Int J Health Plann Manag. This allocation would then be subdivided between all gazetted government health facilities based on a resource allocation criteria developed by the national MoH. Devolution is the statutory granting of powers from the government of a sovereign state to government to government at a sub national level. However, irrespective of the form, the final effects of decentralisation reforms have been influenced by many internal and external factors including the reasons or drivers for decentralisation, and the country’s political context [1, 3,4,5,6]. Makerere University dkwendo@gmail.com*1 ABSTRACT national challenges the country has faced over the years including high poverty levels, burdensome public service, The introduction of Devolution in Kenya after the corruption and marginalization of minorities [1]. 2004;2:5. effects of education decentralization by devolution on students’ performance in tanzania: the case of community secondary schools in temeke municipality bernard anthony ngamesha a dissertation submitted in partial fulfillment of the requirements for the degree of master of education in administration, planning and policy studies of the open 2007;38(1):7–17. Key points • Since 2013, researchers from KEMRI-WT have been tracking the effects of devolution … We examined the effect of devolving people‐management responsibilities to line managers on HR managers' construed image—their perceptions of the internal reputation of the HR unit. I would say devolution is a good thing because we’ve consistently been complaining about KEMSA and now that we have this is actual money. Munga MA, et al. For each tracer, we begin by providing an overview of the organization and management of these functions prior to devolution, and a summary on how they were supposed to be organized under devolution in theory (policy on paper), before turning to key issues arising in the actual implementation process and experiences of actors (policy in practice). 2009;9(9). In practice decentralization involves shifting power and authority over the management of public resources from national to sub-national levels of government. Given the many years of perceived inefficiency in KEMSA, county health managers welcomed these proposals, anticipating that this would give counties greater bargaining power to demand for more efficient supply service from KEMSA. It is one of the counties in the Coastal region of Kenya believed to have been the historical champions of devolution in the country [28]. 2011;72:39–48. Benjamin Tsofa. The facility in-charge is further supposed to consult with the FMCs during the commodity quantification and ordering process. study of Italy indicates that devolution may exacerbate regional disparities in public spending and economic outcomes (Calamai, 2009). 1998;47(10):1513–27. What is a health system learning site? Introduction: In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. Although it is difficult to give definitive answers to these important questions at this early stage, in this article we interpret primary data from fieldwork conducted just before and soon after the 2013 election in four case study counties. However, once they were elected into office in early 2013, the county governors began to agitate for an immediate transfer of all county level functions. 2004;59:163–83. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous county governments, with substantial transfer of responsibility for health service delivery from the central government to these counties. Finally, the brief gives recommendations to policymakers that are considering devolution in their own countries. For example, both elementary-secondary school aid and higher education funding will be hurt by the intensified competition for state dollars. Focusing on two key elements of the health system, Human Resources for Health (HRH) and Essential Medicines and Medical Supplies (EMMS) management, we analysed the early implementation experiences of this major governance reform at county level. Health sector reforms in sub-Saharan Africa: lessons of the last 10 years. On HRH management, the rapid transfer of functions before counties had established their HRH management structures meant that they could not undertake key HRH management roles, including payroll management and payment of salaries. Constitutional debates. On HRH management, several studies reported decentralization being associated with better attraction and retention of lower cadre staff, but poor attraction of specialized health workers [11,12,13,14,15]. BT and SM are members of the KEMRI-Wellcome Trust Research Programme in Kenya that is supported by a core grant (#203077/Z/16/Z) from the Wellcome Trust. 2016 20–03-2017. Study was carried out to investigate the impact of devolution on agricultural extension system. KII C 002. It was introduced to Wales and Scotland – and reestablished in Northern Ireland – from the late 1990s onwards. The implementation of decentralisation polices within the health sector has adopted a wide range of modes and forms, determined by the nature and structure of the sub-national level entity to which responsibility is transferred. These findings will be used to inform the basis of the next stage of the devolution journey. 2501 0 obj <> endobj The learning site setting also provided an opportunity for regular feedback to the county managers and national MoH thus increasing the potential of this study to inform the progressive implementation of devolution in the county and country. Resilient and Responsive Health Systems (RESYST). …. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The interview guide covered questions on all the elements of our conceptual framework (Fig. PubMed PubMed Afr Aff. Evidevce on essential medicine logistics in Ghana and Guatemala. On EMMS management, the literature shows that many countries with decentralized health systems retained most EMMS management functions under central control. Anderson David M. Yours in struggle for Majimbo’. effects of education decentralization by devolution on students’ performance in tanzania: the case of community secondary schools in temeke municipality bernard anthony ngamesha a dissertation submitted in partial fulfillment of the requirements for the degree of master of education in administration, planning and policy studies of the open University of London: London School of Hygiene and Tropical Medicine; 2016. County-level politics in Kenya after devolution. Terms and Conditions, First several counties in their initial days opted to procure ambulances which were perceived to be politically more visible in the eyes of the public and voters, at the expense of procuring essential drugs for their health facilities. The initial themes were guided by the elements of our conceptual framework, which we refined as we familiarized ourselves with the data. …. public participation is very weak, very weak; because when you bring a bill, you bring them (Members of the County Assembly) here to take them through … you invite the committee to take them through the Bill. KII SC 002. Devolution: what it means for health and social care in England Devolution of powers and funds from central down to local government has emerged as one of this government’s flagship policies. 2002;17(1):14–31. KII N 002….. …..through you know negotiations with county governments, I think they accepted that national government would continue paying salaries of county workers in the interim up to December 2013 as they prepare themselves…] KII N 001……. For HRH, this led to major disruptions in staff salary payments, political interference with HRH management functions and confusion over HRH management roles. At a national level, there is need for all stakeholders to come together to deliberate and build consensus on how certain HRH management roles including in-service training and inter-county transfers should be conducted across the country. 1994;14(5):451–77. Another commonly reported HRH management problem linked with decentralization has been frequent delays and disruptions in payments of staff salaries; and challenges in managing in-service training and other career progression initiatives [12, 14, 18]. The human face of decentralization and Intergration of health services: experience from South Africa. The authors declare that they have no competing interests. (Ryder, 2004) HISTORY OF DEVOLUTION IN WALES To really understand the importance of devolution in Wales, people need to look at the history of the country. Essay on Negative Effect of Devolution Negative effects: The implementation of the local government in 1992 provided the impetus for local government units to assume greater roles and 2016 For EMMS, decentralized procurement led to a reported better fill-rate in health facilities, and the county was able to ensure all facilities were supplied with EMMS irrespective of registration status. A case study of early effects of devolution in Kilifi County, Kenya, submited). the effects of devolution of healthcare on the technical efficiency of healthcare services delivery in Bomet County, Kenya. Health facilities would then make orders (‘pull’) from their drawing rights at KEMSA on a quarterly basis and KEMSA would service the facility orders while crediting the facility allocation. Rondinelli D. Government decentralisation in comaprative theory and practice in developing countries. Working in a decentralized system: a threat to health workers’ respect and survival in Uganda.
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