Perceived Factors Influencing Quality Service Delivery in Decentralized Healthcare Systems: a Case of Chuka Level 5 Referral Hospital in Tharaka Nithi County, Kenya

Abstract

Quality healthcare is a human right. While concerted efforts have been put in place to provide quality in devolved healthcare systems, there are still significant obstacles to obtaining high-quality medical care in devolved settings. The purpose of this study was to establish the extent to which the selected perceived factors influence quality service delivery in Decentralized Healthcare Systems; Case of Chuka Level 5 Referral Hospital in Tharaka Nithi County, Kenya. The study sought to establish how institutional leadership, employee capacity enhancement, institutional communication structures and monitoring and evaluation techniques influence service delivery in devolved settings. The study made use of a descriptive survey approach for its methodology. The study's target population was the hospital medical staff and management in Chuka Level 5 County Referral Hospital with a sample size of 120 across all the departments however; a response rate of 95% 114/120 was achieved. In order to assess, interpret, and present the data that was obtained, tables and frequency counts were utilized. The study established that three objectives of the study influenced the quality service delivery in devolved healthcare systems. The gender distribution was skewed towards the male with the male distribution being 76/114 (66.8%), the female gender being nearly half 37/114 (33.2%) of the male population. Besides, 49/114 (43%) agree that existing leadership structures had to a greater extent led to poor services delivery at Chuka Level 5 Hospital, followed by 40/114 respondents (35.1%) who strongly agreed that the existing leadership arrangements at the institution had led to deterioration of services at the health facility. More still, more than half 60/114 (52.6%) of the respondents agreed that the existing capacity enhancement opportunities at the institution had negatively impacted quality services delivery at Chuka Level 5 hospital with another 35/114 (30.7%) strongly agreeing to the same statement. Consequently, 43/114 (37.7%) agreed that the existing institutional communication structures at Chuka Level 5 hospital had positively influenced quality services delivery at the hospital followed by 30/114 (26.3%) who strongly agree on the same. Another 34/114 (29.8%) of the people who answered the survey disagreed that the existing M&E systems at the institution had in any way negatively influenced quality services delivery at Chuka Level 5 hospital followed by 30/114 (26.3%) who were not certain whether the existing M&E systems at the institution had in any way influenced quality services delivery at the hospital. This research provides the conclusion that the existing institutional leadership, employee capacity enhancement, communication structures as well as the monitoring and evaluation methods had either way had positively or negatively influenced the quality of services delivered at Chuka

Level 5 hospital. Precisely, the existing leadership structures and bureaucratic processes had negatively influenced the quality at which services were delivered at Chuka Level 5 Referral Hospital. Besides, lack of continuous and tailored capacity building efforts had contributed to poor service delivery at the health facility. It remained unclear whether the existing communication structures at Chuka Level 5 hospital influenced the quality of services delivered and finally, the existing M&E systems at the institution has in any way negatively influenced quality services delivery at Chuka Level 5 hospital. However, a larger sample size is necessary for more in-depth statistical analysis, and more study is needed to investigate the moderating role of the influence of a variety of factors, which include gender, competence, faith, age, demographic trends, economic background, and knowledge, amongst many others, on the link between various aspects of service supply.