Issue
4 - Challenges of the Devolved Health Sector in Kenya: Teething Problems or Systemic Contradictions?
Corresponding Author(s) : Leah Kimathi
Africa Development,
Vol. 42 No. 1 (2017): Africa Development: Special Issue on Health Governance in Africa: Taking Stock
Abstract
The promulgation of the new constitution in Kenya in August 2010 effectively ushered in devolution as the latest and highest form of decentralization in Kenya. The health sector was the largest service sector to be devolved under this new governance arrangement. The rationale for devolving the sector was to allow the county governments to design innovative models and interventions that suited the unique health needs in their contexts, encourage effective citizen participation and make autonomous and quick decisions on resource mobilization and management possible issues. However, the sector in nearly all counties is currently bedevilled with monumental challenges ranging from capacity gaps, human resource deficiency, lack of critical legal and institutional infrastructure, rampant corruption and a conflictual relationship with the national government. The net effect of these challenges is the stagnation of healthcare and even a reversal of some gains according to health indicators. No doubt what is needed to guarantee an all-inclusive rights- based approach to health service delivery is its proper institutionalization to ensure good governance and effective community participation. This must however be accompanied by wider governance reforms as envisaged in the new constitution for the sustainability of Healthcare Reforms.
Keywords
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- Center for Health Solutions in Kenya, 2013, CHS Forum on Health System Strengthening in the Devolved System of Government, https://www.chskenya.org/wp-content/uploads/2014/04/chs-forum-on-hss-in-devolution-report.pdf, accessed 7 September 2015.
- Commission on Revenue Allocation, 2014, Revenue Allocation Formula, http://www.crakenya.org/information/revenue-allocation-formula/, accessed 10 September 2015.
- Dubusho, T. et al., 2009, Ethiopia: Improving Health Service Delivery, Washington DC: World Bank and the International Bank for Reconstruction and Development.
- El-Saharty, S. et al., 2009, Ethiopia: Making Health Service Delivery More Effective, Washington DC: The World Bank.
- Esidene, C., 2011, Local Government Administration in Kenya: Problems and Prospecte http://www.researchgate.net/profile/Canice_Erunke/publication/233762485_local_government_administration_in_kenya/links/09e4150b52114015ef000000?origin= publication_detail accessed 6 September 2015.
- Government of Kenya, 2010,Constitution of Kenya, Nairobi.
- Government of Kenya, 2013, Kenya Health Policy 2012-2030, Nairobi: Ministry of Medical Services and Ministry of Public Health and Sanitation.
- Government of Kenya, 2014, Options for Kenya’s Health Financing Systems: A Policy Brief, Nairobi: Ministry of Health.
- Hawkins, L., 2009, Devolution of Health Centers and Hospital Autonomy in Thailand: a rapid assessment, Washington DC: World Bank.
- International Rescue Committee, 2015, Every Voice Counts Program Report, Nairobi: International Rescue Committee.
- Kariuki, P., 2014, Corruption Devolved to the Counties, Daily Nation, 4 April, Nairobi. Kibui et al., 2015, ‘Health Policies in Kenya and the New Constitution for Vision 2030’, International Journal of Scientific Research and Innovative Technology 2(1):127.
- Kinuthia, M., 2016, Challenges Facing Devolution in Kenya Nairobi: Kenyatta University.
- KPMG Africa, 2014, Devolution of Healthcare Services in Kenya, https://www.kpmg.com/Africa/en/IssuesAndInsights/Articles-Publications/Documents/Devolution%20of%20HC%20Services%20in%20Kenya.pdf, accessed 8 September 2015.
- Magokha, T., 2015, ‘Blame Game as Kenya’s Health Crisis Hurts’,Standard, Nairobi,
- http://www.standardmedia.co.ke/kenyaat50/article/2000174647/blame-game-as-kenya-s-health-crisis-hurts?pageNo=2, accessed 14 September 2015.
- Ministry of Devolution and National Planning, 2015, Improving Healthcare Delivery in Kenya, Nairobi: Ministry of Devolution and National Planning.
- Ministry of Health, 2006, Taking the Kenya Essential Package for Health to the Community: A strategy for the Delivery of Level One Services, Nairobi: Ministry of Health.
- Ministry of Health, 2013, Kenya Service Availability and Readiness Assessment Mapping, Nairobi: Ministry of Health.
- Ministry of Health, 2014, Kenya Health Policy 2012–2030,Nairobi: Ministry of Health.
- Muoko, B. and Baker C., 2014, Decentralization and Rural Service Delivery in Uganda, Kampala: International Food Policy Research Institute.
- Mutai, A., 2015, Devolution on Trial in Kenya: Case Study of Isiolo County, http://somalianewsroom.com/devolution-on-trial-in-kenya-case-study-on-isiolo-county/,accessed2 September 2015. Kimathi: Challenges of the Devolved Health Sector in Kenya
- Mwamuye, K., and Nyamu, H., 2014, ‘Devolution of Healthcare System in Kenya: A Strategic Approach and its Implementation in Mombasa County, Kenya’, International Journal of Advanced Research 2 (4): 263–8.
- Mwangi, C., 2013, ‘Accessibility to the Kenyan Healthcare System: Barriers to Accessing Proper Healthcare’, unpublished PhD thesis, Arcada University.
- Olugo, S., 2015, ‘Counties Urged to Embrace Partnerships to Improve Healthcare Services’,Standard, Nairobi, http://www.standardmedia.co.ke/sports/article/2000163505/counties-urged-to-embrace-partnership-to-improve-healthcare-services, accessed 18 September 2015.
- Patrick, I., 2013, Relooking at Healthcare in Kenya in the Age of Devolution, University of KwaZulu-Natal.
- Pongpisut, J., 2012, ‘A Decade of Health-Care Decentralization in Thailand: What Lessons can be drawn?’, WHO South-East Asia Journal of Public Health 1 (3): 347– 56.
- World Bank, 2014, Delivering Primary Health Services in Devolved Health Systems of Kenya: Challenges and Prospects, http://documents.worldbank.org/curated/en/2014/09/20351566/delivering-primary-health-services-devolved-health-systems-kenya-challenges-opportunities, accessed 7 September 2015.
- World Health Organization, 1990, Health Systems Decentralization, Geneva: World Health Organization.
References
Center for Health Solutions in Kenya, 2013, CHS Forum on Health System Strengthening in the Devolved System of Government, https://www.chskenya.org/wp-content/uploads/2014/04/chs-forum-on-hss-in-devolution-report.pdf, accessed 7 September 2015.
Commission on Revenue Allocation, 2014, Revenue Allocation Formula, http://www.crakenya.org/information/revenue-allocation-formula/, accessed 10 September 2015.
Dubusho, T. et al., 2009, Ethiopia: Improving Health Service Delivery, Washington DC: World Bank and the International Bank for Reconstruction and Development.
El-Saharty, S. et al., 2009, Ethiopia: Making Health Service Delivery More Effective, Washington DC: The World Bank.
Esidene, C., 2011, Local Government Administration in Kenya: Problems and Prospecte http://www.researchgate.net/profile/Canice_Erunke/publication/233762485_local_government_administration_in_kenya/links/09e4150b52114015ef000000?origin= publication_detail accessed 6 September 2015.
Government of Kenya, 2010,Constitution of Kenya, Nairobi.
Government of Kenya, 2013, Kenya Health Policy 2012-2030, Nairobi: Ministry of Medical Services and Ministry of Public Health and Sanitation.
Government of Kenya, 2014, Options for Kenya’s Health Financing Systems: A Policy Brief, Nairobi: Ministry of Health.
Hawkins, L., 2009, Devolution of Health Centers and Hospital Autonomy in Thailand: a rapid assessment, Washington DC: World Bank.
International Rescue Committee, 2015, Every Voice Counts Program Report, Nairobi: International Rescue Committee.
Kariuki, P., 2014, Corruption Devolved to the Counties, Daily Nation, 4 April, Nairobi. Kibui et al., 2015, ‘Health Policies in Kenya and the New Constitution for Vision 2030’, International Journal of Scientific Research and Innovative Technology 2(1):127.
Kinuthia, M., 2016, Challenges Facing Devolution in Kenya Nairobi: Kenyatta University.
KPMG Africa, 2014, Devolution of Healthcare Services in Kenya, https://www.kpmg.com/Africa/en/IssuesAndInsights/Articles-Publications/Documents/Devolution%20of%20HC%20Services%20in%20Kenya.pdf, accessed 8 September 2015.
Magokha, T., 2015, ‘Blame Game as Kenya’s Health Crisis Hurts’,Standard, Nairobi,
http://www.standardmedia.co.ke/kenyaat50/article/2000174647/blame-game-as-kenya-s-health-crisis-hurts?pageNo=2, accessed 14 September 2015.
Ministry of Devolution and National Planning, 2015, Improving Healthcare Delivery in Kenya, Nairobi: Ministry of Devolution and National Planning.
Ministry of Health, 2006, Taking the Kenya Essential Package for Health to the Community: A strategy for the Delivery of Level One Services, Nairobi: Ministry of Health.
Ministry of Health, 2013, Kenya Service Availability and Readiness Assessment Mapping, Nairobi: Ministry of Health.
Ministry of Health, 2014, Kenya Health Policy 2012–2030,Nairobi: Ministry of Health.
Muoko, B. and Baker C., 2014, Decentralization and Rural Service Delivery in Uganda, Kampala: International Food Policy Research Institute.
Mutai, A., 2015, Devolution on Trial in Kenya: Case Study of Isiolo County, http://somalianewsroom.com/devolution-on-trial-in-kenya-case-study-on-isiolo-county/,accessed2 September 2015. Kimathi: Challenges of the Devolved Health Sector in Kenya
Mwamuye, K., and Nyamu, H., 2014, ‘Devolution of Healthcare System in Kenya: A Strategic Approach and its Implementation in Mombasa County, Kenya’, International Journal of Advanced Research 2 (4): 263–8.
Mwangi, C., 2013, ‘Accessibility to the Kenyan Healthcare System: Barriers to Accessing Proper Healthcare’, unpublished PhD thesis, Arcada University.
Olugo, S., 2015, ‘Counties Urged to Embrace Partnerships to Improve Healthcare Services’,Standard, Nairobi, http://www.standardmedia.co.ke/sports/article/2000163505/counties-urged-to-embrace-partnership-to-improve-healthcare-services, accessed 18 September 2015.
Patrick, I., 2013, Relooking at Healthcare in Kenya in the Age of Devolution, University of KwaZulu-Natal.
Pongpisut, J., 2012, ‘A Decade of Health-Care Decentralization in Thailand: What Lessons can be drawn?’, WHO South-East Asia Journal of Public Health 1 (3): 347– 56.
World Bank, 2014, Delivering Primary Health Services in Devolved Health Systems of Kenya: Challenges and Prospects, http://documents.worldbank.org/curated/en/2014/09/20351566/delivering-primary-health-services-devolved-health-systems-kenya-challenges-opportunities, accessed 7 September 2015.
World Health Organization, 1990, Health Systems Decentralization, Geneva: World Health Organization.