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Political economy analysis of subnational health management in Kenya, Malawi and Uganda.
Rodríguez, Daniela C; Balaji, Lakshmi Narasimhan; Chamdimba, Elita; Kafumba, Juba; Koon, Adam D; Mazalale, Jacob; Mkombe, Dadirai; Munywoki, Joshua; Mwase-Vuma, Tawonga; Namakula, Justine; Nambiar, Bejoy; Neel, Abigail H; Nsabagasani, Xavier; Paina, Ligia; Rogers, Braeden; Tsoka, Maxton; Waweru, Evelyn; Munthali, Alister; Ssengooba, Freddie; Tsofa, Benjamin.
Afiliación
  • Rodríguez DC; International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
  • Balaji LN; Health Programme, UNICEF New York, 3 UN Plaza, New York, NY 10017, USA.
  • Chamdimba E; Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
  • Kafumba J; Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
  • Koon AD; International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
  • Mazalale J; Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
  • Mkombe D; Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
  • Munywoki J; KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya.
  • Mwase-Vuma T; Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
  • Namakula J; School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda.
  • Nambiar B; UNICEF Malawi, PO Box 30375, Airtel Complex Area 40/31, Lilongwe, Malawi.
  • Neel AH; International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
  • Nsabagasani X; School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda.
  • Paina L; International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
  • Rogers B; Health Section, UNICEF Eastern and Southern Africa Regional Office, United Nations Complex, Gigiri, P.O. Box 44145-00100, Nairobi, Kenya.
  • Tsoka M; Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
  • Waweru E; KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya.
  • Munthali A; Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
  • Ssengooba F; School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda.
  • Tsofa B; KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya.
Health Policy Plan ; 38(5): 631-647, 2023 May 17.
Article en En | MEDLINE | ID: mdl-37084282
ABSTRACT
The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management systems and power dynamics of actors can have a significant influence on health managers' ability to improve PHC access and quality. We conducted a problem-driven political economy analysis (PEA) in Kenya, Malawi and Uganda to explore local decision-making environments and how they affect management and governance practices for health. This PEA used document review and key informant interviews (N = 112) with government actors, development partners and civil societies in three districts or counties in each country (N = 9). We found that while decentralization should improve PHC by supporting better decisions in line with local priorities from community input, it has been accompanied by thick bureaucracy, path-dependent and underfunded budgets that result in trade-offs and unfulfilled plans, management support systems that are less aligned to local priorities, weak accountability between local government and development partners, uneven community engagement and insufficient public administration capacity to negotiate these challenges. Emergent findings suggest that coronavirus disease 2019 (COVID-19) not only resulted in greater pressures on health teams and budgets but also improved relations with central government related to better communication and flexible funding, offering some lessons. Without addressing the disconnection between the vision for decentralization and the reality of health managers mired in unhelpful processes and politics, delivering on PHC and universal health coverage goals and the SDG agenda will remain out of reach.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: COVID-19 Tipo de estudio: Health_economic_evaluation / Prognostic_studies Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: COVID-19 Tipo de estudio: Health_economic_evaluation / Prognostic_studies Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos