A Review of Health Financing and Information Systems: The Role of Devolved Governance

Background: Worldwide health systems are facing an increasing number of challenges, while governments remain dedicated to searching for cost-effective options to enhance the capacity of national health systems to perform well. Although the relationship between devolution and disparities in access to health care is mixed, most studies do not attribute observed disparities in healthcare use to Devolution. This review was performed to synthesize evidence around this issue. Specifically, the objective was to answer the question: “What are the contribution of devolution in health financing, health leadership, and health information systems? ”. Methods: CrossRef, Google Scholar, Academic keys, Open Academic journals index, MEDLINE, Embase, CINAHL, and PsycINFO were searched with terms related to devolution and health. The search included terms related to health financing, health information systems, and health leadership. Findings were presented within a narrative synthesis. Quality of the evidence was evaluated using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings: A few studies, all cross-sectional studies, met the selection criteria for this review. Most studies noted the Healthcare is a major element of national budgets worldwide in as much as all levels vary across countries, systems have come under increased pressure to ensure that resources are spent efficiently. Over the years there has been accelerating progress in medical technology hence offering considerable potential for advancing the delivery and organization of the healthcare, with consequences for health care expenditure. On decentralization, risk-adjusted mechanisms are used to allocate resources from the central level to decentralized health authorities. Internationally the indicators like; population size, demographic composition, levels of ill-health, with mortality rates usually being used as a proxy for morbidity and socioeconomic status including cost factors are used to decide on resource allocation. Unfortunately, families who contribute a larger portion of funds to the health system have a minimal voice in demand for health care services. The situation necessitates the need for partnerships in the health system. Studies also revealed that leadership and governance in a health system cut across all the other 5 health system building blocks and all stakeholders of health including the public, governmental and private sector and all persons who use, provide, fund and monitor health care. In Kenya Devolution of the health sector was aimed at improving health care in the country, focus on the “low potential areas”, reduce corruption especially on procurement, foster efficient health care delivery, improve on the quality of health care delivery. County governments were supposed to manage resources and come up with health strategies that would cater for the specific health needs within the county spearheaded by the elected governor with the help of the deputy governor and the county assembly. With regards to health information systems, Adoption of District Health Information System (DHIS2) in all health facilities was in Kenya was aimed at addressing the shortcomings of lack of reliable data to base decision making which included paper-based data capture which lacked timeliness. However, DHIS2 has not been fully utilized in its analysis and presentation capability. Conclusions: Continuous assessment of the impact of components of health systems under devolution is required to the inform enhancement of health service provision in the county. The stakeholders should continuously engage to address the poor performance sectors.