The Influence Of Devolution On Access To Public Healthcare Services In Kenya: A Case Study Of Kisumu County, 2013-2018

Abstract

This study examined the influence of devolution on access to public healthcare services in Kenya between 2013 and 2018, by taking the case of Kisumu County. Financial resources allocation to the healthcare system, people participation and decision making on healthcare matters by county government exemplified devolution, while availability and affordability of public healthcare services exemplified access. This was in view that decision making powers by county government had expanded, and a lot more resources were being disbursed to the counties for the advancement of devolved functions, including health. Also, previous related studies had left gaps; influence of citizen engagement on access to public healthcare services had not been determined. Longitudinal research design was employed to guide the inquiry. Primary data were collected using structured questionnaires, individual interviews and key informant interviews and from secondary sources. A sample of 120 patients attending public healthcare facilities were systematically selected. 27 health facility representatives, 27 healthcare workforce; doctors, nurses and clinical officers were purposively selected. Chief Officer for health, chairman sectorial committee on health services at the county, three assistant county commissioners as well as three health-related non-governmental organizations working within the selected sub-counties were purposively selected. Spearman rho, Chi-square test of independence and descriptive techniques were employed in the analysis of quantitative data, while thematic analysis was employed in the analysis of qualitative data. The study establishes that financial resources allocated to the healthcare system, although still insufficient, has continually improved. It also establishes that resources injected into the healthcare system have largely been used to build new healthcare facilities and renovate existing ones. However, a weak negative correlation between financial resources allocation to the healthcare system and affordability of healthcare services (r = -0.260 when α =0.05), indicates that the low cost of healthcare services witnessed in public healthcare facilities by patients is also influenced by other factors. The framework guiding community engagement in healthcare development is adequate, however, no serious discussions take place in public forums, and members of the public are unable to adequately push for healthcare solutions that address community concerns. In spite of county government management bringing skilled healthcare closer to the population, delays in disbursement of funds inhibits delivery of services. Also, a clear human resource management policy that guides the hiring, retention and promotion of healthcare workers remains a challenge. The study concludes that numerous problems still face devolved healthcare service delivery; improvements are realized in some areas while others lag behind. The study recommends ring-fencing of monies allocated to the health sector against utilization by other undertakings of the county administration; a comprehensive public education program be undertaken across the county to educate the public on devolution and the opportunities it presents for the public; identification of accredited companies where all county government obtain drugs to address the widespread corruption and inefficiency in procurement and distribution of drugs, and ensure consistency in the pricing and quality of drugs. In the long-term, the study proposes the formation of a health commission to supervise the administration of the healthcare system.