4 - Challenges of the Devolved Health Sector in Kenya: Teething Problems or Systemic Contradictions?
Corresponding Author(s) : Leah Kimathi
Afrique et développement,
Vol. 42 No 1 (2017): Afrique et développement: Numéro spécial sur la gouvernance de la santé en Afrique : état des lieux
Résumé
Au Kenya, la promulgation de la nouvelle constitution en août 2010 a véritablement introduit la dévolution en tant que forme de décentralisation la plus récente et la plus élevée. Le secteur de la santé était le plus important secteur des services à compétences dévolues dans ce nouveau système de gouvernance. La logique de cette dévolution était de permettre aux gouvernements de comtés de concevoir des modèles et des interventions novateurs adaptés aux besoins uniques en matière de santé dans leurs contextes, d’encourager la participation efficace des citoyens et de prendre des décisions autonomes et rapides concernant la mobilisation des ressources et la gestion des questions qui se posent. Cependant, dans presque tous les comtés, le secteur est actuellement miné par des défis colossaux qui sont notamment les lacunes en matière de capacité, l’insuffisance des ressources humaines, le manque d’infrastructures légales et institutionnelles cruciales, la corruption rampante et une relation conflictuelle avec le gouvernement national. Le résultat final de ces défis est la stagnation des soins de santé, voire un renversement de certains gains d’après les indicateurs de santé. Il ne fait aucun doute que ce qu’il faut pour garantir une approche des prestations de services de santé inclusive et fondée sur les droits, c’est qu’elle soit elle-même institutionnalisée pour assurer une bonne gouvernance et une participation communautaire efficace. Toutefois, cela doit s’accompagner de plus vastes réformes de la gouvernance, tel que prévu dans la nouvelle constitution pour la durabilité des réformes des systèmes de santé.
Mots-clés
Télécharger la référence bibliographique
Endnote/Zotero/Mendeley (RIS)BibTeX
- 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.
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- 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.
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- Hawkins, L., 2009, Devolution of Health Centers and Hospital Autonomy in Thailand: a rapid assessment, Washington DC: World Bank.
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- Ministry of Devolution and National Planning, 2015, Improving Healthcare Delivery in Kenya, Nairobi: Ministry of Devolution and National Planning.
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- 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.
Les références
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.