Journal article
Political prioritisation for performance-based financing at the county level in Kenya: 2015 to 2018
- Abstract:
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Background: Performance-based financing (PBF) was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level.
Methods: The study employed a single-case study design. The Shiffman and Smith political priority setting framework with adaptations proposed by Walt and Gilson was applied. 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: In the period 2015-2018, the political prioritisation of PBF at the county level in Kilifi was influenced by contextual features including the devolution of power to sub-national actors and rigid public financial management (PFM) structures. It was further influenced by interpretations of the idea of ‘pay-for-performance,’ its framing as ‘additional funding,’ as well as contestation between actors at the sub national level about key PBF design features. Ultimately PBF ceased at the end of 2018 after donor funding stopped.
Conclusion: Health reformers must be cognisant of the power and interests of national and sub national actors in all phases of the policy process, including both bureaucratic and political actors in health and non-health sectors. This is particularly important in devolved public governance contexts where reforms require sustained attention and budgetary commitment at the sub national level. There is also need for early involvement of critical actors to develop shared understandings of the ideas on which interventions are premised, as well as problems and solutions.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 855.5KB, Terms of use)
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- Publisher copy:
- 10.34172/IJHPM.2023.6909
Authors
- Publisher:
- Kerman University of Medical Sciences
- Journal:
- International Journal of Health Policy and Management More from this journal
- Volume:
- 12
- Issue:
- 1
- Pages:
- 1-13
- Article number:
- 6909
- Publication date:
- 2023-01-18
- Acceptance date:
- 2023-01-17
- DOI:
- ISSN:
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2322-5939
- Language:
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English
- Keywords:
- Pubs id:
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1345911
- Local pid:
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pubs:1345911
- Deposit date:
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2023-06-14
Terms of use
- Copyright holder:
- Waithaka et al.
- Copyright date:
- 2023
- Rights statement:
- © 2023 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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