The annual Devolution Conference is a major opportunity for Kenya’s 47 county governments to reflect on the challenges and achievements of decentralised governance. This year, health was in the spotlight:
In his opening remarks, President Kenyatta urged county governments to focus their attention first and foremost on improving access to good quality health services. He reminded the assembled delegates that, of the issues on the ‘Big Four’ agenda, health is the one that troubles Kenyans most.
Four promising approaches to fostering accountability in health
For many years the Health Sector Programme has been working closely with the health departments in Kisumu, Kwale and Vihiga counties (and, since 2017, in Siaya) to strengthen accountability and good governance in the health sector. Each of these counties has developed and tested out approaches to improve the way that health services are planned and delivered so that they meet the needs and expectations of citizens. After five years of devolved governance, there are a lot of lessons to be shared – and some of the approaches may be ready for replication elsewhere.
At a booth organised by GIZ in the exhibition hall, officials from Kisumu, Kwale and Vihiga counties presented and answered questions about four specific approaches to fostering accountability in health: client satisfaction surveys (Kisumu); maternal and perinatal death reviews (Kisumu); employee satisfaction surveys (Kwale); and county health exhibitions (Vihiga). Over the course of four days, close to 1,000 participants – including several governors, deputy governors and members of county assemblies – visited the booth and interacted with the county representatives.
Positive feedback and interest from other counties
‘It was an awesome experience to talk with participants from other counties about our work,’ says Dominic Wamamba, an epidemiologist with the Kisumu County Health Management Team who presented the county’s approach to carrying out digitally-administered client satisfaction surveys. These annual surveys have helped the health department in Kisumu to prioritise areas for investment and improvement, and to track changes in public attitudes over time. ‘We received a lot of positive feedback, including from governors and policymakers. Some of them are interested to replicate the survey in their own counties.’
Dima Galole, the acting quality focal person at the Kwale County Department of Health, spoke with visitors about the role that employee satisfaction surveys in health facilities can play in identifying and then tackling issues affecting staff performance. ‘The people we spoke to were really interested in the link between the employee survey and improved service delivery,’ said Galole. ‘We were able to convey how the survey can lead to basic workplace improvements which then benefit the overall quality of care.’ Many visitors requested copies of the survey tool and more information about the survey process.
The Kisumu County Department of Health has made reducing maternal mortality one of its top priorities. Jane Owuor, the Reproductive Health Coordinator, coordinates the process of maternal and perinatal death reviews in the county, ensuring that each and every death is fully investigated in order to find out what went wrong and how it can be prevented from happening again. She explained to visitors how doing this regularly, in a ‘no blame’ environment, has led to improvements in the quality of maternity services, more effective referral practices, and enhanced teamwork throughout the health system.
Since 2015 the Vihiga County Health Department has been organising annual health exhibitions in which members of the public can interact with public and private health service providers, government officials, NGOs and development partners, and also receive free medical services, such as screenings for HIV and chronic diseases. George Odunga, the County Health Promotion Officer, answered questions about the exhibitions from many interested visitors. Representatives from a number from counties requested invitations to attend the next exhibition, in December of this year, in order to see the approach in action.
Toolkits under development to support replication
The representatives from Kisumu, Kwale and Vihiga counties were gratified by the interest shown in their work. Nearly 1,000 information leaflets about the featured approaches were distributed, and many visitors left their contact details with requests for further information. With support from GIZ, toolkits are currently being developed for two of the approaches – the employee satisfaction survey and the client satisfaction survey – and will be distributed later this year.
In his opening remarks, President Kenyatta observed that ‘the Devolution Conference gives us an opportunity as leaders to combine our strengths for the good of the country.’ The very successful ‘horizontal learning’ which took place at this year’s event demonstrated what this can look like in practice.