Session 3

ORGANIZATION OF HEALTH
SYSTEMS AND SERVICES

1
Objectives

By the end of this unit, the student should be able

to:
 Describe how health systems are organised in
general and Kenya in particular.
 Identify and describe the governance,
management and coordination structures
operating at all levels of health system in Kenya.
 Explain the roles and functions of these
structures at different levels of health system in
Kenya.
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Organisation of Health systems
 Health systems are organised into different forms in
different countries.
 Generally, they are organised based on government
administrative levels
The KHSSP III 2013-2018 defines the Kenya Essential
Package for Health (KEPH) as consisting of the following
cost-effective health services organised:
 By Type (4): Promotive, preventive, curative and
rehabilitative;

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Organisation of Health Services in
Kenya (Cont’d)
 By Target group (Cohorts – 5+1):

– Pregnancy and the new born (up to 28 days); early

childhood (29 days – 59 months); late childhood and
youth (5 – 19 years); adulthood (20 – 59 years);
elderly (60 years and over); cross cutting
interventions (all cohorts).

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 Organization of Health
Services in Kenya (Cont’d)
 By tiers (functional description) and levels
(structural description) of care
TIERS OF CARE LEVELS OF CARE

TIER 1: COMMUNITY Level 1: Community level

SERVICES
TIER 2: PRIMARY CARE Level 2: Dispensary / outpatient facilities
SERVICES
Level 3: Health centre / maternity facilities

TIER 3: COUNTY Level 4: Primary care referral hospitals (County / sub

REFERRAL SERVICES county)
Level 5: Secondary care referral hospitals

TIER 4: NATIONAL Level 6: Tertiary care referral hospitals (general, or

REFERRAL SERVICES specialized)
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 Organisation of Health
Services Delivery Illustrated
LEVELS DESCRIPTION FOCUS

All PGH’s, and National • Highly specialised health care, for area / region of
NATIONAL Referrals specialisation
REFERRAL Are general, regional, or • Training and research services on issues of national
FACILITIES discipline specialists importance

Referral services

• Comprehensive in-patient diagnostic, medical, surgical and

COUNTY All district, sub-district hospitals, rehabilitative care, including reproductive health services
including NGO / private, form • Specialised outpatient services
REFERRAL network of County Referral • Facilitate, and manage referrals from lower levels, and other referrals
FACILITIES Services in a county • With other County Referral Facilities, form the County Referral
System

Referral services

All dispensaries, health • Disease prevention and health promotion services

centres, clinics, maternity • Basic outpatient diagnostic, medical surgical & rehabilitative services
PRIMARY CARE
homes • Inpatient services for emergency clients awaiting referral, clients for
FACILITIES Catchment area: 30,000 observation, and normal delivery services
persons • Facilitate referral of clients from communities, and to referral facilities

Referral services

• Facilitate individuals, households and communities adopt appropriate

COMMUNITY healthy behaviours
No physical facilities • Provide agreed health services
UNITS • Recognise signs and symptoms of conditions requiring referral,
• Facilitate community diagnosis, management &referral.
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Health Systems Structures

Health systems comprise of:

 Governance structures;

 Management structures;

 Coordination/partnership structures.

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 Structures in Kenya’s Health
System
Coordination Governance
Management/St
ewardship
JOINT INTER AGENCY NATIONAL MINISTRY OF
COUNTY EXECUTIVE COMMITTEE
COORDINATING COMMITTEE HEALTH

HEALTH SECTOR COORDINATING

COMMITTEE COUNTY DEPARTMENT FOR COUNTY HEALTH
Technical Working Groups & their
HEALTH MANAGEMENT TEAM
ICCs

COUNTY HEALTH STAKEHOLDERS

FORUM County Hospital
County Hospital Board
Management Team

SUB COUNTY HEALTH SUB COUNTY HEALTH

STAKEHOLDERS FORUM MANAGEMENT TEAM

Primary Care Facility Management Primary Care Facility

Committee Management Team

COMMUNITY HEALTH COMMITTEE COMMUNITY UNIT

Government of Kenya, KHSSP, 2012 - 2017 13
Objectives of Governance and Management
Structures

 Improved voice and accountability: Through

ensuring that their issues and aspirations are
being raised, and incorporated into the priorities
for the health sector at the level.

 Political stability and lack of violence: Through

ensuring that actions of the health managers are
appropriately articulated to the population.

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 Objectives of Governance and Management
Structures (Cont’d)
 Government effectiveness: Through appraising
performance of stewardship functions exercised by
the management levels by participating in, and
approving annual work plans and reports of
performance.

 Regulatory quality: Through ensuring that expected

regulatory functions are carried out to the benefit of
the population.
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 Objectives of Governance and Management
Structures (Cont’d)
 Rule of law: Through ensuring that legal
framework is adhered to, in all actions of the
sector.

 Control of corruption: Through monitoring of

implementation of health activities.

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 Governance Structures
• The governance structures of the health system are
created to provide an oversight role to the
management structures.

• They are supposed to provide voice to the citizens to

ensure that people’s rights of access to quality health
care are respected.
 At the national level, the governance structure for the
health system is the Parliamentary Committee on Health.
 At the county level, the health committee of MCAs 12
 Management Structures
 The sector stewardship and management
framework relates to how the government, through
the Ministry of Health, organise itself to coordinate
and lead the delivery of the defined health
package.

 Management structures exist from national to

community levels.

 National level structures exist at all levels of the

Ministry of Health.
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 National Level Management
Functions
 National planning and policy formulation;
 Enforcement of standards;
 Ensuring commodity security;
 Performance monitoring;
 Capacity strengthening;
 Resource mobilisation;
 Operational and other research;
 Monitor quality and standards of performance of the national
and county governments in the provision of health services14
Management Structures at County Level

 The Constitution of Kenya 2010 has assigned the

larger portion of delivery of health services to the
Counties with exception of National Referral
Services.
 Governance units at County level include:
 County department responsible for health;
 Hospital boards;
 Primary care management committees;
 Community health committees.
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 County Level Management
Functions
 Delivering county health services;

 Licensing and accrediting non state health service providers (HSPs);

 Financing of county level health services;

 Maintaining, enhancing and regulating asset development and HSPs

operations;

 Approving county special partnership agreements (SPAs) for county HSPs;

 In collaboration with national government, gazette regulations for

community managed health supplies to be implemented at county level

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 County Management
 ; Functions (Cont’d)
 Planning, investment and asset ownership function of public
health facilities;

 Developing an investment plan to enable fulfillment of the

highest attainable right to health and document, annually,
progress on fulfillment as required by the Constitution;

 Asset financing and ownership;

 Channeling public and other funds to develop health facilities.

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Technical Management of Health at County

This comprises of:

• Office of the County Executive officer of Health;

• Office of Head - Health department;

• Other offices that shall be approved within the

county by the governor in consultation with the
county assembly.

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 County Technical Management Functions
 Strategic and operational planning, supportive supervision, monitoring and
review of health service delivery in the county.

 Coordinate delivery of health services in the county.

 Provide leadership and stewardship for overall health management in the

county, through building linkages with, and putting in place influencing
strategies for health related sectors in the county, such as education, roads,
gender, nutrition etc.

 Mobilise resources for county health services

• Provide a linkage with County Executive officer, Head of health department and
other actors to facilitate health sector dialogue at the County;
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 Facility Management
Structures
 Hospital Management Teams (HMTs) exist in all types of hospitals. In
general, the membership is made up of the heads of the following
departments:

 Nursing;

 Medical;

 Surgery;

 Obstetrics and Gynaecology;

 Pharmacy;

 Laboratory; and

 Administration

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 Facility Management Functions

 Preparation of hospital work plans, e.g., annual

operation plans.

 Ensuring equitable distribution of resources within the

facility, e.g., supplies, staff within the departments.

 Ensure that quality services are offered to the clients

in the hospital.

 Ensure that proper records and information are

maintained.
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Facility Management Functions
(Cont’d)
 Proper financial management, e.g., ensuring
proper budgeting and utilisation of funds such as
the Facility Improvement Fund (FIF).

 Commodities and supplies management.

 Infrastructure and equipment management.

 Emergency preparedness and timely response.

 Human resource management and development.

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Management Structures at Primary Care Facilities

 The management teams at the primary care

facilities are composed of an officer in-
charge, a clinical officer, a nurse and a public
health officer.

 The link person between the level 2 and 3

facilities and the community is the
Community Health Extension Worker (CHEW).

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 Management Structures at the
Community Level

• At community level, there are no formal management

structures. Management is provided by the County, while
the health facilities provide the supervisory function.

• The link person between the facilities and the community is

the Community Health Extension worker (CHEW).

• CHEWs are supported by CHWs/ CHVs

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Coordination/Partnership Structures
 Partnership means voluntary joint action or
decision-making in a harmonious and
supportive way, for a common goal and
outcome.

 It involves all players or stakeholders who,

through their actions, will influence health
services delivery.

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 Coordination/Partnership Structures (Cont’d)
 In the health sector, partnership is guided by an overall
instrument, the Code of Conduct, which defines roles and
obligations of different sector actors towards attaining its
overall goal and objectives (Paris declaration, Aid
effectiveness).

 The health sector partnership in Kenya is guided by the Kenya

Health Sector-Wide Approach (KHSWAp) introduced in 2005.

 Partnership structures are necessary as they provide

opportunity for stakeholders to share experiences, expertise
and lessons learnt 26
Partnership Structures in the Health Sector

 Fostering partnerships in improving health and

delivering services is critical to the successful
achievement of the objectives of the health
sector.

 The health sector has put in place a multi-

layered sector coordination framework that
consists of the following structures:

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Sector Coordinating Framework

Joint Inter Agency Coordinating Committee (JICC)

Health Sector Coordinating Committee (HSCC)

Health Sector Steering Committee Secretariat

County Health Stakeholders Forum

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 County Stakeholder Forums

 The County Health Stakeholder Forums (CHSF) provide the

oversight role in the provision of the health services at the
County level.

 The County Governor provides the chair for the Forum.

 The members of the Forum are drawn from relevant

government departments and implementing partners,
including faith-based and non-government organisations.

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Functions of County Stakeholder Forums

 Foster collaboration among the health sector

stakeholders by providing a platform for
discussion and dialogue on health-related
issues.

 Review and approve the respective annual

plans to ensure that there is harmonisation
among health sector stakeholders.
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