The 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, challenges facing around the delivery of public healthcare exist. The influence of devolution on the delivery of health services in Kenya had not been evaluated, necessitating this study. The study analyzed how the various components of devolution, including devolved healthcare financing, devolved leadership, devolved healthcare workforce, and devolved medical supply system influence delivery of health services in Meru County, guided by the sequential theory of decentralization and systems theory. A descriptive survey research design was adopted. All the healthcare managers and members of the Sub-County Hospital Management Committees in Meru County council and Meru Level V Hospital Committee totaling 168 comprised the study population. One hundred and sixty eight (168) respondents were required to get a representative sample of healthcare managers in Meru County. A self-administered questionnaire was to collect data. The instruments’ validity and reliability were assessed and data analysis done using version 24 of the Statistical Package for Social Sciences software. Data was screened for completeness and variables with missing or compete data deleted. Cases with >20% missing responses and outliers were also excluded. Data was analysed using descriptive statistics and logistic regression. Descriptive and inferential statistics were used to link the predictor or explanatory independent variables to the outcome or response variable. Of the 168 questionnaires sent out, 112 were returned, translating to a response rate of 66.7%. Most respondents were undergraduates (51.8%) and had than three years of experience (35.7%) in their current capacity. Close to a third (30.4%) had held a managerial position for 3-5 years at the time of the study. A majority (59.0%) concluded that the delivery of healthcare services was efficient and that devolved financing (85.7%), devolved leadership (57.1%), devolved healthcare workforce (81.2%) and devolved medical supply system (60.7%) was optimal. In multivariable logistic regression, suboptimal devolved healthcare financing lowered health service delivery 0.735 fold significantly (P=0.042). Having suboptimal devolved leadership lowered health service delivery 0.525 fold statistically significantly (P=0.028). Suboptimal healthcare workforce lowered health service delivery 0.194 fold statistically significantly (P=0.03), while suboptimal devolved medical supply system lowered health service delivery 0.116 fold statistically significantly (P<0.01). Based on the findings, health facilities should seek additional financing to supplement the traditional income in order to cover operational costs and procure state-of-the-art equipment. The management should recruit qualified personnel such as nurses and supporting staff to avoid gaps in service delivery. Medicine or drug allotment should be prioritized on need basis to avoid stock outs, thus ensuring reliable supplies. A similar study should be done in different counties, preferably those in urban areas, where there has been doctors and nurses strikes.