Together, the DHMT and DHMB are supposed to provide management and supervisory support to lower level health facilities (sub-district hospitals, health centres, and dispensaries).
Health care provision within the devolved system of government as provided for in the Constitution of Kenya (2010) will come up against several obstacles, key among these being the challenge posed by uneven inter-county levels of development, unequal distribution of resources for health especially the distribution of health facilities, human resources, and poorly developed communication infrastructure. Also unevenly distributed across the country are poverty levels, the effect of which is to make health services largely inaccessible to a large chunk of the population that cannot afford the high out-of-pocket expenditures, which are known to be common in Kenya. Some counties starting at a relative disadvantage will take time to build up their capacity and ability to use
MOH through the various health sector strategic plans has expressed commitment to decentralisation intended to provide increased authority for decision making, resource allocation, and management of health care to the district and facility levels. For example, in 1992 the MOH established the District Health Management Teams (DHMTs) and the District Health Management Boards (DHMBs), which were charged with managing public health services at the district level. Together, the DHMT and DHMB are supposed to provide management and supervisory support to lower level health facilities (sub-district hospitals, health centres, and dispensaries).
Health care provision within the devolved system of government as provided for in the Constitution of Kenya (2010) will come up against several obstacles, key among these being the challenge posed by uneven inter-county levels of development, unequal distribution of resources for health especially the distribution of health facilities, human resources, and poorly developed communication infrastructure. Also unevenly distributed across the country are poverty levels, the effect of which is to make health services largely inaccessible to a large chunk of the population that cannot afford the high out-of-pocket expenditures, which are known to be common in Kenya. Some counties starting at a relative disadvantage will take time to build up their capacity and ability to use
References: [i] Urban population in Kenya http://www.tradingeconomics.com/kenya/urban-population-wb-data.html [ii] Feikin DR, Nguyen LM, Adazu K, Ombok M, et al., The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. [ii] Trop Med Int Health. 2009 Jan; 14(1):54-61. Epub 2008 Nov 14.http://www.ncbi.nlm.nih.gov/pubmed/19021892 [iii] The Machakos Project (1981-1994) was supported by the Special Progranune of Research in Human Reproduction, WHO/HRP, WHO, Geneva, the Population Council, New York, the Rockefeller Foundation and the Ministry of Health, Kenya. [iv] The objective of Community Strategy is to enhance access to and use of health services at community level The Strategy is described in “A Strategy for the Delivery of Level One Services” (MOH, June 2006). [v] Ministry of Medical Services and Ministry of Public Health & Sanitation KENYA HEALTH SECTOR STRATEGIC & INVESTMENT PLAN (KHSSP) July 2012 – June 2018: Transforming Health: Accelerating attainment of Health Goals [vi] National Directorates for Health: provide overall direction- policy formulation, national strategic planning, priority setting, budgeting and resource mobilization, regulating, setting standards, formulating guidelines, monitoring and evaluation, and provision of technical backup to the county level. County Health Management Teams: Provide Strategic and operational leadership and stewardship for overall health management in the County, including resource mobilization, creation of linkages with national level referral health services, monitoring and evaluation, coordination and collaboration with State and Non state Stakeholders at the County level health services. County Health Facility Management Teams: Develop and implement facility health plans for levels 1–3 health care services; coordinate and collaborate with stakeholders through County Health Stakeholder Forums; undertake in-service training and capacity building; and supervision, monitoring and evaluation.