Improving basic health service delivery in low-income countries: ‘voice’ to the poor

Mehrotra, Santosh; Jarrett, Stephen

doi:10.1016/s0277-9536(01)00336-7

Cited by 37 publications

(30 citation statements)

References 4 publications

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“…It is also worth noting that very small proportion (4%) of those interviewed used private vehicles. Accessibility issues for those living in rural areas are well documented, whether it is in developed countries [24], or developing countries [25]. This is not the only issue facing those in rural areas, where there may be questions about the quality of the service, capacity or the facilities of the nearest service.…”

Section: B Accessibility To Healthcare Servicesmentioning

confidence: 99%

Factors Influencing Utilization of Health Services in Kenya: The Case of Homa Bay County

Otieno¹,

Macharia²

2014

IJPHS

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In order to improve efficiency in health service delivery in Kenya, the Ministry of Health has developed structures through inter-sectoral collaboration at various levels. Despite efforts by the government and key stakeholders to improve health sector, utilization of health services still remains a major challenge. The purpose of the study was to investigate factors that influence utilization of health services in Homa Bay County, Kenya. The study employed survey design and focused on health beneficiaries, District Health Management Team and other key health stakeholders, and used both quantitative and qualitative data. Quantitative data was collected through household interviews of 384 respondents and qualitative data was generated through Key Informant Interviews of 16 respondents. The study reveals that health financing, service delivery, quality, accessibility and equity influence utilization of health services in Homa Bay County. It is for these reasons that the study recommends that the government should allocate adequate budget towards health services, avail adequate trained health workers, and improve infrastructure in health facilities as well as drugs and other supplies. There is also need for further research on cultural factors influencing utilization of health services.

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Section: B Accessibility To Healthcare Servicesmentioning

confidence: 99%

Factors Influencing Utilization of Health Services in Kenya: The Case of Homa Bay County

Otieno¹,

Macharia²

2014

IJPHS

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“…The relationships between these three levels are crucial: local authorities must experience pressure from both above (for accountability to national governments) and below (for service delivery to local citizens). Hence successful decentralization requires establishing a three-way dynamic among local governments, civil society and an effective central government (Tendler, 1997;Mehrotra, 2002). The combination of these three elements-a functioning central government, empowered local authority, and voice-will ensure effective delivery of services.…”

Section: A Model Of Decentralization That 'Work'mentioning

confidence: 99%

“…One approach to this crisis lay in the greater mobilization of community resources in the development of local health services, recognizing that patients seeking care were already beginning to pay considerable sums of money for treatment of various kinds. This was the situation in which the Bamako Initiative arose in 1987-leading in many countries to a reasonably successful example of voice in ensuring access to affordable essential health services for an increasing proportion of people (Jarrett and Ofusu Amaah, 1992;Mehrotra and Jarrett, 2002). The strategy of the BI is to revitalize public health systems by decentralizing decision-making from the national to the district 278 S. Mehrotra level, instituting community financing and co-management of a minimum package of essential services at the level of the basic health units.…”

Section: Health: Accountability To the Community In Sub-saharan Africamentioning

confidence: 99%

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Governance and basic social services: ensuring accountability in service delivery through deep democratic decentralization

Mehrotra¹

2006

J. Int. Dev.

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Ensuring accountability of local functionaries for effective delivery of basic social services has been a perennial problem of development. Since the poor have limited prospects of 'exit', 'voice' alone works to ensure effectiveness of service delivery. Accountability of lower-level functionaries to superiors in a vertical line ministry is rarely effective. The paper spells out a model of deep democratic decentralization that has been demonstrated to work in a number of countries. Copyright © 2005 John Wiley & Sons, Ltd.

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“…In return, national leaders who track progress possess an essential tool to ensure country coordination and improve implementation (Gostin & Friedman, 2013;ter Veen & Commins, 2011). Otherwise, weak leadership and governance can result to poorer health systems performance; hence, lower achievement of health outcomes (Mehrotra & Jarrett, 2002).…”

Section: Consensus Statements and Global Healthmentioning

confidence: 99%

Health systems strengthening in global and national contexts

Macarayan¹

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Despite advances in medical research, the burden of disease in most countries remains high.Further, health inequalities continue to grow and emerging infectious diseases are still wreaking havoc across countries. To respond to contemporary public health challenges, a new systems thinking paradigm has emerged that highlighted a holistic approach towards health systems, resulting to an emerging field -health policy and systems research (HPSR). HPSR seeks to understand and enhance how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes. However, research gaps remain particularly in applying this paradigm to strengthen health systems performance across countries. This thesis contributes to HPSR by: a. examining the underlying concepts of health systems strengthening; b. determining how health systems contribute to better health outcomes, particularly on reducing infant mortality rates and improving life expectancies at birth, and c. understanding mechanisms to use findings from health systems strengthening assessments to inform global and national-level health policymaking processes.In 2015, 40% of the Global Fund investments go toward health systems strengthening (HSS). The global health threats posed by recent viral epidemics such as Ebola and Zika even further increased calls to invest in and develop better health systems. These health systems investments were also in most cases subjected to performance-based funding, but contrary to other monitoring and evaluation methods used for other health programs, health systems monitoring and evaluation demand a new analytical frame due to its complexity, along with the very different country capacities, uneven data sources and data availability and quality, including the varied contexts that drive priority areas for health systems. As such, monitoring these initiatives remain to be highly contentious despite its importance to inform health resource allocation. In particular, studies often highlighted different conceptual and methodological challenges associated with health systems assessments worldwide.To address these issues, I first introduced a new HSS framework based on existing monitoring and evaluation frameworks collected from my field experience, systematic reviews, and thematic analyses of existing HSS documents and database. Based on the developed HSS framework, existing HSS indicators were also examined to guide further analysis. Further, I quantitatively assessed health systems performance using a new composite indicator based on previous efforts for a global health systems performance index. To do this index, I used data collected from the Demographic Health Surveys, the World Bank Indicators, and the World Health Organisation ii (WHO) Global Health Surveys. In particular, I used fixed-effects and random-effects regression analyses to determine how each health system characteristic affects health outcomes, particularly infant mortality rates and life expectan...

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Improving basic health service delivery in low-income countries: ‘voice’ to the poor

Cited by 37 publications

References 4 publications

Factors Influencing Utilization of Health Services in Kenya: The Case of Homa Bay County

Factors Influencing Utilization of Health Services in Kenya: The Case of Homa Bay County

Governance and basic social services: ensuring accountability in service delivery through deep democratic decentralization

Health systems strengthening in global and national contexts

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