scholarly journals Who is responsible? Local government and accountability for service delivery in Kenya’s devolved health sector

2018 ◽  
pp. 158-171
Author(s):  
Kenneth Okwaroh Ochieng
Keyword(s):  
Decision Making ◽  
Health Services ◽  
Service Delivery ◽  
Local Governments ◽  
Health Sector ◽  
Political Accountability ◽  
County Governments ◽  
Resource Mobilisation ◽  
Health Function ◽  
Delivery Of Health Services

One of the arguments in favour of local governments is their ability to deliver public services better because of their proximity to demand. This is typically achieved through decentralisation – the transfer of some level of formal responsibility, authority and/or resources to smaller, lower tiers of government. This paper examines service delivery in the health sector in Kenya within the context of the country’s newly introduced devolved system of government, which created 47 county governments under the 2010 Constitution. It examines three key responsibilities: i) resource mobilisation, distribution and administration, ii) decision-making, and iii) political accountability, and their bearing on outcomes for delivery of health services. The paper argues that devolution of the health function in Kenya has been only partial, leading to challenges of coordination between the national and county governments and ambiguity over responsibility for service delivery; both factors which risk undermining the opportunities that devolution creates or promises.

Local Government as a Democracy Actor or a Service Delivery Actor

2014 ◽  
pp. 127-147 ◽  
Author(s):  
Peter Demediuk ◽  
Stephen Burgess ◽  
Rolf Solli
Keyword(s):  
Decision Making ◽  
Local Government ◽  
Service Delivery ◽  
Local Governments ◽  
Local Governance ◽  
Governance Practice

Local governance occurs where a local government gives citizens a say in things that really matter to them, and e-governance initiatives provide electronic means to enable citizens to participate in this shared governing of the community. The clearer a local government is about the nature and degree to which it needs to act as a democracy actor (better citizens and better government) and/or a service delivery actor (better decision making), the greater the prospect that it can choose appropriate electronic means through an e-governance approach to meet those ends. In order to guide an e-governance practice and inform further research, this chapter: provides models that articulate the elements that constitute better decision making, better citizens, and better government, and presents examples from five local governments of how electronic means can satisfy particular ends.

Factors Influencing Utilization of Health Services in Kenya: The Case of Homa Bay County

2014 ◽  
Vol 3 (4) ◽  
pp. 213 ◽  
Author(s):  
Stephen Odiwuor Otieno ◽  
David Macharia
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Qualitative Data ◽  
Health Workers ◽  
Health Sector ◽  
Health Service Delivery ◽  
District Health ◽  
Utilization Of Health Services ◽  
Factors Influencing ◽  
The Government

In order to improve efficiency in health service delivery in Kenya, the Ministry of Health has developed structures through inter-sectoral collaboration at various levels. Despite efforts by the government and key stakeholders to improve health sector, utilization of health services still remains a major challenge. The purpose of the study was to investigate factors that influence utilization of health services in Homa Bay County, Kenya. The study employed survey design and focused on health beneficiaries, District Health Management Team and other key health stakeholders, and used both quantitative and qualitative data. Quantitative data was collected through household interviews of 384 respondents and qualitative data was generated through Key Informant Interviews of 16 respondents. The study reveals that health financing, service delivery, quality, accessibility and equity influence utilization of health services in Homa Bay County. It is for these reasons that the study recommends that the government should allocate adequate budget towards health services, avail adequate trained health workers, and improve infrastructure in health facilities as well as drugs and other supplies. There is also need for further research on cultural factors influencing utilization of health services.

DESIGNING AN INTEGRATED HEALTH CARE STRATEGY

2020 ◽  
Vol 21 (1) ◽  
pp. 65-76
Author(s):  
Małgorzata Dymyt
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Systems ◽  
Health Sector ◽  
Integrated Health Care ◽  
Integrated Healthcare ◽  
Care Integration ◽  
Integrated Health ◽  
Key Aspects ◽  
Delivery Of Health Services

The article concerns the strategic dimension of the integration of health care. The concept of integrated health care plays a key role in the improvement of health systems. The complexity of the health care system makes a coherent, comprehensive and coordinated approach to health services necessary. The integration of health care consists in the management and delivery of health services in such a way that patients receive continuity of health care, coordinated at various levels, within and outside the health sector and as needed throughout their lives. The purpose of the article is to present the essence of health care integration and key aspects of the design of integrated healthcare strategy, identify its assumptions and main elements.

scholarly journals Factors Influencing Utilization of Health Services in Kenya: The Case of Homa Bay County

2014 ◽  
Vol 3 (4) ◽  
pp. 213
Author(s):  
Stephen Odiwuor Otieno ◽  
David Macharia
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Qualitative Data ◽  
Health Workers ◽  
Health Sector ◽  
Health Service Delivery ◽  
District Health ◽  
Utilization Of Health Services ◽  
Factors Influencing ◽  
The Government

In order to improve efficiency in health service delivery in Kenya, the Ministry of Health has developed structures through inter-sectoral collaboration at various levels. Despite efforts by the government and key stakeholders to improve health sector, utilization of health services still remains a major challenge. The purpose of the study was to investigate factors that influence utilization of health services in Homa Bay County, Kenya. The study employed survey design and focused on health beneficiaries, District Health Management Team and other key health stakeholders, and used both quantitative and qualitative data. Quantitative data was collected through household interviews of 384 respondents and qualitative data was generated through Key Informant Interviews of 16 respondents. The study reveals that health financing, service delivery, quality, accessibility and equity influence utilization of health services in Homa Bay County. It is for these reasons that the study recommends that the government should allocate adequate budget towards health services, avail adequate trained health workers, and improve infrastructure in health facilities as well as drugs and other supplies. There is also need for further research on cultural factors influencing utilization of health services.

scholarly journals Consumer participation: The challenges to achieving influence and equity

2004 ◽  
Vol 10 (3) ◽  
pp. 15 ◽  
Author(s):  
Sally Nathan
Keyword(s):  
Decision Making ◽  
Health Services ◽  
Community Participation ◽  
Consumer Participation ◽  
Marginalised Groups ◽  
Decision Making Processes ◽  
The Impact ◽  
Delivery Of Health Services ◽  
Improve Access

Consumer participation in the planning and delivery of health services is recommended and promoted to improve access, quality of care and health outcomes despite questions about the evidence of its impact. There are also significant barriers to participation by certain groups in our community in both their own care and in broader decision-making processes. This paper examines the evidence of the impact of consumer and community participation in health services and the difficulties of engaging more marginalised groups. It proposes three challenges to be met in realising the promise of consumer and community participation: 1) building the capacity of consumers and the community to influence 2) building the capacity of the health system to accept and value their views, and 3) providing opportunities for the most marginalised in society to be heard. In meeting these challenges to consumer and community participation, researchers and practitioners also need to work together to find better ways to measure its impact.

scholarly journals Accountability: a necessity to pro-poor service delivery in Municipal Councils in Uganda

2020 ◽  
Vol 1 (1) ◽  
pp. 43-54
Author(s):  
David Mwesigwa ◽  
Keyword(s):  
Service Delivery ◽  
Local Governments ◽  
Political Accountability ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Municipal Council ◽  
Hands On ◽  
Role Players ◽  
Basic Services ◽  
Municipal Development

Purpose: There is mounting fear that the present-day Local Government managers do not appropriately respond to pro-poor service delivery. Yet, the number of people lacking access to quality services is swelling. This fault has placed a growing burden on Local Governments to enhance local councilors' political accountability by ensuring that the basic services are made delivered to citizens with accountability. Given the different challenges and observed shortage of political accountability in Uganda, this study examined the contribution of political accountability towards achieving pro-poor service delivery in a Ugandan Municipality. Research methodology: Using five Focus group discussions, perspectives on accountability are debated as a foundation for improving service delivery. Limitation: The study covers only Uganda and may not easily be generalised to other countries. Results: Results indicate that political accountability is key to implementing a municipal development plan. Contribution: The study contributes to knowledge so that hands-on accountability holds potential and requires more consideration as a means to assimilate learning-based methods and role-players network to back up the delivery of pro-poor services. It is proposed that local councilors become more responsive to meet the growing need for pro-poor service delivery in a Municipal council. Keywords: Accountability, Pro-poor service delivery, Horizontal, Vertical, Diagonal

scholarly journals Analisis Keberlanjutan Inovasi Lokal : Studi Kasus Inovasi e-Health Cimalaka Sehat

2019 ◽  
Vol 22 (2) ◽  
Author(s):  
Endah Mustika Ramdani
Keyword(s):  
Health Services ◽  
Local Governments ◽  
Service Providers ◽  
Local Level ◽  
Health Sector ◽  
Comfort Zone ◽  
Health Innovation ◽  
Health Innovations ◽  
Depth Interviews

Innovation in public services is a demands , both for central and local governments to improve services to the community. In service innovations at the local level, it certainly brings the risk of rejection from people who are not ready to change. This study aims to examine the local innovations in the health sector, Cimalaka Sehat e-health innovation case studies. The method used is descriptive qualitative with a case study at the Innovation of e-health Cimalaka Sehat services as a pioneer of e-health innovations in the Sumedang Regency. The technique of determining informants uses purposive sampling, data collection is done by observation, in-depth interviews, and documentation. The results showed that in innovation healthy cimalaka e-health has many advantages for the community through changing processes from manual to online as well as increasing features of health services that support the development of health services for puskesmas. However, from several advantages, there are several constraints and problems including the lack of a thorough understanding of the usefulness of innovation, low commitment and consistency of service providers to adapt to available innovations, with indications that the organizers are in a comfort zone that is providing alternative services similar to the innovation e-health (service through WhatsApp), which actually reduces the value of the usefulness of innovation, so that people are reluctant to change to existing service innovations.

scholarly journals Exploring the use of emergency health services for stroke: what is known about when to seek emergency help and how transport decisions impact in-hospital emergency care

2021 ◽  
Author(s):  
◽  
Damanpreet Kandola
Keyword(s):  
Decision Making ◽  
British Columbia ◽  
Health Service ◽  
Health Services ◽  
Service Delivery ◽  
Service Use ◽  
Stroke Care ◽  
Health Service Delivery ◽  
Health Service Use ◽  
Emergency Health Services

Transport practices for seeking emergency stroke care remain largely underresearched and poorly understood, particularly for individuals living in small urban, rural, and remote regions. This multi-method study aims to address this knowledge gap and explores the impact of mode of transport on in-hospital stroke care and the decision-making process of seeking emergency medical attention for patients and their caregivers. Data from the Discharge Abstract Database provide information on stroke-related use of emergency health services across British Columbia. Data from the Canadian Institutes for Health Information Special Project 340 provide information on if calling emergency health services impacts the delivery of care, including the completion of neuroimaging, the administration of acute thrombolysis, and the prescription of antithrombotics upon discharge across a northern health region. Focused, semi-structured interviews provide contextual insight into the decision-making processes for seeking emergency stroke care among patient and caregiver participants in a northern health region. Stroke-related emergency health service use across British Columbia from January 2015 to March 2018 was 67.9% (N=19,849), ranging from 58.8% in Northern Health to 70.2% in Fraser Health. In Northern Health (N=784), there were differences between health service delivery areas for stroke-related emergency health service use ranging from 53.7% in the Northwest to 64.8% in the Northern Interior from January 2015 to March 2018. Similar differences in thrombolytic therapy administration and the prescription of antithrombotics were noted. The odds of emergency health service use were greater for those 65 years of age and older than those younger than 65 and lower for those in the Northwest health service delivery area than those in the Northern Interior health service delivery area. Differences were found for the completion of neuroimaging between males and females. Interviews for patient (n=12) and caregiver (n=7) participants provide complementary contextual insights and yielded three key themes, including the decision-making process following a stroke, experiences of care, and perceived gaps and areas in need of further support. This integrated knowledge translation-informed and practice-driven research addresses health services and policy priorities. Findings are anticipated to help inform the development and refinement of emergency health services in British Columbia by highlighting differences in emergency health services use across geographies and identifying factors that inform patient decisionmaking when seeking emergency medical attention.

scholarly journals Can organisation development principles in India's local governments improve governance?

2017 ◽  
pp. 135-156
Author(s):  
Sonali Srivastava ◽  
Madhavi Rajadhyaksha
Keyword(s):  
Decision Making ◽  
Service Delivery ◽  
Local Governments ◽  
Local Governance ◽  
Shared Vision ◽  
Present Form ◽  
Organisation Development ◽  
Organisational Capacity ◽  
Incentive Structures ◽  
The Village

This paper examines the application of organisation development principles to rural local self-government bodies in Karnataka, India with the objective of developing their organisational capacity and improving their efficiency. The premise is that strong gram panchayats (village councils) can address issues hindering service delivery and governance at the grass roots.The paper illustrates the methodology used in the development of an innovative framework called Gram Panchayat Organisation Development (GPOD) and its implementation in action research mode in two village councils since 2011. It further explores the wider applicability of this framework, which has been extended to over 50 gram panchayats (GPs) since 2014. GPOD works towards strengthening the panchayat as an organisation in its entirety, rather than by tackling stand-alone components. It includes building a shared vision in the panchayat, mapping and re-engineering key processes, developing accountability and incentive structures, and supporting the village body in developing and implementing its annual plans. The approach has evolved to its present form based on real-time change management initiatives in GPs in which politically elected members participated in decision-making and implementation. We argue that by following the principles of organisation development and aligning the panchayat’s organisational components, marked improvements in local governance and service delivery were achieved. Impact is captured in terms of systemic outputs such as annual plans, accountability structures and activation of defunct committees, as well as improvements in services such as health, sanitation, drinking water, etc. The paper also includes a critique of the challenges faced as GPOD was scaled up to include new areas.

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