Recentralisation within decentralisation? Improving the functioning of Kenyan hospitals through increased hospital autonomy

October 2016
Edwine Barasa, Anthony Manyara, Sassy Molyneux, Benjamin Tsofa

Kenya’s transition to a devolved system of government, whereby county governments are now the mainstay of local government, has had far reaching impacts on the delivery of public health services. The autonomy that hospitals have over key functions can have several benefits including improved effeciency, better quality of services and increased accountability. 

The KEMRI Wellcome Trust Research programme conducted research to understand how devolution impacted on the autonomy of public county hospitals in Kenya, and how this has affected the functioning of these hospitals. This was a qualitative study in three hospitals in one of the 47 counties in Kenya.

Research findings

  • Hospital autonomy has the potential to improve the efficiency and quality of health service delivery, as well as hospital management capacity and accountability. In Kenya, however, devolution of health services to county level has reduced hospital autonomy over key management functions.
  • Reduced autonomy has compromised hospital functioning by weakening management and leadership capacity, reducing staff motivation, and limiting community participation in hospital affairs. It has also created inefficiencies in service delivery due to delays and increased bureaucracy, compromising the quality of care.
  • National and county decision makers should amend devolution laws to give hospitals autonomy over key functions, and clarify and realign the roles of hospital management and leadership structures to the current institutional and organisational framework in the devolved system. 
Governance Devolution Kenya