Learning to embed quality improvement approaches at community level in Kenya’s devolved

health system

Robinson Karuga Research Fellow

LVCT Health

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2010 2011 2012 2013

Constitutional Referendum Transition

Devolution of Health

Services

Transition…

Roles of National MoH• Policy formulation • Standards & guidelines• Capacity building • Technical support

Roles of Counties• Implementation of policy • Financing health care • Human resource management

Challenges in Devolving Health

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www.lvcthealth.org

Low budgetary allocations

Varying Prioritization of Health

Human resource challenges

Attitudes of Officials

Delayed financial disbursementsSource: http://gadocartoons.com/the-only-county-devolution-has-not-happened-yet/ Source: Health Policy Project (2015)

Political Process of Embedding QI in Devolved Setting

Process Actors

Context Content

• Understand National vs County Roles

• Understand power dynamics

• Align QI to National & County Priorities

• Consider interests at each level• Simplify!

• Understand pre-existing QI structures

• Map other key QI actors

• Ensure full consultation • Consider ALL Interests &

Priorities• Institutionalize QI at all levels