The 2010 constitution guarantees Kenyans access to quality, affordable health care. As part of the process of administrative decentralisation, responsibility for health service delivery was transferred from the Ministry of Health to county governments in 2013. This has created opportunities to make health care more responsive to the needs of local residents and to improve the overall efficiency of health sector management.
While the situation varies across Kenya’s 47 counties, many County Health Management Teams (CHMTs) have been grappling with technical, financial and human resource challenges as they assume their new governance responsibilities in the health sector. In particular, the capacity of CHMTs to lead consultative, evidence-based planning processes needs to be strengthened. Measures which promote accountability and transparency in health sector management are also needed in order to enhance trust in the health system among patients and health workers, and to increase the utilisation of health services.
On behalf of Germany’s Federal Ministry for Economic Cooperation and Development (BMZ), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH implements the Support to the Health Sector project (2017-2018), which aims to improve access to high-quality basic health services for the poor, workers in the informal sector and their families. One component of the project works on strengthening health sector management and governance in four counties: Kisumu, Kwale, Siaya and Vihiga.
Health sector planning is a major area of focus for the project at county level. Project advisors based in the four counties work in close cooperation with CHMTs to enhance their capacities to design and implement good-quality planning processes, including the development of Annual Work Plans (AWPs) as well as five-yearly County Health Sector Strategic and Investment Plans. They provide training on how to analyse and use local health data in planning cycles, so that priorities and targets are informed by evidence. They also advise on approaches to stakeholder consultation to ensure that community perspectives are reflected in planning processes.
Once the AWPs are developed, the project supports CHMTs to assess them using a scoring methodology linked to the national planning guidelines. The scoring tool allows CHMTs to objectively assess the quality of their plans and to identify gaps in both the planning process and the final product. They then come up with action points to address the identified weaknesses in subsequent annual plans, thereby enabling continuous improvement in AWPs over time.
To foster good governance in the health sector, the project advises CHMTs in the four counties on the design and implementation of instruments which promote public participation and enhance transparency. These include public expenditure tracking, service charters, social audits, the establishment of complaint mechanisms, staff and patient satisfaction surveys, and stakeholder engagement forums, e.g. health exhibitions. Project advisors work closely with CHMTs to determine which of these approaches are suitable for addressing local issues, and support both the implementation and generation of learnings.
Best practices and lessons learned for management and governance in the health sector at county level are documented by the project and introduced into horizontal exchange processes between county governments, including through the involvement of the Council of Governors.
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