Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care

Health Policy and Planning
Rosalind McCollumMiriam Taegtmeyer

Abstract

Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands. We sought to explore the impact of devolution on priority-setting for health equity and community health services. We conducted key informant and in-depth interviews with health policymakers, health providers and politicians from 10 counties (n = 269 individuals) and 14 focus group discussions with community members based in 2 counties (n = 146 individuals). Qualitative data were analysed using the framework approach. We found Kenya's devolution reforms were driven by the need to demonstrate responsiveness to county contexts, with positive rami...Continue Reading

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Citations

Feb 27, 2020·Health Policy and Planning·Nancy KagwanjaEdwine Barasa
Nov 7, 2019·Health Systems and Reform·Susan P SparkesAlexandra J Earle
Aug 17, 2019·Frontiers in Veterinary Science·Laura C FalzonEric M Fèvre
Jan 5, 2021·Sexual and Reproductive Health Matters·Lisa OwinoAllan Maleche
Mar 18, 2021·Global Health, Science and Practice·Salim HusseinRobinson Karuga
Jul 19, 2021·Globalization and Health·Mary QiuSara Bennett
Oct 15, 2021·BMC Health Services Research·Angela KairuEdwine Barasa

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