Examining Health System Responsiveness to Public Feedback in Kilifi County, Kenya

Kagwanja, Nancy Nyambura (2023). Examining Health System Responsiveness to Public Feedback in Kilifi County, Kenya. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.00016a2b

Abstract

Responsiveness is a core element of WHO’s health system framework, judged important in ensuring inclusive and accountable health systems. However, responsiveness as a health system goal has been under-researched. I conducted a policy document analysis and a qualitative case study to examine how policy, context, and power dynamics impact responsiveness in the Kenyan health sector. I collected data in two Sub- County Health Management Teams (SCHMTs) and four Health Facility Committees (HFCs), selected as cases of spaces for processing and responding to public feedback, in Kilifi County. This case study work involved interviews with county and sub-county health managers, facility-in-charges, and local politicians, focus group discussions with HFCs, observations and document review.

Study findings suggested limited responsiveness, which was a consequence of interactions between i) a macro-policy context that adopted a narrow health service-focused framing of responsiveness, lacked a coherent strategy for system-wide responsiveness and had inadequate detail on the functioning of feedback mechanisms, ii) actor interactions and power dynamics that contributed to the public -particularly vulnerable groups being constrained from sharing feedback and health system actors being oriented away from public feedback, and iii) meso-level contextual factors such as under-resourcing of the health system and low resourcing of feedback mechanisms that worked to entrench provider norms and hierarchical relationships, and that were not supportive of system responsiveness. Informal feedback mechanisms that evolved from public efforts to leverage responses were not sufficient to generate system-wide responsiveness.

By adopting a systems lens, this work has identified interacting influences on responsiveness. Responsiveness could be strengthened by adopting policy adjustments that reflect its breadth and complexity. Policymakers and health managers should also appreciate and leverage the lived realities of actors and address the meso contextual factors that interact to hinder the processes of receiving and responding to public feedback.