Examining the Influence of Health Sector Co-ordination on the Efficiency of County Health Systems in Kenya

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Abstract Background: Health systems are complex, consisting of multiple interacting structures and actors whose effective co-ordination is paramount to enhancing health system goals. Poor health sector co-ordination is a potential source of inefficiency in the health sector. We examined how the co-ordination of the health sector affects health system efficiency in Kenya. Methods: We conducted a qualitative cross-sectional study, collecting data at the national level and in two purposely selected counties in Kenya. We collected data using in-depth interviews (n = 36) with national and county level respondents, and document reviews. We analyzed the data using a thematic approach. Results: The study found that while formal co-ordination structures exist in the Kenyan health system, duplication, fragmentation, and misalignment of health system functions and actor actions compromise the co-ordination of the health sector. These challenges were observed in both vertical (co-ordination within the ministry of health, and within the county departments of health, and between the national ministry of health and the county department of health) and horizontal co-ordination mechanisms (co-ordination between the ministry of health or the county department of health and non-state partners, and co-ordination among county governments). These co-ordination challenges are likely to impact on the efficiency of the Kenyan health system by increasing the transaction costs of health system functions. Inadequate co-ordination also impairs the implementation of health programmes and hence compromises health system performance. Conclusion: The efficiency of the Kenyan health system could be enhanced by strengthening the co-ordination of the Kenyan health sector. This can be achieved by aligning and harmonizing the intergovernmental and health sector specific co-ordination mechanisms, strengthening the implementation of the Kenya health sector co-ordination framework at the county level, and enhancing donor co-ordination through common funding arrangements and the integration of vertical disease programmes with the rest of the health system. The ministry of health and county departments of health should also review internal organizational structures to enhance functional and role clarity of organizational units and staff respectively. Finally, counties should consider initiating health sector co-ordination mechanisms between counties to reduce the fragmentation of health system functions across neighboring counties.

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