Performance Analysis of The

Kirinyaga County Health System,

Kenya

Gakuu Esbon
Health Policy, Planning & Health Programs Directorate
Department of Health, Kirinyaga County, Kenya
ACC-HSPA; MPH-HS&DC
 PESHTELG Analysis

1.Mapping Context Organizational Structure

& Organigraph
Stakeholder Analysis

2
 Mapping Context: KIRINYAGA County

Total Area - 1,479 KM

Total Population- 610,411 (2019 census)
Population Density - 413/Km2
Urban: Rural Ratio - 16:84

ETHIOPIA Legend
UGANDA

SOMALIA

Public Hospitals
Private For Profit Hospitals
Faith Based Hospitals
INDIAN Primary Healthcare Facilities
TANZANIA OCEAN
3
Political PESHTEL
• Devolved system of government (c. 2013);

•
Executive power-Governor
National Ministry retains influence in vertical
Legal
programs & conditional health grants • Lack of critical legal and institutional
• Conflictual relationship infrastructure
• Weak implementation of existing laws

Economic Context
Ecological
• Agricultural-based economy; • Poor access to tap
• Poverty rate(2016)- 25.6% water and sewerage
(Kenya-36.1%) systems
.

Social Technological
• Population Growth- 1.6% PA • High Mobile uptake rate in the
• Predominantly young; <15yr - 35% community(>80%)
• Literacy levels- >75% for both
sexes(2019)
Health Context
Management Activity Target Achievement
(FY 18/19)

Quarterly performance review and 4 2

planning meetings

Quarterly supervision by County 4 3

and sub-County Health Teams

Annual leadership and 1 1

management performance review

Stakeholder forums conducted 2 1

Budget Utilization Rate(%) 100 67

Source: Kirinyaga County Health Sector Annual Performance Review Report

5 FY 2018/2019
Organizational Boundaries and Stakeholders
Ministry of Governor County
Health Assembly
Development
Other Departments
Partners
e.g Water County Minister for
External Environment Health

Director of Health Internal Environment

CURATIVE AND PREVENTIVE, PROMOTIVE & HEALTH POLICY, PLANNING &

HEALTH ADMINISTRATIVE
REHABILITATIVE HEALTH ENVIRONMENTAL HEALTH HEALTH PROGRAMS
SERVICES DIRECTORATE
SERVICES DIRECTORATE SERVICES DIRECTORATE DIRECTORATE
Private Health
Care Providers
Media Heads of Units

Civil Society
First-Line Health Workers and Services
Religious
Industry Associations (pharmaceutical
Users of Health Bodies
suppliers, etc) Community
services 6
 Functions of the Technical Management Team
 Support of lower-level management structures
 Coordination of community representation
 Rollout of national policies
Leadership  Development of operational
Ensuring and Policy plans
health Governance formulation &
 Forecasting
commodities strategic
security planning  Training needs assessment
 Workforce distribution
Human  Capacity building
 Public-Private partnerships Partnerships Resources for
 Stakeholder fora
and linkages Health
development

 development of budget
estimates for health Coordination & Operations &
Resource management of
management & admin Health
mobilization Health services
activities Service

& Financial in within the
Lobbying
management County delivery  Supervision
 Compliance

7
Key

-web
Organigraph Community

Hub
Ministry of Governor County
Interaction
Health Assembly

Other Departments NGOs

County Minister for
e.g Water Health

Director of Health
Private Health
CURATIVE AND PREVENTIVE, PROMOTIVE & HEALTH POLICY, PLANNING & Care Providers
Media REHABILITATIVE HEALTH
HEALTH ADMINISTRATIVE
ENVIRONMENTAL HEALTH HEALTH PROGRAMS
SERVICES DEPARTMENT
SERVICES DEPARTMENT SERVICES DEPARTMENT DEPARTMENT

Heads of Units

First-Line Health Workers and Services Civil Society

Religious
Users of Health Bodies
Industry Associations (pharmaceutical
services 8
suppliers, etc)
Stakeholder Analysis: Power/Interest towards goals
Consult Key Players
Ministry of
Governor
Health
County Top Executive team
Assembly
Heads of units
Influence/Power

NGOs 1st Line Health workers

Monitor Private Health Keep Informed

Care Providers Media
Community
Other Departments
e.g Water
Users of Health Civil Society
Industry Religious services
Associations Bodies

Interest of stakeholders
9
2.Multi-Polar Framework
Analysis

10
 The Organization Ideals
Alignment with the environment Goal attainment
• Devolved Governance Vision: A healthy and productive population
• Presence of donor agencies
• Progressive constitutional bill of rights Mission: To provide effective coordination of health services to
• Enlightened community & high literacy Strategic be able to achieve the highest attainable health for all in the
levels County
• Presence of prepayment health financing alignment
schemes

Tactical
Contextual alignment
alignment

Safeguarding values & culture Service Provision

Orientations;
Espoused Core Values: Leadership and governance; Resource mobilization; Policy
• Community focus & involvement; development; Human resource management; health commodity
• Partnerships; management; service delivery management; Partnerships
• Equity
• Teamwork;
• Professionalism; Operational Organizational Management;
• Accountability alignment • Well defined organizational structure with clear lines of
Culture: communication.
• Hierarchy; • Health Management Information system
• Authority; • SOP, Protocols and guidelines
• Social Responsibility;

11
 Alignment with the environment
• Polltical economy
• Pluralistic health system
• High out of pocket expenditure & low
pre-payment mechanism
• Presence of NGOs with unstated motives
• Political/donor
subservience
Safeguarding values & culture
Dominant Culture:
• Bureaucracy with informal
communication channels
• Silo (verticalization)
Implicit Culture
• Protecting employees from political &
special interest influences
• Peer reporting
• Absenteeism;
• Corruption
Explicit Values:
• Promote transparency
• Communicate about compliance to
code of conduct
The Organization in Reality
Non-aligned priorities & goals
• Limited room for innovation
Goal attainment
Vision: A healthy and productive population-Too ambitious?
Mission: To provide effective coordination of health services to
be able to achieve the highest attainable health for all in the
County – How to evaluate achievement not well outlined
• Sub-optimal alingment of
activities to goals
• Many coordination hubs
Service Provision
Core Function: Offer Management Support for all the county
health services; crisis management;
Organizational Management;
• Presence of needed managerial workforce-1 Director; 4
departmental Heads
• Informal communication and decision channels
• Overlapping boundaries between the technical team and heads
of units
12
 Alignments of the Project
Strong Weak

• Clearly defined program evaluation plan • Some specialized services not included in the benefits package.

• The objectives of the project are in line with the

Internal organizational goals
coherence
• The stated values are optimal to achieve the stated goals
of the organization

• The programme also plugs into the UHC component of • Narrow focus on financing of public health system in a
Presidential/National government “Big 4 Agenda” mixed health system.
• A subset of the Regional Government’s Mountain Cities
Alignment blueprint 2032-An ambitious long term transformative
with plan.
environment • Political goodwill and devolved governance to health can
be an asset.
• Knowledgeable, enlightened and educated community

13
 Force-Field Analysis

3. Problem Analysis Ishikawa Diagram

14
 Ideal Mission- To provide effective coordination of health services to be able to
achieve the highest attainable health for all in the County
Driving Forces Resisting Forces

1. Devolved autonomy to plan, implement 1. Erratic disbursement of resources

and monitor management functions required for management functions

2. Availability of skilled workforce 2. Bureaucratic/rigid decision-making

STATUS QUO
structure
3. Bottom-up operational planning fostering ownership 3. Inadequate management competencies
and technical skills

4. Knowledgeable, enlightened and educated 4. Entrenched Organizational cultures &

community inertia

5. Misplaced & non-aligned priorities

5. Presence of key stakeholders

2 1 1 2 3 4 5
5 4 3 15
Total = 17 Total = 15
Ishikawa Analysis of Erratic Disbursement of
Resources

16
17