Influence of Devolution Support Systems on Quality of Healthcare Projects in Kenya: a Case of Ward-level Prioritized Healthcare Projects in Keiyo South Sub-county, Elgeyo Marakwet County

Abstract

Good health is a primary concern for all nations globally and therefore nations worldwide are striving towards coming up with well-thought-out healthcare systems which guarantee citizens healthy lives as well as advocate for and promote wellbeing for everyone. To date, there still exist huge differences in quality of healthcare offered to patients in advanced countries such as France in comparison to countries in Sub-Saharan Africa like Kenya. Some of the factors responsible for the differences include the following: funds allocated to towards financing healthcare, adequacy of healthcare workers, expertise of the healthcare workers, health insurance schemes and technology among others. Constitution of Kenya 2010 indicated right to health as one of the basic human rights that should never be compromised at all cost. This study sought to evaluate the influence of devolution support systems on quality of healthcare projects in Kenya: A case of ward-level prioritized healthcare projects in Keiyo South Sub-County. Funding mechanisms, technical expertise, monitoring and evaluation and capacity of local contractors at the county level were considered to be some of the factors responsible for the influence. The study adopted two theories, that is, equity of access to healthcare theory and theory of change to give more insights concerning fairness in accessing healthcare services and ways and means of organizing activities to produce desired results. Additionally, the report has shown the relationship in the form of conceptual framework between independent variables involved and its influence on quality of healthcare projects. The study used descriptive research design and correlation research design with a target population of 500 persons made up of senior county and sub-county health officials, hospital in-charges, hospital management committee and ward development committee. A sample size of 208 persons was determined using Silverman’s formula, out of which 10% of the actual sample was used to collect data in the pilot study which took place in the neighbouring Keiyo North Sub-County to find out how reliable the instruments were. A Cronbach-Alpha coefficient of 0.765 was obtained through split-half technique to check for the reliability of the instruments and since it was found to be above 0.7, the tools were reliable. Quantitative data used simple linear regression model to test the strength of relationship between variables based on observed data and to predict the values of the response variables based on the predictor variable. ANOVA was used to establish the goodness of fit of the linear regression model. It was established that funding mechanisms at county level with r=0.861, r2=0.741, β=0.899, t=6.305 and F (1, 187) =383.817 at p=0.000<0.05, concluded that the variable had a strong positive significant influence on quality of healthcare projects. The study also established that technical expertise at county level with r=0.714, r2=0.509, β=0.832, t=9.434 and F (1, 187) =205.395 at p=0.000<0.05; monitoring and evaluation at county level with r=0.638, r2=0.407, β=0.725, t=5.496 and F (1, 187) =128.686 at p=0.000<0.05; and capacity of local contractors at county level with r=0.593, r2=0.352, β=0.608, t=5.621 and F (1, 187) =232.298 at p=0.000<0.05 had a positive significant influence on quality of healthcare projects. A conclusion was made that funding mechanisms, technical expertise, monitoring and evaluation and capacity of local contractors at the county level influence quality of healthcare projects. The research recommended that it is always important to have expert-guided public participation meetings during project’s prioritization. The research suggested that a replica study should be carried out in other devolved functions in Kenya for purposes of comparison. Also, it suggested that other studies should be done on influence of devolution support systems on quality of other devolved functions such as roads, agriculture and water.