An assessment of decision space and district health care sector performance following decentralisation in Kenya
Document type: mthesis
Download file(s):
183294 (1040 KB)
Abstract:
OBJECTIVE: To analyze the formal decision space district authorities are allowed; what they do with their new found discretion, and the effects, if any on district health sector performance in Kenya. METHODS: This study includes an empirical and a conceptual assessment. Assessment involved applying Bossert's framework to map decision space at five functional domains: finance and expenditure, service organization, human resources, access and governance rules. District health plan for the top three rich districts and bottom three poor districts based on their per capita health expenditure were analysed. Evaluation reports, financial reports, policy documents, published and unpublished studies were also examined. FINDINGS: The MOH has allowed moderate range of choice over finance and expenditure and access rules while limiting choice over service organisation, human resources, governance rules, norms and standards for service provision. District health authorities enjoy a wide range of choice in allocating resources generated from cost-sharing and in contracting with non-salaried staff. Analysis of service output indicators shows that poor districts were on track to achieving their targets for child and maternal health, but performed poorly on other indicators compared to rich districts that were generally on track to achieve most of their targets including: antenatal coverage, percentage of births attended by qualified attendant and in offering family planning services. CONCLUSIONS: Decentralisation is beginning to bring some positive change to the district health sector in Kenya, but more needs to be done to support or subsidize poor districts.
Authors:
Otieno, M.O.
Country:
Kenya
Category:
Research
Department:
Development Policy & Practice
Institute:
KIT (Royal Tropical Institute)
Keywords:
health services
,
poverty
,
policy
,
decentralization
Language:
eng
Organization:
KIT - Royal Tropical Institute
PAGE:
viii, 52
Year:
2009
Region:
East Africa
Right:
© 2009 Otieno
Subject:
Health and Nutrition
Title:
An assessment of decision space and district health care sector performance following decentralisation in Kenya
Training:
Master in International Health (MIH)