Strengthening a sense of community ownership at district level
DFID’s Support to Decentralisation of Health Services in Kenya project is designed to provide flexible and responsive technical assistance to the Ministry of Health to develop structures and management systems to facilitate the decentralisation of essential health services in Kenya.


Decentralisation is seen as a vehicle for promoting efficiency in health services delivery. It is premised on the belief that sub-national entities, through closer interaction with the beneficiaries, can articulate better local needs and problems.

Experiences with decentralisation have been mixed. Its implementation is predicated on the existence of strong and functioning institutions at the sub-national level, complemented with supportive policies, and politics. Often, weakness in institutional capabilities, coupled with unstable policy and political environment have tended to undermine the success of decentralisation.

These experiences characterise the long process and mixed performance of decentralisation, whether through the local government or the sub-national levels of the central government in Kenya.

The project

The project’s primary focus has been to work with the Ministry at the centre to

• institute appropriate reorganization
  
• create new management structures that better reflect its strategy setting and regulatory role
  
• strengthen the ministry’s capacity for coordination of actors, reforms, and service delivery.

At the same time, the project has been working in collaboration with other partners to create and strengthen support systems of planning and budgeting, financial management, and procurement at the district level to enable the districts to manage and deliver essential health services.

The project’s two-pronged approach combining support to facilitate changes in policy and structures at the centre, with capacity building for management and governance of lower level institutions is useful in driving and ensuring a successful decentralisation process.

Outcomes

Notable contributions to the process of decentralisation include:

• adoption of bottom-up planning and budgeting;
  
• adoption and implementation of an essential package of health services
  
• implementation of a “pull” and not a “push” system for the supply of drugs and other medical commodities.

With these initiatives in place, a population-based approach to service delivery is beginning to take root, and will put Kenya on a pathway toward attaining some of the MDG targets. A set of national level monitoring and evaluation (M&E) indicators developed by the project and others, will be used as benchmarks for performance measurement for service delivery.

Lessons learnt in decentralisation

Despite its achievements, the experiences of the project show that the main drivers of decentralisation lies outside a specific sector such as health. Rather it requires a government-wide policy, and political commitment to be effective.