ArticleBMC health services research2018
"Sometimes it is difficult for us to stand up and change this": an analysis of power within priority-setting for health following devolution in Kenya.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed, 47 citations in OpenAlex.
- Inclusiveness of social participation for health reform: findings from a realist review.International journal for equity in health · 2026Review
- Who is at the table and who has the power? Case study analysis of decision-making processes for the Global Financing Facility in Tanzania.Global health action · 2025Article
- 'We cannot just keep it in our palm': A policy analysis of the integration of the case management of neglected tropical diseases into the health system of Liberia.PLOS global public health · 2025Article
- What are the priority-setting approaches for HIV/AIDS, TB and malaria programmes in Ghana? A qualitative perspective from key informants.BMJ public health · 2024Article
- Financing immunisation in Kenya: examining bottlenecks in health sector planning and budgeting at the decentralised level.Cost effectiveness and resource allocation : C/E · 2024Article
- Power and positionality in the practice of health system responsiveness at sub-national level: insights from the Kenyan coast.International journal for equity in health · 2024Article
- Evaluating the effects, implementation experience and political economy of primary healthcare facility autonomy reforms within counties in Kenya: a mixed methods study protocol.BMJ public health · 2024Article
- Health managers' perspectives of community health committees' participation in the annual health sector planning and budgeting process in a devolved unit in Kenya: a cross-sectional study.The Pan African medical journal · 2024Article
- Understanding health system responsiveness to public feedback at the sub-national level: Insights from Kilifi County, Kenya.PLOS global public health · 2024Article
- Geographic prioritisation in Kenya and Uganda: a power analysis of donor transition.BMJ global health · 2023Article
- How does power shape district health management team responsiveness to public feedback in low- and middle-income countries: an interpretive synthesis.Health policy and planning · 2023Article
- Political economy analysis of sub-national health sector planning and budgeting: A case study of three counties in Kenya.PLOS global public health · 2023Article
- The political economy of priority-setting for health in South Sudan: a case study of the health pooled fund.International journal for equity in health · 2022Article
- Salient stakeholders: Using the salience stakeholder model to assess stakeholders' influence in healthcare priority setting.Health policy OPEN · 2021Article
- Power analysis in health policy and systems research: a guide to research conceptualisation.BMJ global health · 2021Article
- Unmet need for primary healthcare and associated individual and household-level factors in Kenya: results from a national survey.BMJ open · 2021Article
- Recognizing and mediating bureaucratic barriers: increasing access to care through small and medium-sized private providers in Kenya.Gates open research · 2021Article
- Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya.PLOS global public health · 2021Article
- Article
- How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries.Health policy and planning · 2020Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundPractices of power lie at the heart of policy processes. In both devolution and priority-setting, actors seek to exert power through influence and control over material, human, intellectual and financial resources. Priority-setting arises as a consequence of the needs and demand exceeding the resources available, requiring some means of choosing between competing demands. This paper examines the use of power within priority-setting processes for healthcare resources at sub-national level, following devolution in Kenya.
methodsWe interviewed 14 national level key informants and 255 purposively selected respondents from across the health system in ten counties. These qualitative data were supplemented by 14 focus group discussions (FGD) involving 146 community members in two counties. We conducted a power analysis using Gaventa's power cube and Veneklasen's expressions of power to interpret our findings.
resultsWe found Kenya's transition towards devolution is transforming the former centralised balance of power, leading to greater ability for influence at the county level, reduced power at national and sub-county (district) levels, and limited change at community level. Within these changing power structures, politicians are felt to play a greater role in priority-setting for health. The interfaces and tensions between politicians, health service providers and the community has at times been felt to undermine health related technical priorities. Underlying social structures and discriminatory practices generally continue unchanged, leading to the continued exclusion of the most vulnerable from priority-setting processes.
conclusionsPower analysis of priority-setting at county level after devolution in Kenya highlights the need for stronger institutional structures, processes and norms to reduce the power imbalances between decision-making actors and to enable community participation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.