Online Program

Community structures as a means toward greater accountability in a responsive health system in Kenya, east africa

Tuesday, November 5, 2013

Katelyn Tente, MSW, MPH, Department of Social Work, Family Relations and Services, The Children's Hospital of Philadelphia, Philadelphia, PA
Rosemary Frasso, PhD, MSc, CPH, Center for Public Health Initiatives, University of Pennsylvania School of Medicine, Philadelphia, PA
Jennifer Cohn, MD MPH, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
Health system accountability operates on all levels of the health system, from the policy level to planning to local service delivery. As a means to enhance local accountability, Ministries of Health and Development Partners have employed various models of community engagement. Community structures, including a range of committees drawn from community members or sub-populations, are a potentially key mechanism for promoting local accountability in the health system. These structures can provide for independent community voices in decentralized planning and budgeting by District Health Management Teams (DHMTs), facilities and other local health system institutions, and are included in the Kenyan Government's community Health Strategy. It has been argued that community structures are an effective means of ensuring responsiveness in local health system administration, but there is little documentation to support or refute that claim. Methods: We conducted a series of in-depth interviews (n=48) and surveys (n=34) with key informants in various community units in Kenya and assessed information available with the MPHS as well as African Medical Research Foundation's programming experience. Results: We identified a range of community structures that link communities (or sub-groups) with elements of the formal health system, including public health facilities, DHMTs, and private health care providers, such as CBOs, clinics and others. Preliminary analysis of qualitative data yielded a list of potential pathways by which various community structures exert influence over the formal health system, which include barazas, community action and dialogue days, CHAK board documentation and disseminating CBHMIS progress on indicators.

Learning Areas:

Assessment of individual and community needs for health education
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
Define and document community level health system accountability and function. Identify the range of community structures and identify mechanisms for their role in improving accountability in the formal health system. Describe gaps in successes of community structures. Identify suggestions for improvement of functioning and communication from various members of the community structure. Identify incentive program/funding for Community Health Worker and Community Health Extension Workers. Explain the perceived improvement/lack of improvement in community health outcomes. Evaluate the community strategy and existing community structures within the Kenya healthcare system.

Keyword(s): Community-Based Health Promotion, Community-Based Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Masters in Public Health and Social Work student at the University of Pennsylvania who spent the summer traveling to various community health units throughout Kenya interviewing Community Health Workers and other key members of community health structures to document the various roles in the system, how people understand and communicate about the health matters in his/her communities, successes in the structure and improvements in communication, functioning and for sustainability.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.