Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast

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dc.contributor.authorNyikuri, Maryen_ZA
dc.contributor.authorTsofa, Benjaminen_ZA
dc.contributor.authorBarasa, Edwineen_ZA
dc.contributor.authorOkoth, Philipen_ZA
dc.contributor.authorMolyneux, Sassyen_ZA
dc.date.accessioned2016-02-10T14:45:52Z
dc.date.available2016-02-10T14:45:52Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: 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.en_ZA
dc.identifier.apacitationNyikuri, M., Tsofa, B., Barasa, E., Okoth, P., & Molyneux, S. (2015). Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast. <i>PLoS One</i>, http://hdl.handle.net/11427/16944en_ZA
dc.identifier.chicagocitationNyikuri, Mary, Benjamin Tsofa, Edwine Barasa, Philip Okoth, and Sassy Molyneux "Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/16944en_ZA
dc.identifier.citationNyikuri, M., Tsofa, B., Barasa, E., Okoth, P., & Molyneux, S. (2014). Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast. PloS one, 10(12), e0144768-e0144768. doi:10.1371/journal.pone.0144768en_ZA
dc.identifier.ris TY - Journal Article AU - Nyikuri, Mary AU - Tsofa, Benjamin AU - Barasa, Edwine AU - Okoth, Philip AU - Molyneux, Sassy AB - 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. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0144768 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast TI - Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast UR - http://hdl.handle.net/11427/16944 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0144768en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16944
dc.identifier.vancouvercitationNyikuri M, Tsofa B, Barasa E, Okoth P, Molyneux S. Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast. PLoS One. 2015; http://hdl.handle.net/11427/16944.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Nyikuri et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHealth services administration and managementen_ZA
dc.subject.otherHealth services researchen_ZA
dc.subject.otherHealth care policyen_ZA
dc.subject.otherKenyaen_ZA
dc.subject.otherFinanceen_ZA
dc.subject.otherNursesen_ZA
dc.subject.otherHealth care facilitiesen_ZA
dc.subject.otherSocioeconomic aspects of healthen_ZA
dc.titleCrises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coasten_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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