Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018
Background Performance-based financing (PBF) was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level.Methods ...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Kerman University of Medical Sciences
2023-12-01
|
| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | https://www.ijhpm.com/article_4392_ef1817502c17ac01b35ea5189d4ff8f5.pdf |
| _version_ | 1827281644584697856 |
|---|---|
| author | Dennis Waithaka Lucy Gilson Edwine Barasa Benjamin Tsofa Marsha Orgill |
| author_facet | Dennis Waithaka Lucy Gilson Edwine Barasa Benjamin Tsofa Marsha Orgill |
| author_sort | Dennis Waithaka |
| collection | DOAJ |
| description | Background Performance-based financing (PBF) was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level.Methods The study employed a single-case study design. The Shiffman and Smith political priority setting framework with adaptations proposed by Walt and Gilson was applied. Data was collected through document review (n = 19) and in-depth interviews (n = 8). Framework analysis was used to analyse data and generate findings.Results In the period 2015-2018, the political prioritisation of PBF at the county level in Kilifi was influenced by contextual features including the devolution of power to sub-national actors and rigid public financial management (PFM) structures. It was further influenced by interpretations of the idea of ‘pay-for-performance,’ its framing as ‘additional funding,’ as well as contestation between actors at the sub national level about key PBF design features. Ultimately PBF ceased at the end of 2018 after donor funding stopped.Conclusion Health reformers must be cognisant of the power and interests of national and sub national actors in all phases of the policy process, including both bureaucratic and political actors in health and non-health sectors. This is particularly important in devolved public governance contexts where reforms require sustained attention and budgetary commitment at the sub national level. There is also need for early involvement of critical actors to develop shared understandings of the ideas on which interventions are premised, as well as problems and solutions. |
| first_indexed | 2024-04-24T09:04:44Z |
| format | Article |
| id | doaj.art-212002f8e077458ea322d496ba307fdb |
| institution | Directory Open Access Journal |
| issn | 2322-5939 |
| language | English |
| last_indexed | 2024-04-24T09:04:44Z |
| publishDate | 2023-12-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-212002f8e077458ea322d496ba307fdb2024-04-15T19:04:25ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392023-12-0112Issue 111310.34172/ijhpm.2023.69094392Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018Dennis Waithaka0Lucy Gilson1Edwine Barasa2Benjamin Tsofa3Marsha Orgill4Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, KenyaHealth Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South AfricaHealth Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, KenyaHealth Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaHealth Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South AfricaBackground Performance-based financing (PBF) was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level.Methods The study employed a single-case study design. The Shiffman and Smith political priority setting framework with adaptations proposed by Walt and Gilson was applied. Data was collected through document review (n = 19) and in-depth interviews (n = 8). Framework analysis was used to analyse data and generate findings.Results In the period 2015-2018, the political prioritisation of PBF at the county level in Kilifi was influenced by contextual features including the devolution of power to sub-national actors and rigid public financial management (PFM) structures. It was further influenced by interpretations of the idea of ‘pay-for-performance,’ its framing as ‘additional funding,’ as well as contestation between actors at the sub national level about key PBF design features. Ultimately PBF ceased at the end of 2018 after donor funding stopped.Conclusion Health reformers must be cognisant of the power and interests of national and sub national actors in all phases of the policy process, including both bureaucratic and political actors in health and non-health sectors. This is particularly important in devolved public governance contexts where reforms require sustained attention and budgetary commitment at the sub national level. There is also need for early involvement of critical actors to develop shared understandings of the ideas on which interventions are premised, as well as problems and solutions.https://www.ijhpm.com/article_4392_ef1817502c17ac01b35ea5189d4ff8f5.pdfperformance-based financingpoliticspolitical prioritizationpowersub-nationalkenya |
| spellingShingle | Dennis Waithaka Lucy Gilson Edwine Barasa Benjamin Tsofa Marsha Orgill Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018 International Journal of Health Policy and Management performance-based financing politics political prioritization power sub-national kenya |
| title | Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018 |
| title_full | Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018 |
| title_fullStr | Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018 |
| title_full_unstemmed | Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018 |
| title_short | Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018 |
| title_sort | political prioritisation for performance based financing at the county level in kenya 2015 to 2018 |
| topic | performance-based financing politics political prioritization power sub-national kenya |
| url | https://www.ijhpm.com/article_4392_ef1817502c17ac01b35ea5189d4ff8f5.pdf |
| work_keys_str_mv | AT denniswaithaka politicalprioritisationforperformancebasedfinancingatthecountylevelinkenya2015to2018 AT lucygilson politicalprioritisationforperformancebasedfinancingatthecountylevelinkenya2015to2018 AT edwinebarasa politicalprioritisationforperformancebasedfinancingatthecountylevelinkenya2015to2018 AT benjamintsofa politicalprioritisationforperformancebasedfinancingatthecountylevelinkenya2015to2018 AT marshaorgill politicalprioritisationforperformancebasedfinancingatthecountylevelinkenya2015to2018 |