Influence of devolved healthcare system on delivery of health services in Meru County, Kenya

Abstract

The promulgation of the Constitution of Kenya, 2010 birthed devolution. After the General Elections held on 4th of March of 2013, devolution of various public functions including healthcare gained momentum. However, there have hitherto been conspicuous challenges facing delivery of public healthcare, which have been attributed to devolution. This has necessitated this research, which sought to evaluate the influence of devolution healthservice delivery in Kenya by focusing on Meru County. The general objective was to evaluate the influence of the devolved healthcare system on delivery of health services in Meru County. Specifically, the study analyzed how the various components of the aforementioned systems, that is, devolved healthcare financing, devolved leadership, devolved healthcare workforce, and devolved medical supply system influence delivery of health services in Meru County. Pertinent empirical studies have been reviewed. The study was guided by the sequential theory of decentralization and the systems theory. A descriptive survey research design was adopted. All the healthcare managers in Kenya constituted our target population. The members of SubCounty Hospital Management Committees and Meru Level V Hospital Committee totaling 168 comprised the study population. A census design was adopted where all the 168 devolved healthcare managers in Meru County were projected to take part in the study. A structured questionnaire was used for data collection. The instruments’ validity and reliability were assessed. The Statistical Package for Social Sciences Version 24.0 tool was used to analyze date. Descriptive and inferential statistics were computed for quantitative data. The results of the analysis were presented in tabular form and were accompanied by pertinent interpretations and discussions. It was found that devolved healthcare financing (r=0.321; p<0.05), devolved leadership (r=0.396; p<0.05), devolved healthcare workforce (r = 0.487; p < 0.05), and devolved medical supply system (r = 0.486; p < 0.05) were significantly correlated with delivery of healthcare services in Meru County. The findings further indicated that 28.9% variance in delivery of health services in Meru County could be explained by the devolved healthcare system. Devolved medical supply (β4 = 0.239) was found to be the most critical component of the devolved healthcare system while devolved leadership (β2 = 0.120) was the least important factor. None of the null hypotheses was rejected. It was concluded that the delivery of healthcare services was pegged on the availability of funds to procure medicine, remunerate workers and ensure the daily operation of health facilities. We also concluded that good corporate leadership could enhance service delivery. In order to improve delivery of health services, it was paramount to have well-remunerated, motivated, and adequate number of staff. Medical supply system was inferred to be very fundamental in delivery of healthcare services. The devolved health facilities should seek supplementary sources of funds to address their operational costs. They should also ensure prudent leadership, which advocates for transparency and accountability. The workforce should be appropriately remunerated and motivated. Furthermore, the medicine and drug allotment should be prioritized on need basis to avoid stock outs and ensure that health services delivery is not compromised.