Competing Multiple Accountability Mechanisms and Public Administrators’ Responses in the Health Sector in Kenya

Karumba, Kenneth


Accountability in public sector is a complex concept. Public administrators are held accountable by multiple mechanisms of accountability. It is unclear in the public health sector in Kenya which of the four mechanisms of hierarchical, professional, legal and political accountability dominates accountability responses of hospital administrators. The objective of this study was to assess which among the competing multiple accountability mechanism is accorded priority in the health sector in Kenya. The study adopted a case study design targeting hospital administrators from 36 public hospitals in 14 Counties in Kenya. The study found out that professional accountability tend to be given precedence over other forms of public accountability in ordinary conditions and hierarchical accountability under crisis situations. The study concluded that hospital administrators are confronted with all the four mechanisms, but their intensity on accountability vary.

Full Text:



Aberbach, J. D., & Rockman, B. A. (2000). In the Web of Politics: Three Decades of the U.S. Federal Executive. Washington, DC: The Brookings Press

Atela, M. H. (2013). Health system accountability and primary health care delivery in rural Kenya: An analysis of the structures, process, and outcomes. (doctoral thesis).

Baruch, Y. (1999). Response rate in academic studies: A comparative analysis. Human Relations, 52(4), 421-438. https://doi:10.1177/001872679905200401

Bennett, A. (2004). Case Study Methods: Design, Use, and Comparative Advantages. In Y. Nahmias-Wolinsky (Ed), Models, Numbers, and Cases (pp. 19-55) Ann Arbor, MI: University of Michigan Press

Blind, P. K. (2011). Accountability in Public Service Delivery: A Multidisciplinary Review of the Concept. A paper for the Expert Group Meeting Engaging Citizens to Enhance Public Sector Accountability and Prevent Corruption in the Delivery of Public Services Vienna, Austria, 7-8 and 11-13 July 2011

Boven, M. (2007). Analysing and assessing accountability: A conceptual framework. European Law Journal, 13(4), 447-468. https://doi: 10.1111/j.1468-0386.2007.00378.x

Boven, M., & Schillemans, T. (2011). The challenge of multiple accountabililty. Does redundancy lead to overload. In M.J Dubnick & H.G. Frederickson, (Eds.), Accountable governance: problems and promises. (pp. 3-21), Armonk, NY: M.E. Sharpe.

Boven, M., Goodin, R., & Schillemans, T. (2014). Public Accountability. Oxford: Oxford University Press

Brinkerhoff, D. (2003). Accountability and Health Systems: Overview, Framework, and Strategies. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates, Inc

Butler, J. (2010). Evolving Political Accountability in Kenya. Center for African Studies. Urbana-Champaign: University of Illinois

Byrkjeflot, H. (2013). Hospital reforms: Consequences for accountability regimes in Denmark, Germany and Norway. DRAFT paper prepared for 22nd IPSA World Congress Madrid July 8-12, 2012 Thursday, July 12, 13:00-14:45

Cendón, A. B. (1999). Accountability and public administration: Concepts, dimensions, developments, openness and transparency in governance: Challenges and opportunities.

Cornwall, A., Lucas, H., & Pasteur, K. (2000). Introduction: Accountability through Participation: Developing workable partnership models in the health sector. IDS Bulletin, 31(1), 1-13. https://doi: 10.1111/j.1759-5436.2000.mp31001001.x

Denhardt, R., & Denhardt, J. (2007). The new public service: Serving rather than steering. New York, NY: M.E. Sharpe, Inc.

Dimock, M. E., & Dimock, G. O. (1969). Public administration (4th ed). Hinsdale, IL: Dryden Press.

Dowdle, M. D. (2006). Public accountability: Designs, dilemmas and experiences. Cambridge: Cambridge University Press.

Dubnick M. J., & Yang, K. (2011). The pursuit of accountability: Promise, problems, and prospects. In D. Menzel & H. White (Eds.), The State of public administration (pp. 171-86). Armonk, NY: M. E. Sharpe, Inc.

Etikan, I., Musa, S. A., Alkassim, R. S. (2016) Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4. https://doi:10.11648/j.ajtas.20160501.11

Finer, H. (1941). Administrative responsibility and democratic government. Public Administration Review, 1(4), 335-50. https://doi: 10.2307/972907

Frederickson, G., & Smith, K. B. (2003). The Public Administration Theory Primer. Boulder, CO: Westview Press

Friedrich, C. J. (1940). Public Policy and the Nature of Administrative Responsibility. Public Policy, 9(1), 1-20.

Friis-Hansen, E., & Ravnkilde, C. M. (2013). Social accountability and public service delivery in rural Africa. Copenhagen: Danish Institute for International Studies, DIIS.

Gachie, M., & Iravo, M. (2016). Determinants of health care service delivery as a devolved function in level four hospitals in Kiambu County, Kenya. Strategic Journal of Business Change, 3(12), 219-239.

Gailmard, S. (2012). Accountability and Principal-Agent Models. In M. Bovens, R.E. Goodin, & T. Schillemans (Eds.), Oxford Handbook of Public Accountability. (pp. 34-52) Oxford: Oxford University Press. https:// doi: 10.1093/9780199641253.013.0016

Gicheru, J. E. (2007). Independence of the Judiciary: Accountability and Contempt of Court. Nairobi: Kenya Law 2007. https://doi: 10.1093/oxfordhb/9780199641253.013.0016

Jarvis, M. D. (2014). Hierarchy. In M. Bovens, R.E. Goodin, & T. Schillemans (Eds.), Oxford Handbook of Public Accountability. (pp. 78-92) Oxford: Oxford University Press. https://doi: 10.1093 /9780199641253.013.0016

Jin, J., & Song, G. (2015). Bureaucratic accountability and disaster response: Why did the Korea Coast Guard fail in its rescue mission during the Sewol ferry accident?, Risk, Hazard & Crisis in Public Policy, 8(3), 2017, 220-243. https://doi: 10.1002/rhc3.12115

Johnston, J. M., & Romzek, B. S. (1999). Contracting and accountability in state medicaid reform: Rhetoric, theories, and reality. Public Administration Review, 59(5), 383-399.

Jos, P. H., & Tompkins, M. E. (2004). The accountability paradox in an age of reinvention: The perennial problem of preserving character and judgement. Administration & Society, 36(3), 255-28. https://doi:10.1177/0095399704263479

Kameri-Mbote, P., & Akech, M. (2011). Kenya: Justice Sector and the Rule of Law. Nairobi: Open Society Foundations.

Kenya Anti- Corruption Commission. (2010). Sectoral perspective on corruption: The case of Kenya public health service delivery. Kenya Anti Corruption Commission.

Kettl, D. F. (2002). The Transformation of Governance: Globalization, Devolution, and the Role of Government. Public Admistration Review, 60(6), 488-497

Kim, S. E., & Lee, J. W. (2010). Impact of competing accountability requirements on perceived work performance. The American Review of Public Administration, 40(1), 100-118. https://doi:10.1177/0275074008329469

Kim, Y. (2017). Analyzing accountability relationships in a crisis: Lessons from the Fukushima disaster. American Review of Public Administration, 00(0), 1-18. https:// doi: 10.1177/0275074017724224

Kimiru, P. M. (2008). The role of professional counseling associations in professional counseling practice in Kenya. (Unpublished Masters Thesis). University of Nairobi.

Kuipers, S., & Hart, P. (2014). Crisis management: Coping with the intolerable. In M. Bovens, R.E. Goodin, & T. Schillemans (Eds.), Oxford Handbook of Public Accountability. Oxford: Oxford University Press. (pp. 589-602).

Lægreid, P. (2014). Accountability and New Public Management. In M. Bovens, R. E. Goodin, & T. Schillemans (Eds.), Oxford Handbook of Public Accountability. (pp. 241-259) Oxford: Oxford University Press. https://doi:10.1093/oxfordhb/ 9780199641253.013.0008

Maass, A. A., & Radaway, L. I. (1959). Gauging administrative responsibility. In C. Stivers (Ed.), Democracy, bureaucracy, and the study of administration, (pp.163-81). Boulder, CO: Westview Press.

Machira, Y. W., & Nizam, R. (2015). Integrating social accountability in healthcare delivery: lessons drawn from Kenya. Kenya devolution; no. 4. Washington, D.C.: World Bank Group.

McDanel, P. (2012). Review of "Accountable Governance: Problems and Promises". Journal of Public Affairs Education, 18(3), 611-613. Retrieved May 9, 2020, from

Minja, D. (2013) Accountability practice in Kenya’s public service: lessons to guide service improvement. International Journal of Business and Management Review, 1(4), 54-63

Mulgan, R. (1997). The Processes of public accountability. Australian Journal of Public Administration, 56(1), 25-36.

Mulgan, R. (2003). Holding Power to Account: Accountability in modern democracies. London: Palgrave

Ndege, P. O. (2009). Colonialism and its legacies in Kenya. Lecture delivered during Fulbright- Hays Group project abroad program: July 5th -August 6th 2009 at the Moi University, Main Campus.

Nulty, D. D. (2008). The adequacy of response rates to online and paper surveys: what can be done? Assessment & Evaluation in Higher Education, 33(3), 301-314.

Nyamu, H. (1975). The state of civil service today. Nairobi. Government Printers

Odhiambo-Mbai, C. (2003). Public service accountability and governance in kenya since independence. African Journal of Political Science, 8(1), 113-145.

Odhiambo-Mbai, C., & Wanyande, P. (2001). Public service ethics in Kenya in United Nation (2001). Public service ethics in Africa, 2, New York, NY: United Nations.

Republic of Kenya (2006). Code of Regulation. Nairobi: Public Service Commission Retrieved from

Romzek, B. S., & Ingraham, P. W. (2000). Cross pres¬sures of accountability: initiative, command, and failure in the Ron Brown plane crash. Public Administration Review, 60(3), 240-253.

Romzek, B., & Dubnick, M. (1987). Accountability in the public sector: Lessons from the Challenger tragedy. Public Administration Review, 47(3), 227-238. https:// doi:10.2307/975901

Romzek, B. S. (2000). Dynamics of Public Sector Accountability in an Era of Reform. International Review of Administrative Sciences, 66(1), 21-44.

Salminen, A., & Lehto, K. (2012). Accountable to whom? Exploring the challenge of multiple accountabilities in Finnish public administration. Halduskultuur-Administrative Culture, 13(2), 147-162.

Schillemans, T., & Busuioc, M. (2014). Predicting public sector accountability: From agency drift to forum drift. Journal of Public Administration Research and Theory, 24(1), 1- 25 https://.doi:10.1093/jopart/muu024

Schwartz, R., &Sulitzeanu-Kenan, R. (2004). Managerial values and accountability pressures: Challenges of crisis and disaster. Journal of Public Administration Research and Theory, 14(1), 79-102.

Sihanya, B. (2012). The role of the Judiciary in the accountability and governance of the devolved Government structure. A Presentation to the Institute of Certified Public Accountants of Kenya (ICPAK) 20th Economic Symposium at the Hilton Hotel, Nairobi, February 24, 2012.

Tello, J., & Baez-Camargo, C. (2015). Strengthening health system accountability: A WHO European Region multi-country study. Copenhagen: WHO Regional Office for Europe.

Tettey, W. J. (2006). The Politics of Media Accountability in Africa: An Examination of Mechanisms and Institutions. International Communication Gazette, 68(3), 229-248.

Tompkins, J. R. (2005). Organization Theory and Public Management. Belmont, CA:Thomson Wadsworth

Transparency International (2006). Transparency International Global Corruption Report 2006: Corruption in The Health Sector: Seeking the Cure. Report presented on February 1, 2006 at the University Club of Washington, D.C. University Hall, Second Floor 1135 16th Street, Northwest Washington, D.C.

Van Belle, S., & Mayhew S. H. (2016). What can we learn on public accountability from non-health disciplines: a meta-narrative review. BMJ Open, 6(7). https://doi:10.1136/bmjopen-2015- 010425

Waterman, R. W., & Meier, K. J. (1998). Principal-Agent Models: An expansion? Journal of Public Administration Research and Theory, 8(2), 173-202.

Yin, R. (1994). Case study research: Design and methods (2nd ed.). Beverly Hills, CA: Sage Publishing.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Journal of Public Administration and Governance  ISSN 2161-7104

Copyright © Macrothink Institute

'Macrothink Institute' is a trademark of Macrothink Institute, Inc.

To make sure that you can receive messages from us, please add the '' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.