Wangũi Machira, Yvonne2015-04-012015-04-012015-02https://hdl.handle.net/10986/21666The Constitution of Kenya provides that most functions of the state are decentralized in a devolution process. The devolved health system is four tiered: community health services, primary care services, county referral services, and national referral services. However, even though roles and responsibilities are elaborately outlined, in practice the transition from national to county governments has been marred by inconsistency, poor understanding of the system, management challenges, and lack of coordination between the national and county governments. This policy note provides observations from a pilot that tested integration of social accountability mechanisms in healthcare delivery in Kenya between 2011 and 2013.en-USCC BY 3.0 IGOpoor performancehealth care providerswastepublic officialscommunitieshealth service providersparticipatory approachesriskshealth service deliveryreproductive healthhealth extensionfinancingfinancial managementincomequality of health carepoor managementperformance criteriacitizen voicedata collectioncommunity healthprimary careserviceshealth carehealth care workerslocal governancehealth care facilitiesincentiveshealthprojecthealth care • qualitycorruptionnational leveloversighthealth facilitiescommunity participationpublic healthquality of healthhealth sectorknowledgefinance managementcommunity memberspharmacieshealth ministriesinstitutionsleprosyexercisescommunity developmenthealth statuspublic informationtrainingaid effectivenesspatientscivil society organisationscontractscitizen participationcivil societycommunity health servicescitizenhealth care serviceshealth managementaccess to health servicesfamily careindicatorsservice deliverysocial developmentpostershealth informationdesignequityaccountabilitymedical researchworkerssocial justicetransparencyright to health caresurveillanceparticipationpublic policiescaregenderhealth policyhomesmedical servicesdemandhealth outcomesurban areamedical suppliesexpendituresyouthdecision makingaccess to health care servicesregulationcommunity activitiesprimary health carecitizenswaste disposalgovernancehealth systeminsurancelocal communityhuman rightsambulanceessential drugshealth care deliverysecurityhealth care service deliverydisease controlworking conditionsevaluationdispensarieshealth providerspublic participationequalityrural areasfinancial informationintegrationcrematoriasocial cohesionfacilitiespolitical commitmentinterventionscommunitystrategypoor governancesystemic corruptionfeesfamilieshospitalshealth interventionsambulance servicesrural developmenthealth servicehealth programshealth servicesimplementationservicedistrictscleanlinesshealth centresWorking Paper10.1596/21666