Devolved Healthcare Finance and Service Delivery in County Government Hospitals in Kenya
Abstract
This study sought to establish the influence of devolved healthcare financing on service delivery in county government hospitals in Kenya. Kenya adopted a system of devolution in 2010 and devolved some of the major national government functions, such as healthcare, to the county governments. In healthcare devolution, the national government retained the functions of policy development, technical support, capacity building, regulation, and management of national referral healthcare facilities, while the county governments heavily focused on provision of primary healthcare services. This technically meant that the national government was the policy developer while the county governments were policy implementers. The Constitution of Kenya defines the relationship between these two governments as one that should be interdependent and consultative, but is this the case on the ground? Debate concerning the influence of healthcare devolution has elicited various reactions from different scholars; however, very few empirical studies have examined the relationship between healthcare devolution and service delivery. Most of these studies have also been done in countries outside the continent of Africa, therefore making generalization of these studies difficult in the Kenyan context. This study therefore sought to contribute to the growing body of knowledge by determining the influence of devolved healthcare finance on service delivery in Kenya. It predominantly employed the positivism research philosophy and used qualitative research design. The target population of the study was 137 county government public hospitals from which a sample size of 385 respondents was selected. Data was collected using a questionnaire and an interview guide. Data was analyzed using SPSS version 27, using both descriptive statistics and statistical modeling. Data was presented in the form of figures, charts, and tables. The findings show that devolved healthcare financing positively and significantly influenced service delivery. This influence was further strengthened by the moderating variable, intergovernmental leadership. The study concludes that devolved healthcare financing influences service delivery. The study recommends that for service delivery to improve, there is need for reform, as far as devolved healthcare financing is concerned, as well as the need to enhance intergovernmental leadership. The study recommends the need for increased healthcare funding, disbursing finances from the national government to the county governments in a timely manner, enhanced financial accountability and making the budgeting process more participatory to improve service delivery.
References
2. Bayad A. & Anwar, Kofand, A. (2021). Porter’s Generic Competitive Strategies and its influence on the Competitive Advantage. International Journal of Advanced Engineering, Management and Science. 7. 42-51. 10.22161/ijaems.76.5.
3. Bayad A. & Anwar, Kofand, A. (2021). Porter’s Generic Competitive Strategies and its influence on the Competitive Advantage. International Journal of Advanced Engineering, Management and Science. 7. 42-51. 10.22161/ijaems.76.5.
4. Chitah, B., Chansa, C., Kaonga, O. & Workie, N. (2018). Myriad of health care financing reforms in Zambia: Have the poor benefited? Health Systems and Reform Journal. 4(4), 313-323. doi: 10.1080/23288604.2018.1510286
5. Daoud, A. (2018). Unifying Studies of Scarcity, Abundance, and Sufficiency. Ecological Economics. 147 (2018-2017). https://doi.org/10.1016/j.ecolecon.2018.01.019
6. Dudovskiy, J. (2018). The ultimate guide to writing a dissertation in business studies: A step-by-step assistance. Retrieved on 18 June, 2019, from https://research-methodology.net/about-us/ebook/
7. Frings, M., Lakes, T. & Müller, D., (2018). Modeling and mapping the burden of disease in Kenya. Scientific Reports, 8 (9826). https://doi.org/10.1038/s41598-018-28266-4
8. Ghai, Y.P. & Ghai J. C (2021). Kenya’s constitution: an instrument for change (second edition). Katiba Institute. https://katibainstitute.org/wp-content/uploads/2021/08/Kenyas-Constitution-Instrument-for-Change.pdf
9. Hofmeister, W., & Tayao, E. (Eds.). (2016). Federalism and decentralization: Perceptions for Political and Institutional Reforms. Singapore: Konrad-Adenauer-Stiftung
10. https://doi.org/10.1016/j.jeca.2019.e00139.
11. IHME (2017). What causes the most deaths? Retrieved on 10 September, 2020, from http://www.healthdata.org/kenya
12. Kairu, A., Orangi, S., Mbuthia, B., Ondera, J., Ravishankar, N., & Barasa, E. (2021). Examining health facility financing in Kenya in the context of devolution. BMC health services research, 21(1), 1086. https://doi.org/10.1186/s12913-021-07123-7
13. Kenya Healthcare Federation (2018). Healthcare financing. Retrieved on July, 21 2018, from http://khf.co.ke/committees/healthcare-financing/
14. Kimathi, L. (2017). Challenges of the Devolved Health Sector in Kenya: Teething Problems or Systemic Contradictions? Africa Development Journal, 62 (1), 55-77.
15. Kumar, S., Kumar, N. & Vivekadhish S. (2016). Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs): Addressing Unfinished Agenda and Strengthening Sustainable Development and Partnership. Indian Journal of Community Medicine, 41 (1), 1-4. doi: 10.4103/0970-0218.170955
16. Li, Y., Chen, S., & Peng, Y. (2023). In the Shadow of Administrative Decentralization: The Impact of Devolution on Subnational Service Provision. The American Review of Public Administration, 53(7-8), 280-295. https://doi.org/10.1177/02750740231185849
17. Manyazewa T. (2017). Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Archives of public health = Archives belges de sante publique, 75(50). https://doi.org/10.1186/s13690-017-0221-9
18. Ministry of Health Kenya (2017). Medium Term Expenditure Framework (MTEF) for the period 2018/19 to 2020/21. Retrieved on 11 June, 2019, from http://www.treasury.go.ke/component/jdownloads/send/194-2018/731-health-sector.html?option=com_jdownloads
19. Mo Ibrahim Foundation (2018). Summary of Discussions on Public Service in Africa. Retrieved on 08 August, 2020, from https://mo.ibrahim.foundation/sites/default/files/2019-03/2018-Next-Generation-Forum-Report.pdf
20. Msafiri, D. (2018). Public service delivery in Tanzania: Fewer problems and bribes, improved satisfaction. Retrieved on 08 August, 2020, from https://afrobarometer.org/sites/default/files/publications/D%C3%A9p%C3%AAches/ab_r7_dispatchno271_service_delivery_in_tanzania.pdf
21. Neofytidou, A. and Fountas, S. (2020). The impact of health on GDP: A panel data investigation. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1703494919300787 on 13 December 2024
22. Okech, T. & Ltumbesi L. S. (2015). Analysis of Universal Health Coverage and equity on health care in Kenya. Global Journal of Health Science, 8 (218). doi: 10.5539/gjhs.v8n7p218
23. Olatunji O. (2018) Public Good and the Crises of Service Delivery in Africa. The Palgrave Handbook of African Politics, Governance and Development. New York: Palgrave Macmillan. https://doi.org/10.1057/978-1-349-95232-8_38
24. Omboki, A. (2018). Patients in Kenyatta Hospital surgery mix-up speak out. Retrieved on 10 September, 2020, from https://nation.africa/news/Patients-KNH-surgery-mix-up-speak-out/1056-4331218-omesvrz/index.html
25. Sosa, A. (2017). Federalism vs. devolution. Retrieved on 07 September, 2018, from https://prezi.com/bsvgznr5wufo/federalism-vs-devolution/
26. Wagana, D. M. (2017). Effect of governance decentralization on service delivery in county governments in Kenya. A thesis in leadership and governance (PhD thesis). Jomo Kenyatta University of Agriculture and Technology, Kenya. Retrieved on 10 September, 2018, from http://ir.jkuat.ac.ke/bitstream/handle/123456789/3278/Phd%20Thesis%20-%20DUNCAN%20MUKUHA%20WAGANA.pdf?sequence=1&isAllowed=y
27. Wasike, A. (2020). Kenya to probe alleged fraud in coronavirus funds. Retrieved on 10 Sepptember, 2020, from https://www.aa.com.tr/en/africa/kenya-to-probe-alleged-fraud-in-coronavirus-funds/1954113
28. Wasuna, B. & Oketch, A. (2020). Scanty information on theft of donated Covid-19 equipment. Retrieved on 10 September, 2020, from
https://nation.africa/kenya/news/scanty-information-on-theft-of-donated-covid-19-equipment-733440
Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.