Governance Factors Influencing the Performance of Devolved Health Care Sector in Kenya

Abstract

Devolved healthcare systems in developing countries have unique challenges due to limited infrastructure, inadequate financial resources, lack of proper management, and lack of infrastructure. These factors impinge upon the greater healthcare outcome as well as public health outcomes. In Kenya, devolution of health services has resulted in the decentralization of many health services from the national government to local governments in order to improve the health of citizens. Despite political support of such a system and initiatives to increase devolution, the performance of the devolved health sector in Kenya has not improved as expected. The overall objective of the study was to determine the governance factors influencing the performance of devolved health sector in Kenya. The specific objectives of the study were to determine how citizen participation, operational capacity by county government and management transparency influence organizational performance of devolved health care sector in Kenya. Responsiveness by the county government was used as the moderating variable of the study. The current study utilized exploratory research design because it involved the collection of data in 47 counties across the country and focused on several selected officials who gave information regarding governance factors influencing devolved health care sector in Kenya. Further purposive sampling was used to arrive at the 188 selected respondents who became the sample size of the study. The study utilized Descriptive statistics and combined the elements of both quantitative and qualitative methods of data collection. Both open and closed ended questionnaires were used to collect appropriate data to test the hypothesis and address the research questions. Statistical Package for Social Sciences (SPSS) data analysis software package was employed to examine the quantitative data using the descriptive statistics. Analysis of Variance (ANOVA) table techniques and beta coefficient tables were utilized in the presentation of regression analysis outcomes. The study carried Pearson correlation to establish the relationship between each of the study variables. The findings of the study revealed a positive association between the governance factors and devolved healthcare sector in Kenya. There was evidence of enhanced public involvement through open public forums organized at various levels. Though the study found that devolution of healthcare in Kenya still faced a number of challenges including; lack of trained personnel, inadequate resource allocation among others, most of the county governments have opened accessibility to treatment for citizens by building more facilities. To ensure successful citizen participation, there was need for more inclusion of citizens in decision making, civic education on health matters, open communication and feedback mechanisms in service delivery. Moreover, with the inclusion of responsiveness by county governments the moderating effect on all independent variables was found to be significant on the performance of devolved health care sector. The study recommended that there is need for the health care sector function to be devolved to the counties to allow for more budgetary allocations, citizen inclusivity in decision making, timely response to health care needs, government planning and interventions and management accountability and transparency in recruitment of health care workers.