Abstract:
BACKGROUND:Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. METHODS:We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. RESULTS:We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. CONCLUSION:Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country's efforts for promoting service delivery equity as a key goal - both for the devolution and the country's quest towards Universal Health Coverage (UHC).
journal_name
Int J Equity Healthjournal_title
International journal for equity in healthauthors
Munywoki J,Kagwanja N,Chuma J,Nzinga J,Barasa E,Tsofa Bdoi
10.1186/s12939-020-01284-3subject
Has Abstractpub_date
2020-09-21 00:00:00pages
165issue
1issn
1475-9276pii
10.1186/s12939-020-01284-3journal_volume
19pub_type
杂志文章abstract:BACKGROUND:With the depth development of health care system reform in China, emergency medical services (EMS) is confronted with challenges as well as opportunities. This study aimed to analyze the equity of China's EMS needs, utilization, and resources distribution, and put forward proposal to improve the equity. MET...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-016-0507-5
更新日期:2017-01-11 00:00:00
abstract:BACKGROUND:Aging and the chronic non-communicable diseases (NCDs) challenge the Chinese government in the process of providing hospitalization services fairly and reasonably. The Chinese government has developed the basic medical insurance system to solve the problem of "expensive medical cost and difficult medical ser...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-019-1117-9
更新日期:2020-01-06 00:00:00
abstract:BACKGROUND:The inequitable allocation of health resources is a worldwide problem, and it is also one of the obstacles facing for health services utilization in China. A new round of health care reform which contains the important aspect of improving the equity in health resource allocation was released by Chinese gover...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-016-0357-1
更新日期:2016-04-19 00:00:00
abstract:BACKGROUND:People experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and con...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-019-1004-4
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:The allocation of health resources in primary health care institutions (PHCI) is crucial to health reform. China has recently implemented many reform measures emphasizing the provision of primary health care services, with equity as one of the major goals. The aim of this study was to analyze the quantity, q...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-018-0896-8
更新日期:2018-12-04 00:00:00
abstract::There is a global trend towards the use of ad hoc participation processes that seek to engage grassroots stakeholders in decisions related to municipal infrastructure, land use and services. We present the results of a scholarly literature review examining 14 articles detailing specific cases of these processes to con...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-015-0252-1
更新日期:2015-11-20 00:00:00
abstract:BACKGROUND:The strategy of health policy has been changed for improving the performances to meeting the increasing healthcare demands. However, limited evidences were found to prove that the bundled payment was valid for service delivering in public sector. This study was designed to evaluate the effectiveness of a bun...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-016-0334-8
更新日期:2016-03-10 00:00:00
abstract:BACKGROUND:In 2007 Uruguay began a reform in the health sector towards the construction of a National Integrated Health System (SNIS), based on public insurance with private and public provision. The main objective of the reform was to universalize access to health services. METHODS:Data comes from the first National ...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-020-01237-w
更新日期:2020-10-26 00:00:00
abstract:OBJECTIVE:Prior to 2007, forced sex with male children in South Africa did not count as rape but as "indecent assault", a much less serious offence. This study sought to document prevalence of male sexual violence among school-going youth. DESIGN:A facilitated self-administered questionnaire in nine of the 11 official...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/1475-9276-7-20
更新日期:2008-07-29 00:00:00
abstract:BACKGROUND:Studies from various countries have observed worse population health in geographical areas with more income inequality. The psychosocial interpretation of this association is that large income disparities are harmful to health because they generate relative deprivation and undermine social cohesion. An alter...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/1475-9276-10-7
更新日期:2011-02-03 00:00:00
abstract:BACKGROUND:In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a ...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/1475-9276-8-36
更新日期:2009-10-24 00:00:00
abstract:BACKGROUND:Despite the considerable changes in the provision of health care to prisoners in the UK there is little published literature that attempts to examine broader aspects of health and the impact of imprisonment on these, focusing instead on disease specific areas. This is surprising given that one of the main dr...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/1475-9276-10-21
更新日期:2011-05-25 00:00:00
abstract:BACKGROUND:We aimed to determine the extent to which three core variables (school environment, peer group and family affluence) were associated with unhealthy behaviours and health outcomes among Tuscan adolescents. The unhealthy behaviours considered were smoking, alcohol consumption, sedentary lifestyle and irregular...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-014-0083-5
更新日期:2014-09-25 00:00:00
abstract:INTRODUCTION:We simulate and analyze Total Health Expenditure (THE) in financial sources and other economic indicators (such as THE per capita, GDP, etc.) in a province of China from 2002 to 2012 on System Dynamics. METHODS:Based on actual data and certain mathematical methods, we use system dynamic software to constr...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-015-0203-x
更新日期:2015-08-27 00:00:00
abstract:BACKGROUND:The provision of insecticide-treated nets (ITNs) is widely accepted in Burkina Faso thanks to large-scale national distribution campaigns. However, household also use other methods of prevention. Thus far, there is little knowledge about the expenditures of these malaria prevention methods, particularly in c...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-014-0108-0
更新日期:2014-11-07 00:00:00
abstract:BACKGROUND:Family planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services. METHODS:Using the Demographic Health Survey data from Burkina Faso, Nige...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-020-01167-7
更新日期:2020-03-27 00:00:00
abstract:BACKGROUND:Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanat...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-018-0832-y
更新日期:2018-08-13 00:00:00
abstract:BACKGROUND:This study aims at quantifying the level and changes over time of inequality in age-specific mortality and life expectancy between the 19 Norwegian counties from 1980 to 2014. METHODS:Data on population and mortality by county was obtained from Statistics Norway for 1980-2014. Life expectancy and age-specif...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-018-0771-7
更新日期:2018-05-24 00:00:00
abstract:BACKGROUND:Due to lack of companionship of parents, compared with non left behind children, left behind children (LBC) suffer from more psychological problems compared with children live with their parents. The aim of this study was to explore the mental health status and the relationship among psychological problems a...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-017-0639-2
更新日期:2017-09-02 00:00:00
abstract:BACKGROUND:Although cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease. METHODS:Focus group discussions were conducted with men, women, and community leaders in the rural settings...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/1475-9276-11-83
更新日期:2012-12-29 00:00:00
abstract:INTRODUCTION:The prevalence of Community Treatment Orders (CTOs) in the Western world has generated considerable discussion regarding best practices in the outpatient treatment of the seriously mentally ill. Although problems encountered by ethnic minority communities in the various health care systems have been studie...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-014-0069-3
更新日期:2014-09-06 00:00:00
abstract:BACKGROUND:Mexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers ...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-015-0289-1
更新日期:2015-12-23 00:00:00
abstract:INTRODUCTION:Major efforts have been made to improve the health care system in Hunan province, China. The aims of this study were to assess whether and to what extent these efforts have impacted on gender and regional disparities of Tuberculosis (TB) incidence in recent years, especially for less developed areas. METH...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/1475-9276-13-32
更新日期:2014-04-27 00:00:00
abstract:BACKGROUND:Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such policy shift is dependent on political su...
journal_title:International journal for equity in health
pub_type: 杂志文章,评审
doi:10.1186/1475-9276-12-91
更新日期:2013-11-15 00:00:00
abstract:BACKGROUND:Despite recent progress in improving access to maternal health services, the utilization of these services remains inequitable among women in developing countries, and rural women are particularly disadvantaged. This study sought to measure i) disparities in the rates of institutional births between rural an...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-019-1025-z
更新日期:2019-08-09 00:00:00
abstract:BACKGROUND:Income-related inequality measures such as the concentration index are often used to describe the unequal distribution of health, health care access, or expenditure in a single measure. This study demonstrates the use of such measures to evaluate the distributional impact of changes in health insurance cover...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-019-0955-9
更新日期:2019-04-16 00:00:00
abstract:BACKGROUND:Previous studies suggested that the racial differences in U.S. suicide rates are decreasing, particularly for African Americans, but the cause behind the temporal variations has yet to be determined. This study aims to investigate the long-term trends in suicide mortality in the U.S. between 1983 and 2012 an...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-016-0400-2
更新日期:2016-07-13 00:00:00
abstract::Reproductive health services are crucial for maternal and child health, but universal health coverage is still not within reach in most societies. Ethiopia's goal of universal health coverage promises access to all necessary services for everyone while providing protection against financial risk. When moving towards u...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-015-0218-3
更新日期:2015-09-30 00:00:00
abstract:BACKGROUND:Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through combined efforts of international and non-governmental organizations, governments, and religious and civil society groups. One question asked by donors, program implementers and observers a...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/s12939-018-0907-9
更新日期:2019-01-30 00:00:00
abstract:: This review investigates the health of immigrants to Canada by critically examining differences in health status between immigrants and the native-born population and by tracing how the health of immigrants changes after settling in the country. Fifty-one published empirical studies met the inclusion criteria for thi...
journal_title:International journal for equity in health
pub_type: 杂志文章
doi:10.1186/1475-9276-9-27
更新日期:2010-11-24 00:00:00