Strengthening health system governance using health facility service charters: a mixed methods assessment of community experiences and perceptions in a district in Kenya

• DOI: 10.1186/s12913-015-1204-6
• Publication Date: 2015-12-04T19:35:49Z
• Authors: Martin Atela; Pauline Bakibinga; Remare Ettarh; Catherine Kyobutungi; Simon Cohn
• Keywords: Health administration; Community Health; Clinical Governance; Health Services Research

Enhancing accountability in health systems is increasingly emphasised as crucial for improving the nature and quality of service delivery worldwide particularly developing countries. Accountability mechanisms include, among others, facilities committees, suggestion boxes, facility patient charters. However, there a dearth information regarding factors that influence performance mechanisms, especially We examine community members' experiences one such mechanism, charter Kericho District, Kenya. A household survey was conducted 2011 1,024 respondents (36 % male, 64 female) aged 17 years above stratified by catchment area, situated division District. In addition, sixteen focus group discussions were with users four areas. Quantitative data analysed through frequency distributions cross-tabulations. Qualitative transcribed using thematic approach. The majority (65 %) had seen their local charter, 84 whom read on charter. Of these, 83 found to be useful or very useful. According respondents, charters provided about services offered costs, gave voice curb potential overcharging helped plan medical expenses before receiving service. members cited several challenges charters: non-adherence provisions workers; illegibility language issues; lack expenditure records; time understand them, often due pressures around queuing; socio-cultural limitations. Findings from this study suggest compliance districts across Kenya regard implementation critical satisfaction delivery. To improve facilities, attention needs focused help enforce official guidelines, address capacity gaps, enhance public awareness use.