Devolution and its Influence on the Provision of Healthcare Services in Tharaka Nithi County, Kenya.

Abstract

The study examined devolution and its influence on the provision of healthcare services in Tharaka Nithi County. Health is a basic human right and this is emphasized in the sustainable development goals. A target population of 177 health workers was used. The sample size was 123 respondents. Both proportionate stratified random sampling and purposive sampling were used for main respondents and key informants respectively. Questionnaires were used to collect quantitative data while interview guides to collect qualitative data. Statistical Package for Social Science (SPSS) version 22 was used in data analysis. Pertaining to human resource, the study found out that the respondent’s salaries had increased and this motivated them to do their duties effectively hence boosting the healthcare services. Despite the increment, they termed it as inadequate. On the other hand, staffing in terms of the number of health workers had decreased, and this made each of them attend more than 101 patients a day. Majority of the respondents did not get a chance to improve their skills through training. There was a significant association between human resource capacity and the provision of healthcare services where P-value =0.000 and X2 =105.517. On health financing: the financing of health services was not enough. Delay in the disbursement of funds affected the normal operations. Supply of drugs and medical equipment delayed due to funding untimely and this forced patients to seek services in other healthcare centers. Majority of the respondents did not access the financial reports of the facility, and those who managed were somehow satisfied. There was a significant association between health financing and the provision of healthcare services where P-value =0.000 and X2 =161.092. The leadership and governance were better before devolution according to the respondents. The hospital leadership involved health workers through departmental heads in decision making. The most common ways of communicating to the staff were through an internal memo and office phone calls. Leadership and governance had a positive relationship with the provision of healthcare services where P-value =0.000 and X2 =218.963. The process of procurement was not done better because many delays were experienced. Health workers, through their departmental heads, were involved in the procurement process before the purchase of critical things like drugs. Not all medications for main ailments were available since patients were forced to purchase some in chemists and private clinics. There was a statistically positive association between procurement and provision of healthcare services where P-value =0.000 and X2 =200.031. The study concluded that devolution had a potential of improving the delivery of health care services both at the county and individual levels. The recommendations made include; county governments should employ more health workers and offer training to improve their skills. More sources of income are required other than depending only on the national government. Lastly, effective policies should be adopted to curb the issue of corruption in the procurement process; for instance; e-procurement could work better.