Factors Influencing the Implementation of Performance Contracting Among Public Health Officers in Nyeri County Kenya

Abstract

Performance contracting (PC) has been institutionalized within Kenya’s public health sector as a reform strategy to strengthen accountability, improve efficiency, and link rewards and sanctions to objectively verifiable results. However, despite its adoption, declining health indicators continue to be observed nationally and within Nyeri County, signaling persistent gaps between policy formulation and practical implementation. This study, therefore, examined the factors influencing the implementation of performance contracting among Public Health Officers (PHOs) and Public Health Technicians (PHTs) in Nyeri County. Specifically, it explored how government policies, stakeholder involvement, human resource (HR) strategies, and institutional factors shape PC implementation. A descriptive cross-sectional research design was employed, targeting all 112 PHOs and PHTs, from which 89 respondents were selected through stratified random sampling. Data were collected using structured self-administered questionnaires validated through expert review and pre-tested. Analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 24.0, applying descriptive statistics, Spearman’s correlation, and multiple regression analysis at a 0.05 level of significance. Results showed that all four independent variables significantly influenced PC implementation (R² = 0.681, F = 45.217, p < 0.001). HR strategies (β = 0.312, p = 0.001) and institutional factors (β = 0.287, p = 0.003) were the strongest predictors, underscoring the role of motivation, training, leadership, and supportive work systems. Correlation coefficients ranged from r = 0.492–0.615 (p < 0.01), indicating moderate to strong positive relationships among the variables. The study concluded that the success of performance contracting depends on integrating clear policy direction, participatory stakeholder engagement, effective HR strategies, and institutional leadership. It recommends strengthening HR capacity-building programs, aligning county policies with devolved operational contexts, and institutionalizing feedback mechanisms. The study contributes to public health management by providing empirical evidence to guide policy and managerial decisions on optimizing performance contracting in devolved health systems.