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Health Sector in Kenya
DDBA 8560 - Seminar in Healthcare Managerial Decision Making
Walden University
Health Sector in Kenya
The health sector comprises the public system, with major players including the MOH
and parastatal organizations, and the private sector, which includes private for-profit,
NGO and FBO facilities. Health services are provided through a network of over 4,700
health facilities countrywide, with the public sector system accounting for about 51
percent of these facilities. The public health system consists of the following levels of
health facilities: national referral hospitals, provincial general hospitals, district hospitals,
health centres, and dispensaries (Mwamuye & Nyamu, 2014).
National referral hospitals are at the apex of the health care system, providing
sophisticated diagnostic, therapeutic, and rehabilitative services. The two national referral
hospitals are Kenyatta National Hospital in Nairobi and Moi Referral and Teaching
Hospital in Eldoret. The equivalent private referral hospitals are Nairobi Hospital and
Aga Khan Hospital in Nairobi. Provincial hospitals act as referral hospitals to their
district hospitals. They also provide very specialized care. The provincial level
acts as an intermediary between the national central level and the districts. They oversee
the implementation of health policy at the district level, maintain quality standards, and
coordinate and control all district health activities. Similar private hospitals at the
provincial level include Aga Khan Hospitals in Kisumu and Mombasa. District hospitals
concentrate on the delivery of health care services and generate their own expenditure
plans and budget requirements based on guidelines from headquarters through the
provinces. The network of health centres provides many of the ambulatory health
services. Health centres generally offer preventive and curative services, mostly adapted
to local needs. Dispensaries are meant to be the system’s first line of contact with
patients, but in some areas, health centres or even hospitals are effectively the first points
of contact. Dispensaries provide wider coverage for preventive health measures, which is
a primary goal of the health policy. The government health service is supplemented by
privately owned and operated hospitals and clinics and faith-based organisations’
hospitals and clinics, which together provide between 30 and 40 percent of the hospital
beds in Kenya (Muga et al., 2014).
Strategic management is fundamental in leading the county in dynamic governance
dispensation. Strategic management provides the momentum for change. In effect,
strategies help to create new beginnings, new chances for success, new challenges for
employees and new hopes for patients. Therefore, it is imperative that county health care
planners understand the changes taking place in their counties and not simply be
responsive to them, but strive to create the future. County leaders must see into the future,
create new visions for success, and be prepared to make substantial effort to achieve the
expected changes (Mwamuye & Nyamu, 2014). Mombasa County has a total of 311
health facilities spread across the county. These are: 1 referral facility, 2 District
hospitals, 41 dispensaries, 8 health centres and 259 uncategorized facilities.
Social challenge
Strategy implementation or strategy execution task is easily the most complicated and
time consuming part of strategic management. While strategy formulation is primarily an
intellectual and creative act involving analysis and synthesis, implementation is a hands-
on operation and action oriented human behavioural activity that calls for executive
leadership and key managerial skills.
Kenya devolved its healthcare system since the time the county government came into
power in March 4th 2013, however, very little has been done to establish the implications
it has had in Kenya and more so Mombasa county which is the gateway to Africa from
western and Asian Countries. Healthcare staff unrest has been witnessed since the advent
of county governance; affecting service delivery thus posing health risks to thousands of
Mombasa residents and scaring away potential investors. Both the national and county
government together with the various development stakeholders have paid little attention
to such a situation despite the fact that if it remains unchecked could jeopardize service
Most studies on strategy implementation in Kenya have focused on its effects on
performance. Kiptugen (2003) did a study to determine the strategic responses of Kenya
Commercial Bank to a changing competitive environment. Since he focused mainly on
strategies that can be adopted in a competitive environment; the study failed to cover the
processes involved in strategy implementation and performance. Muturi (2005) on the other
hand did a study to determine the strategic responses of Christian churches in Kenya to
changes in the external environment. He based his survey on evangelical churches in Nairobi.
This study focused on a different context and concept from what the current study seeks to
cover. Mbaka and Mugambi (2014) sought to review the factors that affect strategy
implementation in the Water Sector in Kenya. The study identified strategy formulation
process, relationship among different departments and different strategy levels, executors,
communication, implementing tactics, consensus, commitment, organization structure,
employees and inadequate resources as some of the factors that affect strategy
implementation. Igecha (2014) examined the determinants of implementation of strategies
at the Institute of Quantity Surveyors of Kenya. The study established that strategy
implementation at the Institute of Quantity Surveyors of Kenya is mainly influenced by
commitment of the top management, communication process, coordination of activities and
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