| Summary: | The 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.
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