Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya

Abstract

BackgroundCommunity participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountabilityMethodsWe conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management.ResultsHFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC.ConclusionsThere is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to improve their training, clarify their roles, and improve engagement with the wider community.

Participation in health planning in a decentralised health system: Experiences from facility governing committees in the Kongwa district of Tanzania

“…They worked in collaboration with community health workers and facility health workers to educate other community members in a village assembly on certain topical health issues, including the importance of child immunisation against various diseases. A study of HFCs and facility management in the Coast province of Kenya reported similar findings, in which facility committees organised health education talks at the facility level (Goodman, Opwora, Kabare, & Molyneux, 2011).…”

Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries

“…In Kenya, the lack of clarity on roles around budgetary control and oversight had negative implications for the relationship between heath committees and health facility workers (Goodman et al, 2011). Community based monitoring of health facilities and health services by HCs can at times create tense relationships between committee members and healthcare workers (Shukla et al, 2011;Singh et al, 2010).…”

“…In Kenya, reforms including direct facility financing (DFF) increased the relevance of HCs (Goodman et al, 2011). Many interviewees felt that DFF widened the scope of HC activities because HCs could plan and implement activities with the additional finances, which increased their participation and developed their sense of facility ownership.…”

“…Some community skepticism was linked to lack of understanding of HC roles. In Kenya, misunderstandings between community members and committee members were a frequent challenge, including cases where community members expected committee members to spend facility finances on community projects outside the HC guidelines (Goodman et al, 2011).…”

“…Kenya's Health Facility Committees described by Goodman et al, 2011) or may not speak dominant languages used at health centers (ex. Peru's Comites Locales de Administracion de Salud (CLAS) described by Iwami andPetchey 2002, Shepard 2006).…”