Effectiveness of Hospital Management Committees in Busia County, Kenya

The Kenya Ministry of Health restructured the health sector in 2009 with the goal of promoting and improving the health status of all citizens. It established the Hospital Management Services Fund to be managed at the facility level by the Hospital Management Committees (HMCs). Since the establishment of the HMCs at the county level following the devolution of health services in 2016, no evaluation has been done to assess their performance in Busia County. We assessed the criteria, selection process, orientation, induction, and the performance of the HMCs in Busia and considered their implications for Kenya and similar contexts in Africa. Data were collected by purposive sampling of all HMC members in six level 4 and one level 5 hospitals through Focus Group Discussions and key informant interviews. Documents collected both at the facility and county levels were analysed and used appropriately. All seven hospitals evaluated did not fully comply with the National Guidelines. Three (43%) of the hospitals nominated persons with educational levels below the required O-level certification. Another 3 (43%) contravened the Constitution of Kenya (2010) by excluding persons with disabilities and minorities. The study identified systemic commissions and omissions in the recruitment process, leading to anxiety and frustrations by members of HMCs, staff and the catchment population of the respective hospitals. In conclusion, the nominated HMC members have no legitimacy to assume their roles and responsibilities as they have not been gazetted, appointed, oriented, and facilitated.