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Challenges of Implanting Devolved Health Care in the Counties in Kenya Essay Sample

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Challenges of Implanting Devolved Health Care in the Counties in Kenya Essay Sample

Kenya’s health care system has remained largely centralised with decisions taken at MOH headquarters from where they are conveyed top-down through the provincial medical officers to the district level. Centralised functions at the headquarters include policy formulation, coordinating activities of all health players (government and non-governmental organizations), initiating and managing implementation of policy changes on various issues including charging of user fees, and undertaking monitoring and evaluation of impact of policy changes at the district level.nb MOH through the various health sector strategic plans has expressed commitment to decentralisation intended to provide increased authority for decision making, resource allocation, and management of health care to the district and facility levels. For example, in 1992 the MOH established the District Health Management Teams (DHMTs) and the District Health Management Boards (DHMBs), which were charged with managing public health services at the district level. Together, the DHMT and DHMB are supposed to provide management and supervisory support to lower level health facilities (sub-district hospitals, health centres, and dispensaries).

Health care provision within the devolved system of government as provided for in the Constitution of Kenya (2010) will come up against several obstacles, key among these being the challenge posed by uneven inter-county levels of development, unequal distribution of resources for health especially the distribution of health facilities, human resources, and poorly developed communication infrastructure. Also unevenly distributed across the country are poverty levels, the effect of which is to make health services largely inaccessible to a large chunk of the population that cannot afford the high out-of-pocket expenditures, which are known to be common in Kenya. Some counties starting at a relative disadvantage will take time to build up their capacity and ability to use devolved resources well, which may lead to even wider disparities. According to the Fourth Schedule of the Constitution, county governments are entrusted with all functions related to health care except for health policy and national referral health facilities which remain the responsibility of the national government. Specifically, County Health Services will be responsible for health facilities and pharmacies at Levels 1 to 4; ambulance services; and promotion of primary health care.

However, within the situation highlighted above it is obvious that some of the counties will be hard pressed fulfilling this mandate. Such counties may benefit from experiences derived from elsewhere, where health services have been provided with some measure of success at low cost. The draft Kenya Health Sector Strategic & Investment Plan[v](KHSSP)July 2012 – June 2018 proposes: Partnership, Governance and Stewardship- which taken together should address the health agenda towards the fulfillment of the right to health. The strategic plan proposes that within the counties, the stewardship responsibilities for health services will be exercised at three levels: the National Directorates for Health, the County health management teams, and County Health facility management teams. However, scrutiny of the prescribed responsibilities, functions and roles[vi] of these bodies portrays a continuation of dominance by MOH headquarters in matters to do with policy formulation, planning and priority setting, which leaves the county management teams to be purely concerned with programme implementation (under close supervision from above).

This is unfortunate since it perpetuates central planning which has not always taken into consideration the peculiarities of our country’s diversity, with consequent wide disparities in health status. The major challenge facing proposed county health services is the serious shortage of resources, human and material, especially due to financial limitations. Currently the public health sector is seriously under-funded and is generally operating on shoe-string budgets, inadequate infrastructure and lack of essential supplies. Although better distribution and deployment of health personnel may somewhat alleviate current acute shortages in some counties, still more will be needed. Many counties will especially require strengthening in health planning and monitoring. In Kenya, as in most sub-Saharan African countries, nearly three quarters of the population lives in rural areas.

According to the World Bank Indicators in 2008, about 79 percent of Kenya’s population lived in rural areas[i], where the infrastructure for communication and health services is poorly developed. Under such circumstances, there is no short-cut to it that, unless the population is extraordinarily motivated, services have to be brought closer to people rather than expecting them to travel long distances for the services. This is true for all promotive health services such as family planning, antenatal and postnatal care and child health services (growth monitoring and immunization). This has recently been confirmed by a study based in western Kenya [ii], which explored the impact of distance to health facility on utilisation of child health services. The study showed that for every 1 km increase in distance of residence from a health clinic, the rate of clinic attendance decreased by 34% from the previous kilometer. This means that creative strategies will be needed to ensure rural populations can have access to health services, which are a reasonable distances from them.


[i] Urban population in Kenya http://www.tradingeconomics.com/kenya/urban-population-wb-data.html [ii] Feikin DR, Nguyen LM, Adazu K, Ombok M, et al., The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. [ii] Trop Med Int Health. 2009 Jan; 14(1):54-61. Epub 2008 Nov 14.http://www.ncbi.nlm.nih.gov/pubmed/19021892 [iii] The Machakos Project (1981-1994) was supported by the Special Progranune of Research in Human Reproduction, WHO/HRP, WHO, Geneva, the Population Council, New York, the Rockefeller Foundation and the Ministry of Health, Kenya. [iv] The objective of Community Strategy is to enhance access to and use of health services at community level The Strategy is described in “A Strategy for the Delivery of Level One Services” (MOH, June 2006). [v] Ministry of Medical Services and Ministry of Public Health & Sanitation KENYA HEALTH SECTOR STRATEGIC & INVESTMENT PLAN (KHSSP) July 2012 – June 2018: Transforming Health: Accelerating attainment of Health Goals [vi] National Directorates for Health: provide overall direction- policy formulation, national strategic planning, priority setting, budgeting and resource mobilization, regulating, setting standards, formulating guidelines, monitoring and evaluation, and provision of technical backup to the county level. County Health Management Teams: Provide Strategic and operational leadership and stewardship for overall health management in the County, including resource mobilization, creation of linkages with national level referral health services, monitoring and evaluation, coordination and collaboration with State and Non state Stakeholders at the County level health services. County Health Facility Management Teams: Develop and implement facility health plans for levels 1–3 health care services; coordinate and collaborate with stakeholders through County Health
Stakeholder Forums; undertake in-service training and capacity building; and supervision, monitoring and evaluation.

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