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Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019
Background: Performance based financing was introduced to Kilifi county actors in Kenya in 2015. Kilifi was identified by the Kenyan national government as one of the 20 arid and semi-arid counties (out of 47 counties) mandated to start the implementation of the scheme and potentially inform the dev...
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| Format: | Thesis |
| Language: | English |
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Department of Public Health and Family Medicine
2022
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| _version_ | 1867613174038003712 |
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| access_status_str | Open Access |
| author | Waithaka, Dennis Wambiri |
| author2 | Orgill, Marsha |
| author_browse | Orgill, Marsha Waithaka, Dennis Wambiri |
| author_facet | Orgill, Marsha Waithaka, Dennis Wambiri |
| author_sort | Waithaka, Dennis Wambiri |
| collection | Thesis |
| description | Background: Performance based financing was introduced to Kilifi county actors in Kenya in 2015. Kilifi was identified by the Kenyan national government as one of the 20 arid and semi-arid counties (out of 47 counties) mandated to start the implementation of the scheme and potentially inform the development of a nation-wide PBF policy. This study investigates how political and bureaucratic actors at the local level in Kilifi county have subsequently influenced the extent to which PBF has been politically prioritised at the sub-national level. Methods: The study employed a single-case study design. The Shiffman and Smith (2007) political priority setting framework with adaptations proposed by Walt and Gilson (2014) was used. Data was collected through document review (n=19) and in-depth interviews (n=8). Framework analysis was used to analyse data and generate findings. Results: Throughout the study period (2015-2018), national policy elites gave sustained attention to PBF as a priority issue for implementation, this sustained attention was however not present at the sub national level in Kilifi county and funding for PBF was not prioritised post donor funding. Key factors that contributed to this in Kilifi county included: redistribution of power from national actors to sub-national actors following devolution, this affected the national Ministry of Health's ability to lead and be an effective guiding organisation; misalignment between the globally advocated idea of ‘pay for performance' and the local pre-existing centralised and rigid approaches to public financial management; and actors at the sub national level who contested the PBF intervention design features and its framing as ‘additional funding'. As a consequence, the implementation of PBF in Kilifi was for a short time only using donor resources and did not last beyond donor timelines and funding. Conclusion: This research shows that for health reforms to gain political priority in highly devolved contexts, there is need to recognise the formal and informal institutions existing at the devolved level of governance and for adequate early involvement and leadership from sub-national bureaucratic and political actors, in health and beyond the health sector. In addition, advocacy for the health reforms should embody frames that align with the political context to increase the chances of gaining political traction. Finally, the political context including political and bureaucratic power at different levels of government are crucial features that will also influence the acceptability of reform and ultimately political prioritisation. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/36210 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:56.645Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/36210 Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019 Waithaka, Dennis Wambiri Orgill, Marsha Gilson, Lucy performance-based financing politics political prioritisation agenda setting policy analysis policy introduction power devolution sub-national Kilifi county Kenya Background: Performance based financing was introduced to Kilifi county actors in Kenya in 2015. Kilifi was identified by the Kenyan national government as one of the 20 arid and semi-arid counties (out of 47 counties) mandated to start the implementation of the scheme and potentially inform the development of a nation-wide PBF policy. This study investigates how political and bureaucratic actors at the local level in Kilifi county have subsequently influenced the extent to which PBF has been politically prioritised at the sub-national level. Methods: The study employed a single-case study design. The Shiffman and Smith (2007) political priority setting framework with adaptations proposed by Walt and Gilson (2014) was used. Data was collected through document review (n=19) and in-depth interviews (n=8). Framework analysis was used to analyse data and generate findings. Results: Throughout the study period (2015-2018), national policy elites gave sustained attention to PBF as a priority issue for implementation, this sustained attention was however not present at the sub national level in Kilifi county and funding for PBF was not prioritised post donor funding. Key factors that contributed to this in Kilifi county included: redistribution of power from national actors to sub-national actors following devolution, this affected the national Ministry of Health's ability to lead and be an effective guiding organisation; misalignment between the globally advocated idea of ‘pay for performance' and the local pre-existing centralised and rigid approaches to public financial management; and actors at the sub national level who contested the PBF intervention design features and its framing as ‘additional funding'. As a consequence, the implementation of PBF in Kilifi was for a short time only using donor resources and did not last beyond donor timelines and funding. Conclusion: This research shows that for health reforms to gain political priority in highly devolved contexts, there is need to recognise the formal and informal institutions existing at the devolved level of governance and for adequate early involvement and leadership from sub-national bureaucratic and political actors, in health and beyond the health sector. In addition, advocacy for the health reforms should embody frames that align with the political context to increase the chances of gaining political traction. Finally, the political context including political and bureaucratic power at different levels of government are crucial features that will also influence the acceptability of reform and ultimately political prioritisation. 2022-03-22T11:48:12Z 2022-03-22T11:48:12Z 2021 2022-03-22T07:51:52Z Master Thesis Masters MPH http://hdl.handle.net/11427/36210 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences |
| spellingShingle | performance-based financing politics political prioritisation agenda setting policy analysis policy introduction power devolution sub-national Kilifi county Kenya Waithaka, Dennis Wambiri Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019 |
| thesis_degree_str | Master's |
| title | Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019 |
| title_full | Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019 |
| title_fullStr | Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019 |
| title_full_unstemmed | Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019 |
| title_short | Political prioritisation for performance-based financing at the county level in Kenya: 2016 to 2019 |
| title_sort | political prioritisation for performance based financing at the county level in kenya 2016 to 2019 |
| topic | performance-based financing politics political prioritisation agenda setting policy analysis policy introduction power devolution sub-national Kilifi county Kenya |
| url | http://hdl.handle.net/11427/36210 |
| work_keys_str_mv | AT waithakadenniswambiri politicalprioritisationforperformancebasedfinancingatthecountylevelinkenya2016to2019 |