Governance of Health Systems and Service Delivery in National Referral Hospitals in Kenya

Abstract

In recent years, there has been an increased attention to building formidable health systems governance to promote the highest attainable standard of health service delivery which has become a fundamental part of our human rights and of our understanding of a life in dignity. The health systems governance has taken on increasing importance in the provision of health care services in health institutions. The public hospitals in Kenya have weak health systems governance affecting quality healthcare. The study sought to examine the governance of health systems governance on service delivery in National Referral hospitals in Kenya. The specific objectives that the study sought to achieve were: To examine the influence of health policy, social accountability, oversight mechanisms and stakeholder participation on service delivery in National Referral hospitals in Kenya; To investigate the moderating influence of mobile technology on the relationship between health systems governance and service delivery in National Referral hospitals in Kenya. The study was anchored to the Contingency Leadership Theory, Stewardship theory, stakeholder Theory, and New Public Management Theory. The study identified six categories of the target respondents, namely, 5 directors, 43 board members, and 88 heads of departments. A pilot test was conducted to detect weaknesses in design and instrumentation. Data analysis was carried out using descriptive statistics, correlation, and regression analysis. The study used regression analysis and moderated stepwise multiple regressions to analyze the association between the variables at a 0.05 level of significance. The qualitative data was analyzed by the use of content analysis. Results revealed that all the health system governance aspects had a positive and significant relationship with service delivery in the national referral hospitals in Kenya. However, the magnitude of the influence was different for the specific health systems governance. Oversight mechanisms had the largest effect followed by stakeholder participation then health policy and finally social accountability. Further, the results showed that mobile technology had a significant moderating effect on the relationship between health systems governance and service delivery in the national referral hospitals in Kenya. The study concluded that health systems governance had the potential to positively and significantly influence service delivery in the national referral hospitals in Kenya in terms of accessibility, affordability, coverage, customer satisfaction, and timeliness of the services. The results support the current theories related to the study. Consequently, this study provides public hospitals with insights into how to improve healthcare service delivery through the adoption of appropriate health systems governance in the national referral hospitals. The study recommended that the management of the national referral hospitals should adopt a culture of adopting appropriate health systems governance systems. This could go a long way in ensuring there is improved service delivery in the national referral hospitals in Kenya