Recentralization within decentralization: county hospital autonomy under devolution in Kenya

Barasa, E. W., Manyara, A. M. , Molyneux, S. and Tsofa, B. (2017) Recentralization within decentralization: county hospital autonomy under devolution in Kenya. PLoS ONE, 12(8), e0182440. (doi: 10.1371/journal.pone.0182440) (PMID:28771558) (PMCID:PMC5542634)

Abstract

: Background In 2013, Kenya transitioned into a devolved system of government with a central government and 47 semi-autonomous county governments. In this paper, we report early experiences of devolution in the Kenyan health sector, with a focus on public county hospitals. Specifically, we examine changes in hospital autonomy as a result of devolution, and how these have affected hospital functioning. Methods: We used a qualitative case study approach to examine the level of autonomy that hospitals had over key management functions and how this had affected hospital functioning in three county hospitals in coastal Kenya. We collected data by in-depth interviews of county health managers and hospital managers in the case study hospitals (n = 21). We adopted the framework proposed by Chawla et al (1995) to examine the autonomy that hospitals had over five management domains (strategic management, finance, procurement, human resource, and administration), and how these influenced hospital functioning. Findings: Devolution had resulted in a substantial reduction in the autonomy of county hospitals over the five key functions examined. This resulted in weakened hospital management and leadership, reduced community participation in hospital affairs, compromised quality of services, reduced motivation among hospital staff, non-alignment of county and hospital priorities, staff insubordination, and compromised quality of care. Conclusion: Increasing the autonomy of county hospitals in Kenya will improve their functioning. County governments should develop legislation that give hospitals greater control over resources and key management functions.

• Item Type: Articles
• Additional Information: EB is funded by a Wellcome Trust Research Training Fellowship #WT107527/Z/15/Z funds from the DELTAS Africa Initiative [grant DEL-15-003] with funding from the Wellcome Trust [grant 107769/Z/15/Z] and the UK government. AM is funded by a Wellcome Trust IDeaL grant. EB, AM, SM, BT are members of the KEMRI-Wellcome Trust Research Programme in Kenya (core grant number #077092). S.M. was supported over the course of much of this work by a fellowship from the Wellcome Trust (grant number #092654). This work was supported by the UK Department for International Development as part of the Consortium for Research on Resilient and Responsive Health Systems (RESYST.) Additional funds came from the UK Aid from the UK Department for International Development (DFID) for the benefit of developing countries.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Manyara, Dr Anthony

Creator Roles

Manyara, A. M.: Data curation, Formal analysis, Writing – review and editing

• Authors: Barasa, E. W., Manyara, A. M., Molyneux, S., and Tsofa, B.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: PLoS ONE
• Publisher: Public Library of Science
• ISSN: 1932-6203
• ISSN (Online): 1932-6203
• Copyright Holders: Copyright © 2017 Barasa et al.
• First Published: First published in PLoS ONE 12(8): e0182440
• Publisher Policy: Reproduced under a Creative Commons License