Devolution and Health Service Delivery: a Case Study of Kiambu County, Kenya

Abstract

Devolution is the process by which central governments delegate power to subnational entities. It is a type of administrative decentralization whereby there is the delegation of responsibility to the sub-national level for public functions such as those in the health sector. The health services in Kenya were devolved with the promulgation of the Constitution in 2010 to expand the jurisdiction of counties in making decisions, allocation of resources and management of healthcare service delivery. The main purpose of the study was to examine the influence of devolution on health service delivery within Kiambu County in Kenya. The study objectives further examined the influence of devolved healthcare financing, devolved human resource management and devolved political leadership on health service delivery. The research hypothesis of the study was that devolved healthcare financing, devolved human resource management and devolved political leadership have no statistical significance on health service delivery. A descriptive research design was used in this study. The study’s population comprised of 463 hospital staff from the eleven (11) Level 4 Hospitals within Kiambu County. Two hundred and ten hospital staff were sampled using a simple random sampling method. From each of the 11, Level 4 Hospitals nineteen hospital staff were selected. Data was collected from the hospital staff using a questionnaire. The data collected was analysed with the use of frequencies, percentages, means and standard deviation. The research hypotheses were tested at 95% confidence level using regression analysis. The regression analysis revealed that devolved healthcare financing and devolved human resource management both had a positive and significant influence on the delivery of health services. The β1 coefficients for these two factors were 0.441 and 0.525 respectively, and their corresponding p-values were 0.000, which is less than the significance level of α = 0.05. Conversely, devolved political leadership exhibited a negative and significant impact on health service delivery, with a β1 coefficient of -0.225 and a p-value of 0.000, which is also less than the significance level of α = 0.05. The study therefore rejected the hypothesis that devolved healthcare financing, devolved human resource management and devolved political leadership have no statistical significance on health service delivery. The study key findings indicated that the Level 4 hospitals were not adequately funded. Also, the study findings showed that the doctor and nurse patient ratio were not adequate to meet the Level 4 hospital demands therefore it was concluded that there was possibility of overworking of the available staff which may lead to low productivity and inefficiencies in the hospital therefore affecting quality of health services. Additionally, the study findings indicated that the community political leaders within the locality of the Level 4 hospitals were not involved in the management of the Level 4 hospitals implying that community political leaders lacked awareness of the importance of being involved in the management of the hospitals such as ensuring the hospital is adequately funded to enhance health service delivery. The study therefore concluded that devolution influences health service delivery. The study recommends that Kiambu County Government to develop a policy similar to the Abuja Declaration 2001 of dedicating not less than 15% of the annual county budget towards healthcare service delivery. Additionally, Kiambu County Government should carry out a capacity needs assessment to establish the staffing levels required in health facilities in Kiambu County and thereafter to put in place a policy on health facility staffing capacity ensure efficient health service delivery. The study also suggests recommends Kiambu County Assembly to pass a legislation requiring involvement of community political leaders in the management of health facilities within their jurisdictions in order to be aware of their needs and understand the dynamics of operating a health facility.