Recentralization within decentralization: County hospital autonomy under devolution in Kenya
Recentralization within decentralization: County hospital autonomy under devolution in Kenya
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DOI：
10.1371/journal.pone.0182440
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发表时间：
2017-08-03
期刊：
影响因子：
3.7
通讯作者：
Tsofa, Benjamin
中科院分区：
文献类型：
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作者：
Barasa, Edwine W.;Manyara, Anthony M.;Tsofa, Benjamin
背景2013年，肯尼亚过渡到一个权力下放的政府系统，中央政府和47个半自治县政府。在本文中，我们报告了肯尼亚卫生部门权力下放的早期经验，重点是公立县医院。具体来说，我们研究医院自主权的变化，作为权力下放的结果，以及这些如何影响医院functioning.MethodsWe使用了一个定性的案例研究的方法来研究的自主权水平，医院的主要管理职能，这是如何影响医院的运作在肯尼亚沿海的三个县医院。我们收集的数据进行深入访谈的县卫生管理人员和医院管理人员的案例研究医院（n = 21）。我们采用了Chawla等人（1995）提出的框架来研究医院在五个管理领域（战略管理，财务，采购，人力资源和行政）的自主权，以及这些如何影响医院functioning.FindingsDevolution导致县级医院在五个关键职能上的自主权大幅减少。这导致了医院管理和领导能力的削弱，减少社区参与医院事务，损害服务质量，减少医院工作人员的积极性，不结盟的县和医院的优先事项，工作人员不服从，并损害了护理质量.ConclusionIncreasingthe自治县医院在肯尼亚将改善其运作。县政府应该制定立法，赋予医院对资源和关键管理职能更大的控制权。
BackgroundIn 2013, Kenya transitioned into a devolved system of government with a central government and 47 semi-autonomous county governments. In this paper, we report early experiences of devolution in the Kenyan health sector, with a focus on public county hospitals. Specifically, we examine changes in hospital autonomy as a result of devolution, and how these have affected hospital functioning.MethodsWe used a qualitative case study approach to examine the level of autonomy that hospitals had over key management functions and how this had affected hospital functioning in three county hospitals in coastal Kenya. We collected data by in-depth interviews of county health managers and hospital managers in the case study hospitals (n = 21). We adopted the framework proposed by Chawla et al (1995) to examine the autonomy that hospitals had over five management domains (strategic management, finance, procurement, human resource, and administration), and how these influenced hospital functioning.FindingsDevolution had resulted in a substantial reduction in the autonomy of county hospitals over the five key functions examined. This resulted in weakened hospital management and leadership, reduced community participation in hospital affairs, compromised quality of services, reduced motivation among hospital staff, non-alignment of county and hospital priorities, staff insubordination, and compromised quality of care.ConclusionIncreasing the autonomy of county hospitals in Kenya will improve their functioning. County governments should develop legislation that give hospitals greater control over resources and key management functions.