Competing Multiple Accountability Mechanisms and Public Administrators’ Responses in the Health Sector in Kenya

Abstract

The concept of accountability in the public sector is complex and has generated debate in the history of public administration. This study focused on accountability of public administrators under normal conditions and crisis situations where it is unclear which of the four mechanisms of hierarchical, professional, legal and political accountability dominates responses of hospital administrators in the public health sector in Kenya. Literature has pointed to existence of complex and competing multiple accountability mechanisms that often creates cross-pressure in public administration leading to negative consequences. However, these studies have been conducted in other public service jurisdictions outside Kenya. Besides, these studies have not conducted empirical research targeting hospital administrators. This research project, adopted the Principal-Agent theory and Romzek and Dubnick (1987) and a case study design to assess the multiple accountability mechanisms and responses of hospital administrators in Kenya. The study targeted hospital administrators from 36 public hospitals in 14 Counties in Kenya. Primary data was collected using a selfadministered questionnaire posted through email. Secondary data was obtained through desk review of relevant documents in the Kenya’s public service and the health sector. Study findings demonstrated the existence of the four mechanisms of accountability and how they operate in ensuring hospital administrators are held accountable. Additionally, findings showed that professional accountability seem to be given precedence over the other forms of public accountability in ordinary conditions and hierarchical accountability under crisis situations. The study concluded that the four mechanisms of accountability exist and operate distinctively in the health sector and as result hospital administrators are confronted by all the four mechanisms, but their intensity on accountability vary.