Abstract:
Introduction
Community participation in the governance of health services is an important component in
engaging stakeholders (patients, public and partners) in decision-making and related activities in health care. Community participation is assumed to contribute to quality improvement
and goal attainment but remains elusive. We examined the implementation of community
participation, through collaborative governance in primary health care facilities in Uasin
Gishu County, Western Kenya, under the policy of devolved governance of 2013.
Methods
Utilizing a multiple case study methodology, five primary health care facilities were purposively selected. Study participants were individuals involved in the collaborative governance
of primary health care facilities (from health service providers and community members),
including in decision-making, management, oversight, service provision and problem solving. Data were collected through document review, key informant interviews and observations undertaken from 2017 to 2018. Audio recording, notetaking and a reflective journal
aided data collection. Data were transcribed, cleaned, coded and analysed iteratively into
emerging themes using a governance attributes framework.
Findings
A total of 60 participants representing individual service providers and community members
participated in interviews and observations. The minutes of all meetings of five primary
health care facilities were reviewed for three years (2014–2016) and eight health facility
committee meetings were observed. Findings indicate that in some cases, structures for collaborative community engagement exist but functioning is ineffective for a number of reasons. Health facility committee meetings were most frequent when there were project funds,
with discussions focusing mainly on construction projects as opposed to the day-to-day
functioning of the facility. The
Data Availability Statement: Governance is a
sensitive topic and qualitative data is difficult to deidentify the data completely. Data from this study
can be availed through approving ethics committee
political connections or were retired government workers. There were no formal mechanisms for stakeholder forums and how these worked were unclear. Drug stock outs, funding
delays and unclear operational guidelines affected collaborative governance performance.
Conclusion
Implementing collaborative governance effectively requires that the scope of focus for collaboration include both specific projects and the routine functioning of the primary health
care facility by the health facility committee. In the study area, structures are required to
manage effective stakeholder engagement.