Kenyan Health Sector Research Articles

Financial and Geographic Barriers to Health Care Access in Kenya: The Quest towards Universal Health Coverage

Abstract Background: Access to health care services without being plunged into financial hardship is a life blood of the Universal Health Coverage. Kenya's health sector is heavily dependent on out of pocket health expenditure. This model of health financing is inequitable and leads to underutilization of the much needed health care services. Majority of Kenyans travel for longer distances to access health care services. The geographic access barrier is linked to delayed care, missed appointments, delayed medication and undue loss of life. This study examines the correlates of financial and geographic health care access barriers in the UHC implementing Counties in Kenya. Methodology: The study used a cross-sectional data collected from 249 respondents using exit interviews at the health facilities drawn from the Kenya Master Health Facility List (KMHL). A multivariate log it regression model was used to analyze the predictors of probability of failure to access health care services owing to prohibitive health care and transport costs. Results: High out-of-pocket monthly expenditure on medicine; wider proximity, higher transportation cost and a longer traveling time to a health facility increases the probability of not seeking medical treatment owing to prohibitive health care and transportation costs. These factors thus, acts as key barriers to health care access. Conclusion: Financial and geographic access barriers negatively impact on health care access. To hasten the realization of the Universal Health Coverage, prepayment models such as use of taxes and insurance should be pursued.

Corporate Governance Practices and Performance of Faith Based Health Facilities in Nyanza Region

The study sought to find out the relationship between corporate governance practices and performance of faith based health facilities in Nyanza region. The objectives of the study was guided by the following corporate governance practices; board composition, size of the board, board sub-committees, CEO duality and the frequency of the meetings. The study employed a cross-sectional survey design to establish the relationship. The study found out that 93.5% of the faith-based health facilities in the Nyanza region had sub-committees, 67.7% of the facilities had a board size of 7-8 while 74.2% of the facilities had frequency of 4 This study adopted Balance scorecard developed by Kaplan and Norton to measure organizational performance. The study found out financial perspective of performance had high correlations with corporate governance practices (R=0.621) with 38% of financial performance influenced by the corporate governance practices. Internal business processes perspectives also had high correlations with corporate governance practices however both the customers’ perspectives and innovation, learning and growth perspectives had low correlations with corporate governance practices. The study therefore concluded that the corporate governance practices affected performance of the faith based health facilities although at a varied degree. The regression analysis showed that there was a positive influence of corporate governance practice on the performance of the faith based health facilities in Nyanza region. Thus the practice of good corporate governance enhances performance of faith based health facilities. The study recommended that the secretariats of the faith based health facilities should establish a clear policies on the terms of engagement of the directors, CEO and performance appraisal of the board to check on their effectiveness. The board should also be given inductions and continuous professional trainings to equip them with new technics. For further studies, the study suggests that another study be conducted to establish the corporate governance practices and performance of health sector in Kenya.

Effects of Communication On Quality Service Delivery in Mission Hospitals in Meru County, Kenya

Communication is one of the most critical management practices in an organization. It is argued that managers spend over 70 percent of their time communicating. This is because without effective communication, understanding is lost or compromised in the ‘noise’ and mess that is everyday work life. Communication is effective if done well downwards, upwards and sideways from seniors, subordinates and peers respectively and effective feedback given. The means or channels of communication should also be very clear and short to avoid long bureaucracies and excessive routes that compromise the quality of what is being communicated. The health sector in Kenya is highly regulated by both the Government and relevant professional bodies to ensure quality is maintained in training of medical caregivers and in dispensing services. Three major categories of healthcare service providers exist in Kenya – public, private and mission/faith-based organizations with variants in between. Meru County, one of the forty-seven counties in Kenya, is situated almost at the center of the country and has all these major categories of hospitals. Within the mission hospitals in Meru County, besides the government and professional bodies, close regulation is also practiced by faith-based organizations that sponsor the hospitals. The purpose of this study was to establish the nature and effect of communication in providing quality service delivery in the mission hospitals in Meru County, Kenya. The study was formulated as a survey to cover all the eight mission hospitals namely Nkubu, Chaaria, Kiirua, Maua, Mutuati, Tigania, Igoji and Gitoro. Piloting was done at Wamba mission hospital in Isiolo county to ensure validity of study tools. Descriptive study design was used. Major stakeholders in the hospitals were targeted as respondents including CEOs, Human resource and public relations officers and other staff as internal stakeholders while patients, suppliers and neighbours formed external stakeholders. A total of 128 were interviewed as a representative sample. A drop and pick method was used where questionnaires for each hospital were delivered and distributed to the potential respondents. Some respondents like patients and neighbours were assisted by researchers to fill in the questionnaires to avoid bothering them unnecessarily. Data was analyzed quantitatively using SPSS Version 23 and results described using descriptive statistics and presented in tables. The study found that communication had a significant positive affect on quality-of-service delivery (R=0.498, F=6.922, P=0.00) in mission hospitals.Effective communication and customer care was lauded as a critical consideration in dealing with clients and was emphasized among all levels of staff of mission hospitals to ensure sustainability of quality service delivery. The study recommended further analysis of private and public hospitals on the same parameters for comparison.

Rethinking the Human Resource (HR) Strategy in the Face of Systematic Failures in the Devolved Health Sector in Kenya

This viewpoint paper is about rethinking the human resources (HR) strategy in the face of systematic failures in the devolved health sector in Kenya. The paper gives a background introduction of the health sector of Kenya as defined and established by the constitution of Kenya, explains the sharing of functions devolved in the health sector, and explains the history of devolution of the health sector. Under the identification and justification of the study, the paper highlights how specialized skills in health service provision are concentrated in urban centers and emphasizes a lack of inter county transfer of services. The paper further explains the distribution of healthcare service provision, the current management of HR, and the statement of specific problems in Kenya; such problems include outcry from healthcare providers, which is manifested by frequent strikes across the country over issues to do with salaries, promotions, and career development. The viewpoint of the authors is that the seven building blocks of the health sector in Kenya are vital. The six building blocks can be handled by county governments while one block that deals with the management of HR of the health sector should be reformed, strengthened, and handled by the national government, hence the paper proposes the introduction of a health service commission to manage human resource components of the health sector. Finally, boost the Ministry of Health’s effective control of the healthcare workforce by advancing and integrating policies relating to health systems, services

Rethinking the human resource (HR) strategy in the face of systematic failures in the devolved health sector in Kenya

This viewpoint paper is about rethinking the human resources (HR) strategy in the face of systematic failures in the devolved health sector in Kenya. The paper gives a background introduction of the health sector of Kenya as defined and established by the constitution of Kenya, explains the sharing of functions devolved in the health sector, and explains the history of devolution of the health sector. Under the identification and justification of the study, the paper highlights how specialized skills in health service provision are concentrated in urban centers and emphasizes a lack of inter-county transfer of services. The paper further explains the distribution of healthcare service provision, the current management of HR, and the statement of specific problems in Kenya; such problems include outcry from healthcare providers, which is manifested by frequent strikes across the country over issues to do with salaries, promotions, and career development. The viewpoint of the authors is that the seven building blocks of the health sector in Kenya are vital. The six building blocks can be handled by county governments while one block that deals with the management of HR of the health sector should be reformed, strengthened, and handled by the national government, hence the paper proposes the introduction of a health service commission to manage human resource components of the health sector. Finally, boost the Ministry of Health’s effective control of the healthcare workforce by advancing and integrating policies relating to health systems, services, and cross-sectorial collaboration to revive primary healthcare services and attain universal health coverage.

Towards Universal Health Coverage

This paper explores the universal health coverage (UHC) in Kenya through the lens of its potential to progressively realize the constitutional promise of the right to the highest attainable standard of health. The health sector in Kenya has experienced tremendous changes since the government piloted the UHC program in four counties that led to the abolition of all fees, more than 200 community health units launched, 7700 community health volunteers with over 700 health workers recruited (MOH, 2020). Still, the government is in the process of scaling up UHC, reforming the national hospital insurance fund (NHIF) to establish a mandatory universal health coverage scheme. This paper sought to examine the framing of UHC; assess the healthcare system between 2017 -2020; investigate the challenges faced in the implementation of UHC in Kenya. The researcher utilized documents analysis to collect the relevant data using a coding schedule. A purposive search was undertaken to identify key policy documents and relevant documents. 18 documents were sampled. The findings reveal that Kenya’s healthcare facilities index stands at 59%, with a density of 2.2 per 10,000 population, the workforce density is at 15.6/10,000. Four counties including Tharaka Nithi (33.8), Nyeri (31.0), Uasin Gishu (28.2), and Nairobi (26.3) have achieved well above the WHO target. Several strategies and programs such as Afya Care, abolished maternity fees for mothers delivering at public facilities, and expansion of the National Health Insurance Fund, has been initiated to drive the UHC agenda. The Ministry of Health’s (MoH) budget also continues to rise, in 2018/19 the MoH received its largest allocation. Kenya, now more than ever, has an opportunity to accelerate progress towards equitable access to healthcare.

Effect of Corporate Governance Practices on Organizational Performance of State Corporations in the Health Sector, Kenya

Sound corporate governance practices are a major contributor to effective and efficient management of State Corporations in the health sector in Kenya. Since independence, the level of accountability in management of State Corporations has continued to decline despite the availability of various monitoring structures like legal frameworks, ethics and integrity, policies and the code of conduct and ethics intended to provide a clear road map to successful performance of the State Corporations. The objective of this study was to determine the effect of corporate governance practices on the performance of the State Corporations in the health sector in Kenya. The study adopted a descriptive research design with a population comprising of the health State Corporations. Primary data was collected the using questionnaires. Data was analyzed using SPSS software. The results indicated that accountability and organizational performance of health State Corporations is positively and significantly related. The results further indicated that transparency and organizational performance of health State Corporations is positively and significantly related Board Responsibility and organizational performance of health State Corporations is positively and significantly related. Moral Integrity and organizational performance of health State Corporations is positively and significantly related The study concluded that corporate governance practices have a positive and significant effect on organizational performance of State Corporations in the health sector in Kenya. The study recommended that the management of the State corporations should establish certain control mechanisms that ensure accountability. The study recommended that there should continuous internal check and audit on the part of management and low level of management to ensure adequate accountability systems in the State Corporations. Keywords: Corporate Governance, Organizational Performance & State Corporations

Public-Private Partnerships and the Healthcare Sector Performance in Kenya

Healthcare is one of the fundamental development agenda to any nation and its adequate provision in an accessible, quality and sustainable manner is the supreme responsibility of the state. However, the burden of healthcare cannot be met by the government alone, but requires substantial investment from the private sector as well. This article reviews the existing empirical literature to examine the contribution of private investment on the healthcare sector performance in Kenya. Existing evidence shows that there is minimal private-public partnership in the health sector in Kenya. The main factors inhibiting private-public partnership investment in the sector were attributed to the uncertainty associated with universal healthcare. Further, the scheme is characterised by an overall lack of transparency and accountability surrounding contracts, costing and allocations with many of the safeguards against these kinds of challenges blatantly ignored by several actors and in turn raising issues of accessibility for citizens. Also, private sector credit and political regimes have a negative but significant influence on private investments generally.

Assessment of the Quality of Health Information for Good Health Care: A Case of Kerugoya Level 4 Hospital, Kirinyaga County

Improving healthcare services has been paramount to both the national and county governments in Kenya. However, this broad national goal has failed to be achieved within the health sector in Kenya due to dilapidated systems, lack of coordination and poor quality of the health records within the industry. The current study sought to establish the influence of quality health records on improving healthcare in Kerugoya Level IV hospital. Specifically, the research focused on the creation of health information, relevance of health information, completeness and accuracy of patient’s health information and accessibility of health information on the improving of health services. The research was grounded on the negativity theory. The research adopted a quantitative design with a population of 288 staff members being targeted in the study. The sample respondents were 165 staff members with both quantitative questionnaires and interview schedules being utilized in the research. The study adopted quantitative techniques in the data analysis and thematical analysis. The findings showed that 87% of the sample respondents were able to participate in the study. The research concludes that creation of health information, relevance of information and accessibility of health records are significant predictors to improved healthcare services. The research revealed that the level of management support and resource availability are positive and significant predictors of the level of improved healthcare services in Kerugoya level IV hospital. The study findings noted there is a positive but insignificant relationship between completeness and accuracy of health information and improved healthcare services within the level IV hospital. The study recommends that the hospitals should improve the digitalization of health records which will foster storage and accessibility. The hospitals should also enhance coordination with the national government to improve their health infrastructure.

Influence of Devolved Human Resource Governance Structure on Service Delivery in the Public Health Sector in Kenya

The purpose of the study was to establish the influence of devolved human resource governance structure on service delivery in the public health sector in the County government of Trans Nzoia, Kenya. The study was anchored on sequential theory of decentralization and adopted embedded mixed methods research design. The target population was 663 respondents comprising of 15 hospital administrators, 16 doctors, 50 clinical officers, 240 nurses and 342 patient care givers in all the 74 public health care facilities in the County government of Trans Nzoia. Stratified random sampling technique was used to select the study sample. A total of 331 respondents comprising of 8 administrators, 8 doctors, 19 clinical officers 148 nurses and 148 patient care givers were sampled from 74 public health facilities for study. Out of the sample size of 331 of respondents, 281 participated giving a response rate of 85 percent. Data was collected using questionnaires and document analysis guide. Validity of data collection instruments was determined by experts and peers, and the tool modified accordingly after a pilot study in the neighboring Bungoma County. Reliability was established using Cronbach Alpha technique. Both descriptive and inferential statistics were used in data analysis with the help of SPSS program version 21. Descriptive statistics involved frequencies, percentages, means and standard deviation while inferential statistics involved the use of Spearman rank order correlation, simple and multiple regressions. Data was presented using tables. Study findings revealed that health care service delivery was not satisfactory. Devolved human resource governance structure had not been fully implemented. The study established that implementation of devolved human resource significantly influenced service delivery in the health sector. The study recommended that county governments should ensure adequate staffing, motivation and equipping of health facilities to enhance service delivery. Both the medical and support staff should be trained, compensated and equipped appropriately for designated roles. Keywords : Devolved human resource governance structure, service delivery in the health sector DOI: 10.7176/PPAR/11-1-02 Publication date: January 31 st 2021

Influence of Devolved Financial Resource Governance Structure on Service Delivery in Public Health Sector in Kenya

The purpose of the study was to establish the relationship between implementation of devolved financial resource governance structure and service delivery in the public health sector of the County government of Trans Nzoia, Kenya. The study was anchored on sequential theory of decentralization and adopted embedded mixed methods research design. The target population was 663 respondents comprising of 15 hospital administrators, 16 doctors, 50 clinical officers, 240 nurses and 342 patient care givers in all the 74 public health care facilities in the County government of Trans Nzoia. Stratified random sampling technique was used to select 331 respondents comprising of 8 administrators, 8 doctors, 19 clinical officers, 148 nurses and 148 patient care givers were sampled from 74 public health facilities for study. Data was collected using questionnaires, checklist and document analysis guide. Validity of data collection instruments was determined by experts and peers, and the tool modified accordingly after a pilot study in the neighboring Bungoma County. Reliability was established using test Cronbach Alpha technique. Both descriptive and inferential statistics were used in data analysis with the help of SPSS program version 21. Descriptive statistics involved frequencies, percentages, means and standard deviation, while inferential statistics involved the use of Spearman Rank Order Correlation, simple linear and multiple regressions. Data was presented using tables. The study established that health care service delivery was not satisfactory and that devolved financial resource governance structure had not been fully implemented. The study established a positive relationship between implementation of devolved financial resource governance structure and service delivery in the public health sector. The study recommended for adequate revenue allocation, timely disbursement and own revenue generation by county governments. The study also recommended for annual audits to ensure effective and efficient use of financial resources. Keywords : Devolved financial governance structure, service delivery in the health sector DOI: 10.7176/PPAR/11-1-03 Publication date: January 31 st 2021

The Church and the Healthcare Sector in Kenya: A Functional Analysis of Its Development through Evangelization

The health sector in Kenya has grown rapidly. The corner stone of this growth was laid by the early Christian Missionaries who combined Evangelization with education and health. Thishistorical developmentled to the development and expansion of the healthcare system in Kenya by contributing to the building of a firm foundation upon which Kenya’s health care stands today. TheChurch’s education-health functional strategy cemented this milestone leading to the growth of a vibrant health care sector in Kenya. This has culminated in a well-coordinated ChurchGovernment partnership in the implementation of health programs. Today Kenya is the leading country in the East African region in the delivery of well-established and functional health care system. The Church’s pioneer efforts saw the healthcare in Kenya expand rapidly to all parts of the country thus playing a significant role in the healthcare market.The objective of this paper was therefore to explore the Church’scontribution to the development of healthcare sector in Kenya, to examine the functional role of an integrated and holistic approach to health care as a tool for the nurturing of Christian values and faith that support spiritual growth among people, to assess the sociological implicationsunderpinning the entire process of growth of health care through a Church-Government participatory partnership approach and how this approach has created a better society.Purposive sampling procedure was used to select four mainstream Churches that pioneered Evangelization in Kenya. Using qualitative approach, secondary data was obtained through face to face interviews with key informants from the four mainstream Churches.Data was transcribed and analysed qualitatively in for of themes. The findings show that the Church played a significant role in the development of health care in Kenya, they also show that the use of an integrated and holistic approach to health care was responsible for the evangelization and treatment of many Christians in Kenya and from a sociological perspective the findings show that the Church plays a significant role in unifying society. The study recommends that the Church should be supported through government policies to continue investing in the health care sector, other Churches in Kenya should adopt an integrated holistic approach to health care and the Church should strengthen its unifying role for the sake of a stable nation. The study will benefit the Church, policy makers and other stakeholders.

Safety and Acceptability of Thermal Ablation for Treatment of Human Papillomavirus Among Women Living With HIV in Western Kenya.

PURPOSEThe WHO now recommends thermal ablation as an alternative to cryotherapy within “screen-and-treat” cervical cancer programs in low- and middle-income countries (LMICs). We conducted a safety and acceptability clinical trial of thermal ablation in a Kenyan Ministry of Health hospital among women living with HIV (WLWH; ClinicalTrials.gov identifier: NCT04191967).METHODSBetween August 2019 and February 2020, WLWH age 25-65 years underwent human papillomavirus (HPV) self-collection in western Kenya. HPV-positive women underwent visual inspection with acetic acid, biopsy, and treatment with thermal ablation performed by a nonphysician clinician, if eligible by standard guidelines. A questionnaire was administered after treatment to assess for pain and treatment acceptability. Adverse events (AEs) were evaluated 4-6 weeks after treatment with a standardized grading tool.RESULTSA total of 293 HPV-positive WLWH underwent thermal ablation in the study period. The mean age was 40.4 years (standard deviation, 8.7 years). After treatment, 15 (5.1%), 231 (78.8%), 42 (14.3%), and 5 (1.8%) reported none, mild, moderate, and severe pain with treatment, respectively. At follow-up, spotting, vaginal discharge, and pelvic pain were reported by 99 (37.8%), 258 (98.5%), and 46 (17.6%), respectively, for a median of 3.3 (interquartile range [IQR], 2-3), 14 (IQR, 7-21), and 7 (IQR, 3-7) days, respectively. Most participants graded their AEs as mild (grade 1): 94 (95.0%) for bleeding, 125 (48.5%) for vaginal discharge, and 37 (80.4%) for pelvic pain. No grade 3 or 4 AEs were reported. The vast majority (99.2%) were satisfied with the treatment and would recommend it to a friend.CONCLUSIONThermal ablation performed by nonphysicians in the public health sector in Kenya proved safe and highly acceptable in treating HPV-positive WLWH.

Engendering Rule of Law in Health Care Delivery in Kenya

The healthcare sector in Kenya has been in a state of turmoil for a long time with this manifesting itself in varied forms. This has in many ways translated to adverse outcomes on individuals seeking healthcare services. Incrementally funding the healthcare sector has not necessarily translated to the improvement of services offered. This is indicative of the fact that past approaches to development have failed to acknowledge that development is a combination of distinct processes, at times having glaring intersectionalities. Particularly, the place of law as a tool for social, economic, and political change has been underappreciated with devastating consequences. Failure to adhere to the Rule of Law in the health sector has principally been a structural barrier to health improvement in the country with a multitude of stakeholders in the health sector being willing partakers in the disregard of the law. The implication of this has been a health sector that is riddled with corruption, disregard of court processes, the mushrooming of rogue providers, and high mortality rates which in the end translates to apathy from the users of healthcare services. This paper asserts the place of the Rule of Law as a foundational determinant of health. The paper analyzes some of the pitfalls that have plagued the health sector in Kenya and draws a connection between these challenges and the failure to adhere to the law. What becomes apparent throughout this analysis is that a strong correlation exists between likely health outcomes and adherence to the law.

Competing Multiple Accountability Mechanisms and Public Administrators’ Responses in the Health Sector in Kenya

Accountability in public sector is a complex concept. Public administrators are held accountable by multiple mechanisms of accountability. It is unclear in the public health sector in Kenya which of the four mechanisms of hierarchical, professional, legal and political accountability dominates accountability responses of hospital administrators. The objective of this study was to assess which among the competing multiple accountability mechanism is accorded priority in the health sector in Kenya. The study adopted a case study design targeting hospital administrators from 36 public hospitals in 14 Counties in Kenya. The study found out that professional accountability tend to be given precedence over other forms of public accountability in ordinary conditions and hierarchical accountability under crisis situations. The study concluded that hospital administrators are confronted with all the four mechanisms, but their intensity on accountability vary.

An Assessment of the Influence of Working Environment on Service Delivery in the Public Health Sector in Nyeri County, Kenya

Globally, the health sector is an area that any government must focus on since health is a right of every human being. Kenya particularly initiated the idea of devolution and the Big Four Agenda to ensure service delivery to citizens was achieved. Nevertheless, the situation in the public health sector has been encountering challenges due to dissatisfaction of personnel culminating in strikes. The objective of this study was to explore the effect of the working environment on service delivery in the health sector in Nyeri County, Kenya. The study was guided by the person–environment fit theory. The descriptive cross-sectional research design was used. The target population was derived from public hospitals in Nyeri County. Proportionate stratified random sampling was utilized, where 141 respondents were targeted, comprising doctors, clinical officers, and nurses. Data was collected using a closedended questionnaire. A pilot study was conducted at Mukurwe-ini Hospital to enhance the validity and reliability of the data-collection instrument. A Cronbach alpha coefficient of 0.7 was used to ascertain the reliability of the instrument. Data was analyzed using descriptive and inferential statistics from the 78.7% respondents. The findings established that the working environment had positive and significant effects on service delivery (β1 = 0.476, p-value = 0.000) at the 5% level of significance, hence rejecting the null hypothesis. The study further established that the public health sector in Kenya should address the drug shortage, medical staff working hours, and machine maintenance as they would adversely affect quality of service delivery. The study recommends that the public health sector should provide health workers a conducive working environment and all necessary tools and equipment to enable them to discharge their duties effectively with a view to enhance service delivery to patients. Future research should focus on the importance of on–the-job training for effective service delivery in the public health sector.

Challenges of devolved health care in Kenya: an analysis of the policy and legislative framework

This paper comes in the wake of the COVID-19 Pandemic. A pandemic that not only ground the world to a halt, but one that also forced governments and stakeholders alike to critically evaluate the health sector. Inherent challenges plaguing the sector have been emphasized, and latent challenges brought to the surface. In Kenya, health is the largest devolved function of government, thanks to the Constitution of 2010, which devolved administrative and other governance functions to the 47 counties. Through what should have been a transitional period until now, devolution continues to present diverse administrative and governance challenges across the board, and the health sector, like many others, has not been spared. This paper examines the concept of health in light of public health and as a fundamental human right. This is followed by an examination of the policy and legislative framework that informs, guides, governs and regulates the health sector in Kenya as well as an exposition of the core challenges affecting the health sector. Recommendations and further areas of research form the conclusion of this paper.

Effect of Devolution on the Performance of Human Resource Function in Health Sector in Kenya: The Case of Garissa County

The declaration of a new constitution of Kenya on 31st August 2010 successfully made two levels of government; the national and county governments. Establishment of health services is one of the tasks that were devolved to the county. Devolution of health functions was meant to enhance access to more-fair and top-notch health services to the Kenyan citizens. This study sought to analyze the effect of devolution on human resource performance in healthcare sector in Kenya with special focus on Garissa County. The study specific objectives included to; examine how devolution has affected recruitment of health care staff in Garissa County; to analyze how devolution has affected training of health care staff in Garissa County. The study was guided by new public management theory. The study employed a descriptive research design to examine the effect of devolution on human resource performance in healthcare sector in Kenya. The target population was the healthcare workers with management portfolios and the sample population was 184 respondents which were arrived at using stratified sampling method. Both primary and secondary data were accessed. A questionnaire was used to collect primary data. Descriptive proportions of the respondents and their cadres were derived. Qualitative data was analyzed thematically, while quantitative data was analyzed using descriptive statistics and regression analysis. The findings were presented using tables and charts. The study found out that devolution has affected human resource performance in healthcare sector in Garissa County. The study established that lack of proper methods of recruitment of health care staff; lack of training of health care staff and application of ineffective methods of procurement of medical facilities hindered the performance of health care staff in the County. The study drew conclusion that the major effect of devolution on human resource performance in healthcare sector in Kenya; a case of Garissa County includes; recruitment of health care staff; training of health care staff and procurement of medical facilities. The study recommended that the County government should employ effective employee recruitment methods by hiring staff with technical expertise in health services delivery; the County government should also allocate and efficiently distribute enough financial resources to fund the recruitment exercise; the recruited staff should be better remunerated in order to improve their level of motivation and job satisfaction. The study further recommended that the County government should implement an effective and continuous employee training and development programmes on health care services delivery in the County. The County government should source and hire qualified doctors; employ enough and qualified nurses; hire enough and qualified support staff and give emphasis on hiring very experienced medical staff as lead trainers on health care services delivery in the County. The County government should adhere to all public procurement regulations in Kenya like public procurement and disposal act. The procurement methods should ensure that there is availability of medical facilities; there is a sufficient medical facility and there is high reliability of procured medical facilities in all regions in the County.

Putting knowledge flows front and centre in health systems strengthening

ABSTRACTThis paper is a conceptual paper outlining a framework to analyse the main barriers linking knowledge production and application in the area of health in developing countries. It does so through a broad mapping and rethinking of the role of social and technological innovation in health systems strengthening. An analytical framework called the 4F framework – where the four Fs stand for Form, Field, Flows and Functions – is presented. By conducting a very high-level analysis of the barriers and enablers in knowledge production and application in the health sector in Kenya we give an indicative overview of the 4F Framework’s potential. The empirical analysis suggests knowledge is often siloed into particular areas. At the macro level, there is insufficient focus on knowledge exchange between policy sectors i.e. health, industry, education. The analysis suggests that the framework provides a means to move from building ‘health and wellbeing systems’ to focusing on ‘competence building systems in the area of health and wellbeing’ which will provide a longer term holistic approach to health systems strengthening. The paper ends by presenting a number of recommendations for policy makers to ensure enhanced up-take of both technological and social innovation in health systems.

Who is responsible? Local government and accountability for service delivery in Kenya’s devolved health sector

One of the arguments in favour of local governments is their ability to deliver public services better because of their proximity to demand. This is typically achieved through decentralisation – the transfer of some level of formal responsibility, authority and/or resources to smaller, lower tiers of government. This paper examines service delivery in the health sector in Kenya within the context of the country’s newly introduced devolved system of government, which created 47 county governments under the 2010 Constitution. It examines three key responsibilities: i) resource mobilisation, distribution and administration, ii) decision-making, and iii) political accountability, and their bearing on outcomes for delivery of health services. The paper argues that devolution of the health function in Kenya has been only partial, leading to challenges of coordination between the national and county governments and ambiguity over responsibility for service delivery; both factors which risk undermining the opportunities that devolution creates or promises.