Exploring perceptions of community health policy in Kenya and identifying implications for policy change
Bibliographic Data
| ID | 11491424 |
|---|---|
| Authors | Rosalind McCollum (0000-0003-4982-1734, Liverpool School of Tropical Medicine, corresponding author), Lilian Otiso (0000-0003-0164-154X, LVCT Health), Maryline Mireku (LVCT Health), Sally Theobald (0000-0002-9053-211X, Liverpool School of Tropical Medicine), Korrie De Koning (0000-0003-2517-7200, Royal Tropical Institute), Salim Hussein (0000-0002-6430-4316, Ministry of Health), Miriam Taegtmeyer (0000-0002-5377-2536, Liverpool School of Tropical Medicine) |
| Year | 2016 |
| Volume | 31 |
| Issue | 1 |
| Pages | 10-20 |
| Publication date | 2016-02-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy and Planning (JOURNAL) |
| Journal identifiers | ISSN: 0268-1080 • E-ISSN: 1460-2237 |
| Publisher | Oxford University Press (PUBLISHER • GB) |
| DOI | 10.1093/heapol/czv007 |
| PMID | 25820367 |
| OpenAlex | W2048879774 |
| Language | EN |
| Citations received | 18 |
| References cited | 22 |
BACKGROUND: Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. METHODS: We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before framework analysis. RESULTS: There is widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas for change identified include: lack of clear supervisory structure including provision of adequate travel resources, current uneven coverage and equity of community health services, limited community knowledge about the strategy revision and demand for home-based HIV testing and counselling. CONCLUSION: This in-depth analysis which captures multiple perspectives results in robust recommendations for strategy revision informed by the Five Wonders of Change Framework. These recommendations point towards a more people-centred health system for improved equity and effectiveness and indicate priority areas for action if success of policy change through the roll-out of the revised strategy is to be realized.
Business · Developing country · Economic growth · Economics · Environmental resource management · Health care · Perception · Political science · Public relations · Community Health and Development · Global Maternal and Child Health · Poverty, Education, and Child Welfare · Psychology · Health Policy
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| Unique citing works | 18 |
|---|---|
| Citations per year | 1,8 |
| Citation span | 2016 - 2025 (10) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 14 |