| dc.description.abstract | Kenya’s
Ministry of Health (MOH) commitment to address the inherent constraints in the health
sector has included deliberate decentralization efforts aimed at strengthening the effective
implementation of activities at the district level, and fostering closer coordination and
collaboration amongst the line ministries, donors, organizations, and other stakeholders. Among
these efforts, local District Health Management Boards (DHMBs) and District Health
Management Teams (DHMTs) gradually assumed responsibilities for the operation of the
facilities under their jurisdiction through a single line grant, annual work plans, and procurement
plans. To assess the current effectiveness of the district health management systems in meeting
their responsibilities, we analyze data from a special District Health Management module of the
2004 Kenya Service Provision Assessment Survey to discern the degree to which the DHMTs
and DHMBs meet norms and standards in the areas of governance and management, human
resource development and management, commodity management, infrastructure development,
health care financing, budgeting and management, and performance monitoring.
Notably, data on DHMTs and DHMBs were missing for 20 percent of the districts. This
level of nonresponse has the potential to weaken the validity of the findings, particularly when
the excluded DHMTs are in provinces with some of the worst health indicators in the country.
Their exclusion was due to difficult terrain and insecure environment, both of which imply that
the right of the population to health care services is compromised.
The results of this descriptive analysis indicate that although most of the DHMTs hold
meetings frequently, the unavailability of the guidelines on the functioning of the DHMTs made
it difficult to determine compliance of DHMTs with any existing norms and standards. The
survey missed the opportunity to assess the activities and achievements of the HFMCs and
HCMTs, which are important for decentralization. Although most of the DHMTs had
documented plans for improving reproductive health, less than a quarter reported implementing
their plans on time. Lack of funds and transport were the most cited reasons for failure by
DHMTs to meet their supervision targets despite the near universal existence of documented
supervision plans. In terms of support of human resources, continuing professional development
is an accepted norm in the districts, but there is urgent need to strengthen and expand the scope
of updates to serving staff through the establishment of district health training committees and
regular monitoring of their activities. An assessment of available infrastructure indicated that
repair and maintenance units existed in most districts, with nearly all of the districts contracted
with the provincial workshop for repair and maintenance work. Communication facilities
between most district hospitals and close to three quarters of the health centers with referral
facilities under government management had capacity to communicate easily by telephone or
two-way radio with a referral facility to arrange transport during emergencies. The situation was
much better for NGO/mission-run facilities. Regarding financing issues, despite existence of
both recurrent and development funds, funding for medicines, equipment, and maintaining
buildings was inadequate for most districts. Sources for funding for district health services
included central government funding supplemented by local government, revolving funds, and
other sources. Increased annual budgetary allocations to the agreed 15 percent to ministries of
health, in agreement with the Abuja accord, may increase financial resources required for
medicines, equipment, and maintenance of buildings. | en |
