Between communities and health facilities in health service delivery - Reality or myth?

Health service delivery remains a challenge for rural Kenya. Health sector reforms have come in at a time when different models are being tried to imp rove access and utilisation of health services being offered by various pro viders, such as NGOs, government and private for-profit practitioners, This article will examine a model that World Neighbours has been trying out. It explores questions raised by this model such as: can community voices infl uence quality and type of service? Can communities access and use services being offered from a facility where they do nor decide on management, staff ing or supplies! Can the more vulnerable members access these services wher e they have to pay! What institutional arrangements spur the energy of a co mmunity to influence health service delivery! The article analyses the abov e questions in light of trends of health service delivery from 1990s to dat e in terms of policy environment versus reality on the ground, using the ex ample of Mukuyuni Health Centre where World Neighbours has been operating.