NDLI: Devolution and its effects on health workforce and commodities management – early implementation experiences in Kilifi County, Kenya

Content Provider	Springer Nature : BioMed Central
Author	Tsofa, Benjamin Goodman, Catherine Gilson, Lucy Molyneux, Sassy
Abstract	Background Decentralisation is argued to promote community participation, accountability, technical efficiency, and equity in the management of resources, and has been a recurring theme in health system reforms for several decades. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous county governments, with substantial transfer of responsibility for health service delivery from the central government to these counties. Focusing on two key elements of the health system, Human Resources for Health (HRH) and Essential Medicines and Medical Supplies (EMMS) management, we analysed the early implementation experiences of this major governance reform at county level. Methods We employed a qualitative case study design, focusing on Kilifi County, and adapted the decision space framework developed by Bossert et al., to guide our inquiry and analysis. Data were collected through document reviews, key informant interviews, and participant and non-participant observations between December 2012 and December 2014. Results As with other county level functions, HRH and EMMS management functions were rapidly transferred to counties before appropriate county-level structures and adequate capacity to undertake these functions were in place. For HRH, this led to major disruptions in staff salary payments, political interference with HRH management functions and confusion over HRH management roles. There was also lack of clarity over specific roles and responsibilities at county and national government, and of key players at each level. Subsequently health worker strikes and mass resignations were witnessed. With EMMS, significant delays in procurement led to long stock-outs of essential drugs in health facilities. However, when the county finally managed to procure drugs, health facilities reported a better order fill-rate compared to the period prior to devolution. Conclusion The devolved government system in Kenya has significantly increased county level decision-space for HRH and EMMS management functions. However, harnessing the full potential benefits of this increased autonomy requires targeted interventions to clarify the roles and responsibilities of different actors at all levels of the new system, and to build capacity of the counties to undertake certain specific HRH and EMMS management tasks. Capacity considerations should always be central when designing health sector decentralisation policies.
Related Links	https://equityhealthj.biomedcentral.com/counter/pdf/10.1186/s12939-017-0663-2.pdf
Ending Page	13
Page Count	13
Starting Page	1
File Format	HTM / HTML
ISSN	14759276
DOI	10.1186/s12939-017-0663-2
Journal	International Journal for Equity in Health
Issue Number	1
Volume Number	16
Language	English
Publisher	BioMed Central
Publisher Date	2017-09-15
Access Restriction	Open
Subject Keyword	Public Health Health Promotion and Disease Prevention Health Services Research Health Policy Social Justice Equality and Human Rights Social Policy Decentralisation Devolution Governance Health workforce management Commodities management
Content Type	Text
Resource Type	Article
Subject	Health Policy Public Health, Environmental and Occupational Health
Journal Impact Factor	4.5/2023
5-Year Journal Impact Factor	4.7/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya

“We are toothless and hanging, but optimistic”: sub county managers’ experiences of rapid devolution in coastal Kenya

Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County

Applying an intersectionality lens to examine health for vulnerable individuals following devolution in Kenya

Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya

Measuring inequalities in the public health workforce at county-level Centers for Disease Control and Prevention in China

Doing implementation research on health governance: a frontline researcher’s reflexive account of field-level challenges and their management

Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya

Postings and transfers in the Ghanaian health system: a study of health workforce governance

Devolution and its effects on health workforce and commodities management – early implementation experiences in Kilifi County, Kenya

Similar Documents

How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya

“We are toothless and hanging, but optimistic”: sub county managers’ experiences of rapid devolution in coastal Kenya

Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County

Applying an intersectionality lens to examine health for vulnerable individuals following devolution in Kenya

Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya

Measuring inequalities in the public health workforce at county-level Centers for Disease Control and Prevention in China

Doing implementation research on health governance: a frontline researcher’s reflexive account of field-level challenges and their management

Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya

Postings and transfers in the Ghanaian health system: a study of health workforce governance

Devolution and its effects on health workforce and commodities management – early implementation experiences in Kilifi County, Kenya