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The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya

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 cha...

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Autores principales: Barasa, Edwine, Nyawira, Lizah, Musiega, Anita, Kairu, Angela, Orangi, Stacey, Tsofa, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664271/
https://www.ncbi.nlm.nih.gov/pubmed/36375850
http://dx.doi.org/10.1136/bmjgh-2022-010260
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author Barasa, Edwine
Nyawira, Lizah
Musiega, Anita
Kairu, Angela
Orangi, Stacey
Tsofa, Benjamin
author_facet Barasa, Edwine
Nyawira, Lizah
Musiega, Anita
Kairu, Angela
Orangi, Stacey
Tsofa, Benjamin
author_sort Barasa, Edwine
collection PubMed
description 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.
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spelling pubmed-96642712022-11-15 The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya Barasa, Edwine Nyawira, Lizah Musiega, Anita Kairu, Angela Orangi, Stacey Tsofa, Benjamin BMJ Glob Health Analysis 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. BMJ Publishing Group 2022-11-14 /pmc/articles/PMC9664271/ /pubmed/36375850 http://dx.doi.org/10.1136/bmjgh-2022-010260 Text en © 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. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Analysis
Barasa, Edwine
Nyawira, Lizah
Musiega, Anita
Kairu, Angela
Orangi, Stacey
Tsofa, Benjamin
The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya
title The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya
title_full The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya
title_fullStr The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya
title_full_unstemmed The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya
title_short The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya
title_sort autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in kenya
topic Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664271/
https://www.ncbi.nlm.nih.gov/pubmed/36375850
http://dx.doi.org/10.1136/bmjgh-2022-010260
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