| dc.description.abstract | According to Sohani (2005: 4) in Kenya, although 80% of the populations live in rural areas, only 30% of health spending goes to them. The delivery of healthcare services in the rural areas has been poor and rural health facilities have been performing below expectation (LaVonne, 1992:3).
The purpose of the study was to assess the performance and sustainability of community health care centres in providing health care to the rural poor. The study was guided by 3 objectives as follows to; determine the extent to which communities participate in health care service delivery in Kathonzweni division of Makueni district, establish the major strengths and weaknesses of community-based health care centres in terms of performance and sustainability in Kathonzweni division and examine the role of development partners (GOK, NGOs, CBOs, Donors) in supporting community-based health care centres in Kathonzweni division.
The study used both qualitative and quantitative research methods. The researcher purposively selected 3 sub-locations, namely Yinthungu, Mbuvo and Kanzokea within Kathonzweni Division because this is where the community based health centres exist. The health care centres were chosen purposively and the respondents chosen using cluster sampling. The researcher interviewed 114 respondents (96 households and 18 key informants).
The study was guided by the following theories; Social system theory which looks at the performance of a system to determine the extent of its effectiveness. Exchange theory provided an explanation both for the behavior of actors within the structure and for changes in the structure itself and lastly participatory development model which highlights tapping resources from the community, government and other agencies to enhance service delivery.
The main findings of the study were that the centres are providing essential services to the community by bringing health care services to the communities. There were moderate levels x
of community organization and engagement in the centres establishment and management despite facing challenges due to constant drought in the area.
The non availability of essential services, adequate staffing, funds and sometimes drugs reduces the performance of the centres thereby affecting the utilization of the facilities. Development partners were seen to have a significant impact on the management and sustenance of the services being offered at the centres. The study revealed that there was over-dependence on one development partner and duplication of resources. The committee's management were doing a commendable job in managing the centres but gaps were identified in terms of resource mobilization, networking, access to health information and management skills.
In conclusion, the results suggest that the performance and sustainability of the health centres is affected by external and internal factors. Secondly coalitions and community partnerships provided a means of pooling abilities, expertise and resources of numerous stakeholders to positively affect community health interventions. Thirdly, the expression of community participation through the establishment of CBOs is important because these structures (CBOs) are suitable formal community organizations that give them collective bargaining power.
Improving the viability of the centres is a crucial element that will influence sustainability. This relates to organizational linkages and relationships for support, financial viability, technical support, access to relevant information that guides implementation and service provision and the capacity of the committees/staff in management. Hence the following recommendations are proposed that will enhance the performance and sustainability of the centres; First, introduction of incentives and benefits to encourage participation, building the capacity of management committees and the clinical team involved in the centres through educational sessions and participatory trainings.
Third, identify strategic development partners to support them with adequate funding for infrastructure development and provision of essential services and focus on services that the communities have the ability to support. Fourthly, the centres need to engage In Income generating activities that will provide extra funds to support and sustain the centres.
Finally, the development of indicators for planning what is to be sustained, how, by whom, how much and by when can serve as sustainability objectives to be monitored throughout the project lifetime | en |
