The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya.
Health policy
Health systems
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
26
07
2022
accepted:
29
10
2022
entrez:
14
11
2022
pubmed:
15
11
2022
medline:
18
11
2022
Statut:
ppublish
Résumé
The financing of public health facilities influences their performance. A key feature that defines health facility financing is the degree of financial autonomy. Understanding the factors that influence public health facility financial autonomy is pertinent to developing strategies to addressing challenges that arise from constrained autonomy. In this paper, we apply a complexity lens to draw on a body of research that we have conducted in Kenya over the past decade, from the onset of devolution reforms, to unpack the determinants of public health facility financial autonomy in a context of decentralisation and provide suggestions for pertinent considerations when designing interventions to address financial autonomy challenges. We find that the factors that affect public health facility autonomy are not only structural, but also procedural, and political and interact in complex ways. These factors include; the public finance management (PFM) laws, sense-making by actors in the health system, political interests in control over resources, subnational level PFM capacity, PFM implementation bottlenecks and broader operational autonomy. Drawing from this analysis, we recommend that efforts at resolving public health facility financial autonomy include: PFM capacity development for subnational levels of government in decentralised settings, the use of a political lens that recognises interests and seeks to align incentives in engagement and solution finding for health facility financial autonomy, the audit of PFM processes to establish and resolve implementation bottlenecks that impinge on public health facility autonomy, and the resolution of operational autonomy to as a facilitator of financial autonomy.
Identifiants
pubmed: 36375850
pii: bmjgh-2022-010260
doi: 10.1136/bmjgh-2022-010260
pmc: PMC9664271
pii:
doi:
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Wellcome Trust
ID : 092654
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/R01373X/1
Pays : United Kingdom
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Int J Equity Health. 2017 Sep 15;16(1):151
pubmed: 28911325
Int J Health Serv. 2014;44(1):73-92
pubmed: 24684085
Health Policy Plan. 2018 Dec 1;33(10):1118-1127
pubmed: 30544175
Int J Equity Health. 2017 Sep 15;16(1):169
pubmed: 28911328
Arch Iran Med. 2015 Jul;18(7):416-24
pubmed: 26161705
Health Policy Plan. 2022 Nov 11;:
pubmed: 36367746
Int J Health Plann Manage. 2021 Sep;36(5):1521-1532
pubmed: 33955046
PLoS One. 2017 Aug 3;12(8):e0182440
pubmed: 28771558
Soc Sci Med. 1998 Nov;47(10):1513-27
pubmed: 9823047
Int J Equity Health. 2017 Sep 15;16(1):113
pubmed: 28911332
Health Policy Plan. 2021 Oct 12;36(9):1408-1417
pubmed: 34165146
Health Policy Plan. 2017 Apr 1;32(3):329-337
pubmed: 27679522
Int J Health Plann Manage. 2007 Jan-Mar;22(1):45-62
pubmed: 17385332
Int J Health Plann Manage. 2021 Nov;36(6):2277-2296
pubmed: 34382238
BMC Health Serv Res. 2021 Oct 13;21(1):1086
pubmed: 34645443
Soc Sci Med. 2011 Jan;72(1):39-48
pubmed: 21134705
Health Policy Plan. 2003 Jun;18(2):182-94
pubmed: 12740323
BMC Health Serv Res. 2022 Aug 16;22(1):1046
pubmed: 35974324
Int J Health Plann Manage. 1999 Apr-Jun;14(2):129-53
pubmed: 10538935