Challenges of Implanting Devolved Health Care in the Counties in Kenya

|Healthcare – A Framework for Local Action 2007; organisational policies, local and regional guidelines for |

Hospitals have organizational structures that allows them to carry out their duties efficiently and successfully. What separates the organizational structure of a healthcare organization from a business, essentially that the hospital 's organization is chiefly founded on the amalgamation of medical and administrative staff (Carayon, et al., 2014). The organizational structure of the twenty-first century solutions in health care hospitals involves, both divisional and hierarchical structure. In the of the chain of command hierarchy, there are various levels of professional’s that fall under other levels within the facility, and each staff member is organized in regards to departments that are related to their (KSA’s) skills, attributes and job duties (Carayon, et al., 2014). Hospital organization philosophies is based on development of values and ethics, with the understanding on moral principles relating to human conduct. These systems are comprised with the processes in decision making and determining the best actions to consider between the difficult alternatives when pertaining to patient care.

With the focus on these five areas, Governments in each country are creating health systems that aim to provide services that are affordable, equitable and accessible. To achieve a sustainable health system, cooperation and participation of all health care providers is vital. This will work towards WHO’s goal of achieving “better health for all”

Due to many changes in health service organizations’ internal and external environment, planning can be sometimes onerous (Longest & Darr, 2008, p. 366). Therefore, a well thought strategic plan will guide leaders and keep them focus on the organization’s mission. In health service organizations, strategic planning is emanated at the top level of the pyramid, then pass down to others in leadership positions (Longest & Darr, 2008, p. 366). A strategic planning process consists of many steps: a situational analysis, external environment analysis, internal environment analysis, strategy formulation, strategic implementation, and strategic control. As mentioned before, health service organization faced many challenges, a strategic planning not only helps with planning, controlling, and decision making, but it also allows management to analyze their strengths and weaknesses, as well as opportunities and threats. Again, the strategic planning process has proven to be effective when implemented by the entire organization.

“Running a health care organization is a team sport. It is very important that all members of the team-whether on the medical staff, in management or on the board-understand the role of governance and what constitutes effective governance” (Arnwine, 2002). Running a hospital is a difficult task. Several factors need to be seriously thought of and considered in every decision and undertaking. Unfortunately, all the three important factors in governing a hospital is not always in harmony. As likened to a team sport, if the three major components are not working with each other as a team, there will be tension and a great divide will be experienced. And often times, the patients will be in the middle and will be greatly impacted. This writer believes that there are several factors that contribute to the tension that usually exists among the medical staff, the board and administration. One factor is the disconnect, where each entity is not seeing each other eye to eye and their visions may be different from each other. Another factor may be the lack of communication in order to bridge the gap and to build a respectful and a relationship wherein there is trust for each end every member of the group. Often times, the medical staff is concerned with ensuring that patients are cared for in a manner that their practice is protected as well as the patients are getting the appropriate care. On the other hand, the board of trustees may be focused in ensuring that that

Health care systems are organizations that are formed to meet the overall health needs of the population. Health care is regarded as one of the leading cause in promoting not only physical and mental health but the well-being of the population. Legislation is implemented requiring government to offer services to all members of its society. The role of health services and the organizations that provide aid is to focus on the health of an individual and to uphold their human rights. According to WHO (2013), a “well-functioning health care system requires a robust financing mechanism, a well-trained and adequately-paid workforce, reliable information on which to base decisions and policies, and well maintained facilities and logistics to deliver quality medicines and technologies (World Health Organization; 2013).

Vertical initiatives can lead to dependent systems. As described by lecture 4 from week 5, vertical programs “ can result in the “tail wagging the dog” syndrome, in which the organization or health system becomes dependent on these external resources and must respond to specific initiatives of interest to their donors, and not on those programs and services which the organization wants to implement In contrast horizontal initiatives commonly have as an objective to create sustainable systems”. Based on these statements, it would easy to just assume that the best way to build sustainable systems is through horizontal initiatives since it is an integrated management of multiple determinants of health and focuses on the use of local staff, facilities,

It is important to do accountability because it is an only way of enhancing task incentive. This makes the organization's policies responsive and also effective. That is why different mechanisms of accountability have come up including hospital boards, public campaigns, and village health committees. These are being used to bring awareness publicly and also globally in implementation of health services and programs (Herzlinger 2006). They support a wide range of activities which include

I give the instructor, Dr. Ashish Chandra, permission to use this assignment, Healthcare in Kenya as an example for future students and classes.

The concept of governance within a health care organization must be well design and welcome cooperation (Berger, S. (2011). When those that make policies can understand how to apply cooperative regulatory structure in healthcare setting it is noted that self-interest is not the only way of motivating positive behavior. The concept of governance spells out who is responsible for ensuring and providing support and services to all members needing health resources (Berger, S. (2011).

These health care organizations have two types of planning to follow, and they are tactical and strategic planning. When tactical planning takes place, there is a short term goal in mind (Society for Human Resource Management, 2102). The course of action for a tactical plan is to achieve a goal within a year or less time period (Society for Human Resource Management, 2102). A tactical plan has a smaller scope and shorter time span than a strategic plan (Society for Human Resource Management, 2102). It takes several tactical plans to achieve the strategic plan (Society for Human Resource Management, 2102). Strategic planning differs from tactical planning, because in strategic plan, the course of action is to achieve goals for the long term (Society for Human Resource Management, 2102). Strategic planning goals are usually wanted to be completed with five years (Society for Human Resource Management, 2102). The organization’s mission statement purpose and direction are reflected upon strategic planning (Society for Human Resource Management, 2102). Top management must view reports on operations, external environments and finances when looking to develop a strategic plan (Society for Human Resource Management, 2102). The development of tactical plans are influenced by strategic plans (Society for Human Resource Management, 2102).

Health System has been developed; the most basic unit is a Sub-Health Post or Health Post in each Village Development Committee area. However, the expansion of the Health System has not been matched by an expansion in the domestive resources, workers and supplies, and the available resources are not efficiently distributed. In

A country’s economy and well-being depends upon how strong its healthcare system is. A country would grow into a stronger nation if the people are mentally and physically stronger. Moreover, healthcare systems are usually complex and complicated systems and thus, they need a lot of attention. As Donley (2005) states, “[t]he changing patterns of health care delivery have increased complexity in all practice environments” (p. 314). By a complicated system, it means how different healthcare organizations together play a pivotal role in measuring success of a country’s healthcare system. These healthcare organizations further rely on various departments within the system which are in turn led by various leaders. Thus, it is evident how leaders are the key link in deciding the fate

The leadership structure of New Zealand health care system has a slight modification. Later 2008, the twenty-one District Health Boards (DOB) that act as a consumer and supporter maintained in the population liable for health to ensure services are arranged effectively and efficiently for all New Zealand. District Health Board consist of seven elected members and four delegated by the Minister of Health (MOH). It requires to select board members, but the condition is to have two representatives from the Maori Party, the Manu Motuhake Party, which organized rigidly the well-being of the public and aiming for the transparency of expenses incurred in local health services and the administration be back to local communities. A complex system of governing bodies that work together with the Minister of Heath (with Cabinet and the government) provided by the National Health Board. Health Workforce New Zealand and other ministerial advisory committee.

Leadership structure of New Zealand health care system has a slight modification. Later 2008, the twenty-one District Health Boards (DOB) that act as a consumer and supporter maintained for the population liable for health to ensure services are arrange effectively and efficiently for all New Zealand. District Health Board consist of seven elected members and four delegated by the Minister of Health (MOH). It requires to select board members, but the condition is to have two representative from Maori Party, the Manu Motuhake Party which organized rigidly the well-being of the public and aiming for the transparency of expenses incurred in local health services and the administration be back to local communities. A complex system of governing bodies that works together from the Minister of Heath (with Cabinet and the government) provided by the National Health Board. Health Workforce New Zealand and other ministerial advisory committee.