Health care reforms in Kenya: the performance of the District Health Management Boards in the Coast Province of Kenya

As a consequence of a series of structural adjustment programmes (SAP), health financing reforms were instituted in Kenya in 1989. In particular, cost sharing was introduced, although support was not universal since the philosophy of free health care had a strong legacy. The initial failure of the cost-sharing strategy led to the formation of District Health Management Boards (DHMB) in 1992. Their operation is geared towards facilitating the full implementation of the cost-sharing strategy to ensure increased equity, efficiency and quality of health care services. This study examines the performance and effectiveness of the DHMB, using the Coast Province as a case study. It shows that the various cadres of providers thus far perceive DHMB as poor performers as measured by their satisfaction with the boards’ work. The major problems characterizing the DHMB’s performance are: lack of power of DHMB officials; lack of a strong resource base; lack of a monitoring system for the expenditure of the cost-sharing revenues; lack of vital operational information; and ineffective leadership. Bibliogr. [ASC Leiden abstract]

Title: Health care reforms in Kenya: the performance of the District Health Management Boards in the Coast Province of Kenya
Author: Shauri, Halimu Suleiman
Year: 2001
Periodical: L’Afrique orientale
Pages: 339-372
Language: English
Geographic term: Kenya
Abstract: As a consequence of a series of structural adjustment programmes (SAP), health financing reforms were instituted in Kenya in 1989. In particular, cost sharing was introduced, although support was not universal since the philosophy of free health care had a strong legacy. The initial failure of the cost-sharing strategy led to the formation of District Health Management Boards (DHMB) in 1992. Their operation is geared towards facilitating the full implementation of the cost-sharing strategy to ensure increased equity, efficiency and quality of health care services. This study examines the performance and effectiveness of the DHMB, using the Coast Province as a case study. It shows that the various cadres of providers thus far perceive DHMB as poor performers as measured by their satisfaction with the boards’ work. The major problems characterizing the DHMB’s performance are: lack of power of DHMB officials; lack of a strong resource base; lack of a monitoring system for the expenditure of the cost-sharing revenues; lack of vital operational information; and ineffective leadership. Bibliogr. [ASC Leiden abstract]