Browsing by Author "Barasa, Edwine"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Open Access
    Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast
    (Public Library of Science, 2015) Nyikuri, Mary; Tsofa, Benjamin; Barasa, Edwine; Okoth, Philip; Molyneux, Sassy
    BACKGROUND: Public primary health care (PHC) facilities are for many individuals the first point of contact with the formal health care system. These facilities are managed by professional nurses or clinical officers who are recognised to play a key role in implementing health sector reforms and facilitating initiatives aimed at strengthening community involvement. Little in-depth research exists about the dimensions and challenges of these managers' jobs, or on the impact of decentralisation on their roles and responsibilities. In this paper, we describe the roles and responsibilities of PHC managers-or 'in-charges' in Kenya, and their challenges and coping strategies, under accelerated devolution. METHODS: The data presented in this paper is part of a wider set of activities aimed at understanding governance changes under devolution in Kenya, under the umbrella of a 'learning site'. A learning site is a long term process of collaboration between health managers and researchers deciding together on key health system questions and interventions. Data were collected through seven formal in depth interviews and observations at four PHC facilities as well as eight in depth interviews and informal interactions with sub-county managers from June 2013 to July 2014. Drawing on the Aragon framework of organisation capacity we discuss the multiple accountabilities, daily routines, challenges and coping strategies among PHC facility managers. RESULTS: PHC in-charges perform complex and diverse roles in a difficult environment with relatively little formal preparation. Their key concerns are lack of job clarity and preparedness, the difficulty of balancing multidirectional accountability responsibilities amidst significant resource shortages, and remuneration anxieties. We show that day-to-day management in an environment of resource constraints and uncertainty requires PHC in-charges who are resilient, reflective, and continuously able to learn and adapt. We highlight the importance of leadership development including the building of critical soft skills such as relationship building.
  • Thumbnail Image
    Item
    Open Access
    Factors influencing institutionalization of health technology assessment in Kenya
    (BioMed Central, 2023-06-22) Mbau, Rahab; Vassall, Anna; Gilson, Lucy; Barasa, Edwine
    Abstract Background There is a global interest in institutionalizing health technology assessment (HTA) as an approach for explicit healthcare priority-setting. Institutionalization of HTA refers to the process of conducting and utilizing HTA as a normative practice for guiding resource allocation decisions within the health system. In this study, we aimed to examine the factors that were influencing institutionalization of HTA in Kenya. Methods We conducted a qualitative case study using document reviews and in-depth interviews with 30 participants involved in the HTA institutionalization process in Kenya. We used a thematic approach to analyze the data. Results We found that institutionalization of HTA in Kenya was being supported by factors such as establishment of organizational structures for HTA; availability of legal frameworks and policies on HTA; increasing availability of awareness creation and capacity-building initiatives for HTA; policymakers’ interests in universal health coverage and optimal allocation of resources; technocrats’ interests in evidence-based processes; presence of international collaboration for HTA; and lastly, involvement of bilateral agencies. On the other hand, institutionalization of HTA was being undermined by limited availability of skilled human resources, financial resources, and information resources for HTA; lack of HTA guidelines and decision-making frameworks; limited HTA awareness among subnational stakeholders; and industries’ interests in safeguarding their revenue. Conclusions Kenya’s Ministry of Health can facilitate institutionalization of HTA by adopting a systemic approach that involves: - (a) introducing long-term capacity-building initiatives to strengthen human and technical capacity for HTA; (b) earmarking national health budgets to ensure adequate financial resources for HTA; (c) introducing a cost database and promoting timely data collection to ensure availability of data for HTA; (d) developing context specific HTA guidelines and decision-making frameworks to facilitate HTA processes; (e) conducting deeper advocacy to strengthen HTA awareness among subnational stakeholders; and (f) managing stakeholders’ interests to minimize opposition to institutionalization of HTA.
  • Thumbnail Image
    Item
    Open Access
    Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County
    (2020-02-10) Waithaka, Dennis; Kagwanja, Nancy; Nzinga, Jacinta; Tsofa, Benjamin; Leli, Hassan; Mataza, Christine; Nyaguara, Amek; Bejon, Philip; Gilson, Lucy; Barasa, Edwine; Molyneux, Sassy
    Abstract Background While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers’ strikes. Methods We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n = 5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n = 26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses’ strike. Findings In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes. Conclusion Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.
  • Thumbnail Image
    Item
    Open Access
    Socioeconomic inequalities and inequities in the screening and treatment of diabetes and hypertension in Kenya
    (2021) Omondi, Robinson Oyando; Ataguba, John; Barasa, Edwine
    The burden of non-communicable diseases (NCDs) is on a disproportionate rise in low-and middleincome countries (LMICs). Equity in the utilisation of screening and treatment services for NCDs is important in reducing associated disease burden. For instance, the 2030 Sustainable Development Goal 3.4 that aims to reduce by one-third premature NCDs mortality, has adopted prevention and treatment as critical interventions for achieving this target. However, little is known about equity in the use of screening and treatment services for major NCDs like diabetes and hypertension in Kenya. This dissertation assesses horizontal equity (i.e. equal treatment for equal need) in the screening and treatment for diabetes and hypertension. Further, it examines factors contributing to inequality. Data from the 2015 STEPwise cross-sectional survey on NCDs risk factors were used in the analysis. Concentration curves, concentration indices and horizontal inequity index were used to assess socioeconomic inequality and inequity in the screening and treatment for diabetes and hypertension. The Wagstaff decomposition approach was used to examine factors contributing to socioeconomic inequality in screening and treatment. For a granular presentation of inequity and inequality findings, analyses were conducted across the wealth and regional divides in Kenya. Overall, the rich benefited disproportionately more in the utilisation of screening and treatment services, given their population share of need. Of note, inequalities in the use of screening and treatment interventions for diabetes and hypertension were observed in the geographic regions. In general, non-need factors such as educational attainment, area of residence, exposure to media, employment, and wealth status were the largest contributors to inequality in both screening and treatment. By contrast, need factors like sex also significantly contributed to inequality in diabetes and hypertension screening. After controlling for need, a statistically significant pro-rich inequity in the use of diabetes and hypertension screening was observed. Both the use of diabetes and hypertension treatment were pro-rich though a statistically significant result was only seen for the former. For equity in the screening and treatment for diabetes and hypertension in Kenya, demand enhancing mechanisms such as health education through the mass media and free NCD screening in the public sector should be implemented. Also, given the interplay of factors beyond the health sector that affect utilisation of healthcare services, there is a need for multi-sectoral approaches at various levels to address drivers of social inequality with a critical focus in rural and marginalised areas.