Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya

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dc.contributor.authorAbuya, Timothyen_ZA
dc.contributor.authorAmin, Abdinasiren_ZA
dc.contributor.authorMolyneux, Sassyen_ZA
dc.contributor.authorAkhwale, Willisen_ZA
dc.contributor.authorMarsh, Vickien_ZA
dc.contributor.authorGilson, Lucyen_ZA
dc.date.accessioned2015-11-11T11:55:24Z
dc.date.available2015-11-11T11:55:24Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND: The home-management of malaria strategy seeks to improve prompt and effective anti-malarial drug use through the informal sector, with a potential channel being the Private Medicine Retailers (PMRs). Previous evaluations of PMR programmes focused on their impact on retailer knowledge and practices, with limited evidence about the influence of implementation processes on the impacts at scale. This paper examines how the implementation processes of three PMR programmes in Kenya, each scaled up within a district, contributed to the outcomes observed. These were a Ministry of Health programme in Kwale district; and two programmes supported by non-governmental organizations in collaboration with government in Kisii Central and Bungoma districts. METHODS: The research methods included 24 focus group discussions with clients and PMRs, 19 in-depth interviews with implementing actors, document review and a diary of events. The data were analysed using the combination of a broad policy analysis framework and more specific scaling up/diffusion of innovations frameworks. RESULTS: The Kisii programme, a case study of successful implementation, was underpinned by good relationships between district health managers and a "resource team", supported by a memorandum of understanding which enabled successful implementation. It had flexible budgetary and decision making processes which were responsive to local contexts, and took account of local socio-economic activities. In contrast, the Kwale programme, which had implementation challenges, was characterised by a complex funding process, with lengthy timelines, that was tied to the government financial management system which constrained implementation Although there was a flexible funding system in Bungoma, a perceived lack of transparency in fund management, inadequate management of inter-organisational relationships, and inability to adapt and respond to changing circumstances led to implementation difficulties. CONCLUSIONS: For effective scaling up of PMR programmes, the provision of technical support and adequate resources are vital, but not sufficient on their own. An active strategy to manage relationships between implementing actors through effective communication mechanisms is essential. Successful outcomes may be realised if a strong and transparent management system, including management of financial resources, is put in place. This study provides evidence of the value of assessing implementation processes as part of impact evaluation for public health programmes.en_ZA
dc.identifier.apacitationAbuya, T., Amin, A., Molyneux, S., Akhwale, W., Marsh, V., & Gilson, L. (2010). Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/14864en_ZA
dc.identifier.chicagocitationAbuya, Timothy, Abdinasir Amin, Sassy Molyneux, Willis Akhwale, Vicki Marsh, and Lucy Gilson "Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya." <i>BMC Health Services Research</i> (2010) http://hdl.handle.net/11427/14864en_ZA
dc.identifier.citationAbuya, T., Amin, A., Molyneux, S., Akhwale, W., Marsh, V., & Gilson, L. (2010). Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya. BMC health services research, 10(Suppl 1), S7.en_ZA
dc.identifier.ris TY - Journal Article AU - Abuya, Timothy AU - Amin, Abdinasir AU - Molyneux, Sassy AU - Akhwale, Willis AU - Marsh, Vicki AU - Gilson, Lucy AB - BACKGROUND: The home-management of malaria strategy seeks to improve prompt and effective anti-malarial drug use through the informal sector, with a potential channel being the Private Medicine Retailers (PMRs). Previous evaluations of PMR programmes focused on their impact on retailer knowledge and practices, with limited evidence about the influence of implementation processes on the impacts at scale. This paper examines how the implementation processes of three PMR programmes in Kenya, each scaled up within a district, contributed to the outcomes observed. These were a Ministry of Health programme in Kwale district; and two programmes supported by non-governmental organizations in collaboration with government in Kisii Central and Bungoma districts. METHODS: The research methods included 24 focus group discussions with clients and PMRs, 19 in-depth interviews with implementing actors, document review and a diary of events. The data were analysed using the combination of a broad policy analysis framework and more specific scaling up/diffusion of innovations frameworks. RESULTS: The Kisii programme, a case study of successful implementation, was underpinned by good relationships between district health managers and a "resource team", supported by a memorandum of understanding which enabled successful implementation. It had flexible budgetary and decision making processes which were responsive to local contexts, and took account of local socio-economic activities. In contrast, the Kwale programme, which had implementation challenges, was characterised by a complex funding process, with lengthy timelines, that was tied to the government financial management system which constrained implementation Although there was a flexible funding system in Bungoma, a perceived lack of transparency in fund management, inadequate management of inter-organisational relationships, and inability to adapt and respond to changing circumstances led to implementation difficulties. CONCLUSIONS: For effective scaling up of PMR programmes, the provision of technical support and adequate resources are vital, but not sufficient on their own. An active strategy to manage relationships between implementing actors through effective communication mechanisms is essential. Successful outcomes may be realised if a strong and transparent management system, including management of financial resources, is put in place. This study provides evidence of the value of assessing implementation processes as part of impact evaluation for public health programmes. DA - 2010 DB - OpenUCT DO - 10.1186/1472-6963-10-S1-S7 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya TI - Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya UR - http://hdl.handle.net/11427/14864 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14864
dc.identifier.urihttp://dx.doi.org/10.1186/1472-6963-10-S1-S7
dc.identifier.vancouvercitationAbuya T, Amin A, Molyneux S, Akhwale W, Marsh V, Gilson L. Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya. BMC Health Services Research. 2010; http://hdl.handle.net/11427/14864.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_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 Licenseen_ZA
dc.rights.holder2010 Abuya et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://www.biomedcentral.com/bmchealthservres/en_ZA
dc.subject.otherDistrict Health Systemen_ZA
dc.subject.otherInnovation Implementationen_ZA
dc.subject.otherBungoma Districten_ZA
dc.subject.otherPolicy Analysis Frameworken_ZA
dc.subject.otherUser Organizationen_ZA
dc.subject.otherMedicine Retaileren_ZA
dc.subject.otherImplementation Processen_ZA
dc.subject.otherFinancial Management Systemen_ZA
dc.subject.otherTraining Progen_ZA
dc.titleImportance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenyaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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