Devolution and its effects on health workforce and commodities management - early implementation experiences in...

Area of Science:

• Public Health Policy
• Health Systems Management
• Decentralization and Governance

Background:

• Decentralization is a key strategy in health system reforms, aiming to improve resource management, efficiency, and equity.
• Kenya's 2010 constitution devolved health service delivery to 47 semi-autonomous county governments.
• This study examines the early implementation of health decentralization, focusing on Human Resources for Health (HRH) and Essential Medicines and Medical Supplies (EMMS) management.

Purpose of the Study:

• To analyze the initial experiences of implementing health decentralization in Kenya at the county level.
• To assess the impact of devolution on Human Resources for Health (HRH) and Essential Medicines and Medical Supplies (EMMS) management.
• To identify challenges and opportunities in enhancing county-level decision-space for health management functions.

Main Methods:

• A qualitative case study design was employed, focusing on Kilifi County.
• The decision space framework was adapted for inquiry and analysis.
• Data collection involved document reviews, key informant interviews, and observations from December 2012 to December 2014.

Main Results:

• Rapid transfer of HRH and EMMS functions to counties occurred before adequate structures and capacity were established.
• HRH management faced disruptions, including salary payment issues, political interference, and role confusion, leading to strikes and resignations.
• EMMS management experienced procurement delays and stock-outs, though order fill-rates improved post-procurement.

Conclusions:

• Kenyan devolution has expanded county decision-space for HRH and EMMS management.
• Realizing decentralization's benefits requires clarifying roles and building county capacity for HRH and EMMS tasks.
• Capacity considerations must be central to designing future health sector decentralization policies.