Does Decentralization Deliver Health Services to vulnerable Groups in Kenya? A Case Study of Busia and Kakamega Counties -Kenya

Abstract

1. Background Decentralization has become an increasingly important concept in development theory and practice in the world since the 1970s. Decentralization is generally understood to be referring to policies and processes that shift the locus of decision-making and management to the local level, Hellington (2005). According to Elamon (2004), decentralization is particularly attractive because some forms of it promise direct accountability of public institutions; improved management of resources; more reliable information for planning and a more effective interagency collaboration and coordination. Furthermore, it is argued that local ocials and community leaders have better knowledge and information about the local context and are therefore more aware of what can work best within the resource constraints while contributing to the achievement of the broader social, economic and development goals of central government. In the health sector, the impetus for decentralization has its roots in the Alma-Ata declaration of Primary Health Care, WHO (1978). This was enhanced by the World Health Organization’s advocacy for strengthening the health system at district level as the most appropriate level for planning and providing health services. Bankausaikaite (2005) argues that decentralization therefore appeals to the health sector largely because it is seen as a means to achieving the Primary Health Care (PHC) goals and for its potential to achieve multiple objectives. Furthermore, decentralization continues to be a subject of intense discussions in the health sector reform processes and is seen as a key strategy for achieving poverty reduction objectives and for attaining the global Millennium Development Goals (MDGs). Klouda (1995) argues that in the context of Sub-Saharan Africa, a region that has the majority of poor countries in the world, poor health indices and high burden of preventable diseases including a devastating impact of HIV/AIDS, decentralization is perceived as offering a key development strategy in addressing these complex problems. In the specic case of HIV/AIDS, decentralization is perceived as suited to stimulate far-reaching changes that can respond to the complex factors that lead to its transmission and the multiple services necessary to adequately support affected communities through multisectoral actions. Furthermore, Ribot (2002) has said that development is often argued as a motive for decentralization. It is argued that decentralization facilitates integrated local development, a necessary factor in the control of HIV/AIDS. The United Nations Development Program, UNDP (2000) has actively promoted decentralization in local government and points out that one of the earliest efforts in using decentralization to address the HIV/AIDS pandemic in sub-Saharan Africa has been through the Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa. These efforts have been supported by donor agencies such as USAID, UNDP , World Bank and Private Foundations. According to Schneider (2005) the Ford Foundation in Southern Africa (South Africa, Zimbabwe, Namibia, and Mozambique) for example, focused its grant making on strengthening local government and civic responses to HIV/AIDS at district and community levels. In Kenya, the government adopted a deconcentrated form of decentralization at independence in 1963. However, since the presidential and local elections of 2002, the government has tended to shift towards a more devolutionary form of decentralization by enacting policies and Acts of parliament that enable it to transfer funds to decentralized levels. According to NCCK ((2005) these funds include the Constituency HIV/AIDS Fund of 2003, established by legal notice 170 of the Corporations Act 1999. According to Orege (2005) this fund is primarily expected to support prevention, care and mitigation of the impact of HIV/AIDS within the communities. Managed by the National AIDS Control Council (NACC), it provides grants to civil society organization at constituency and district levels. According to NACC (2006) the Constituency AIDS Control Committees (CACCs) are responsible for the implementation, coordination and management of funded projects at the local level. The overall aim of the study is to assess how the decentralized AIDS Funds are used to respond to the social problems among children affected by HIV/AIDS in Amagoro constituency in Busia County and Mumias and Matungu constituencies in Kakamega County.