Efficacy of Health-care Under Devolved Governance in Kenya: the Case of Makueni County

Abstract

Health is understood to be very important for human wellbeing, sustainable economy and social development. The introduction of 2010 Kenyan constitution changed the entire governance order in the country including devolution of health care. The general objective was to find out whether or not devolution of health services in Kenya is so far realizing the objects of devolution as stipulated in the Kenyan Constitution, Article 174. Specifically, the study evaluated the influence of the devolved governance on maternal healthcare, primary healthcare and universal healthcare in Makueni county. The study employed the agency theory and descriptive research design. The study targeted residents in Makueni county. The sample size was 120 registered voters from the selected wards in Makueni county. Primary data collected by a questionnaire was used in this study. Both quantitative and qualitative data was generated by the study. Descriptive analyses which include mode, median, mean and frequencies were used to analyze the qualitative data. After coding, the qualitative data was put under different themes according to the study’s objectives. The study found that a unit change in devolved governance positive changes in maternal healthcare in Makueni county (r= 0.715; p-value=0.000). The study found that a unit change in devolved governance positive changes in primary healthcare in Makueni county (r= 0.997; p-value=0.000). The study found that a unit change in devolved governance positive changes in universal healthcare in Makueni county (r= 0.523; p-value=0.000). The study concluded that maternal healthcare primary healthcare and universal healthcare has been significantly influenced by devolved governance in Makueni county. The Makueni county government’s workings have popularized pre-natal care,breast feeding, have reduced both maternal and under five years children deaths. The number of health facilities with mother child health department has also increased. It was also found that the county government of Makueni has not put effort on family planning sensitization. On primary healthcare, the county government of Makueni also has increased the number of health workers. Construction of toilets and their maintenance in public places has also being done by the county government. It was further found that hand washing with soap in schools has been enhanced by devolved government. The study also found that garbage collection in urban and in the shopping centers have not been enhanced by the county government. Inspection of food selling outlets is not properly enhanced since the introduction of devolved governance of Makueni county. On universal healthcare, the study found that Makuenicare health insurance has been a great relief to the residents of Makueni county as far as medical expenses is concerned. The insurance has also made drugs available in health facilities in Makueni. Due to the increase of health facilities in Makueni the distance to access health facility has reduced, however few people have registered with N.H.I.F. since the introduction of devolved governance. One of the recommendations of the study is that both tiers of the government should enhance the public awareness of the issues regarding the family planning. The study also recommends that the county government should continue ensuring that every health facility within the county has maternal departments equipped with necessary equipments. The study recommends that county government of Makueni should come up with strategies of improving clean water provision within all the sub counties of Makueni. The study further recommends that the county should continue persuading the Makueni residents to register with National Insurance Fund (NHIF).