| dc.description.abstract | This research set out to find out effects of decentralization on the delivery of health care
services in Kenya, as perceived by patients and hospital staff in selected provincial general
hospitals. The important aspects considered were: The effect of decentralization on the
proportion of direct and referral patients, how frequently are cases that can effectively be
handled at the district hospitals referred to the provincial government hospitals and if these
practices have affected efficiency of service delivery at the provincial general hospitals.
To achieve the objectives, pnmary data was collected using two separate structured
questionnaires, one for staff and the other for patients.
The population of study comprised staff at senior, middle and lower levels of management;
staff in middle management formed majority of the sample (91.5%). Understandably,
majority of the staff who deal. directly with patients at treatment level are in the middle
management level. The findings of this study indicate that: Generally, the number of cases
referred to the provincial general hospitals from the district hospitals have decreased, there
are some cases referred to the PGH which can effectively be handled at the district hospitals,
and efficiency of service delivery is perceived by both staff and patients to have improved at
the provincial general hospitals. It has also been shown that majority of patients who seek
treatment at the provincial general hospitals have not been referred from the district or lower
level health facilities. This implies that such people find services at the lower health facilities
not acceptable. The major reasons for referrals as cited by respondents are lack of specialized
staff and equipment at the district hospitals; hence some cases that can be dealt with at that
level are referred to the PGHs. Although, the majority of the patients involved in the study
rated services received as satisfactory, a significant proportion of the patients was dissatisfied
with the services.
This led to the conclusion that efficiency at the provincial general hospitals is affected by
cases of patients referred to this level that could be dealt with at the district hospitals if the
latter had adequate specialized facilities and staff.
It can therefore be derived that, equipping district hospitals and health centres with adequate
facilities and specialized personnel will help improve services at that level. Consequently,
this will win the confidence of the public to use these facilities as their first level of contact,
freeing the Provincial hospitals to be used strictly for referral purposes. This will in turn
enhance the efficiency and the effectiveness of the provincial. hospitals. However, it is
important to note that the level of efficiency of the provincial government hospitals may also
be affected by other factors that were not included in this study. Based on the findings of the
study, recommendations are made on what needs to be done to improve efficiency and for
future research. | en |
