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
Abstract Background Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralizatio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12939-020-01284-3 |
| _version_ | 1828464783176761344 |
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| author | Joshua Munywoki Nancy Kagwanja Jane Chuma Jacinta Nzinga Edwine Barasa Benjamin Tsofa |
| author_facet | Joshua Munywoki Nancy Kagwanja Jane Chuma Jacinta Nzinga Edwine Barasa Benjamin Tsofa |
| author_sort | Joshua Munywoki |
| collection | DOAJ |
| description | Abstract Background Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. Methods We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. Results We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. Conclusion Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country’s efforts for promoting service delivery equity as a key goal – both for the devolution and the country’s quest towards Universal Health Coverage (UHC). |
| first_indexed | 2024-12-11T03:20:33Z |
| format | Article |
| id | doaj.art-56e7a522cf494dcbae613aa435a423c4 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-11T03:20:33Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-56e7a522cf494dcbae613aa435a423c42022-12-22T01:22:38ZengBMCInternational Journal for Equity in Health1475-92762020-09-0119111310.1186/s12939-020-01284-3Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in KenyaJoshua Munywoki0Nancy Kagwanja1Jane Chuma2Jacinta Nzinga3Edwine Barasa4Benjamin Tsofa5KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research CoastKEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research CoastKEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research CoastKEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research CoastKEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research CoastKEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research CoastAbstract Background Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. Methods We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. Results We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. Conclusion Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country’s efforts for promoting service delivery equity as a key goal – both for the devolution and the country’s quest towards Universal Health Coverage (UHC).http://link.springer.com/article/10.1186/s12939-020-01284-3Priority settingHealth system decentralisationHuman resources for healthDecision space |
| spellingShingle | Joshua Munywoki Nancy Kagwanja Jane Chuma Jacinta Nzinga Edwine Barasa Benjamin Tsofa 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 International Journal for Equity in Health Priority setting Health system decentralisation Human resources for health Decision space |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Priority setting Health system decentralisation Human resources for health Decision space |
| url | http://link.springer.com/article/10.1186/s12939-020-01284-3 |
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