MBA-HCM Theses and Dissertations (2024)

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Browsing MBA-HCM Theses and Dissertations (2024) by Author "Abukar, S. M."

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    The Effect of devolved governance on the delivery of health services in Wajir County, Kenya
    (Strathmore University, 2024) Abukar, S. M.
    One of the key components of the Kenyan constitution is the concept of devolution which emphasizes the bringing of crucial services closer to people at the grassroot level. Devolved governance has been endorsed as a means of reducing inefficiencies when delivering healthcare services besides enhancing responsiveness to community needs. Wajir County was among the counties ill equipped to provide quality health services under the devolved governance structure. Even though studies had demonstrated the connection between devolved governance systems and improved delivery of services including healthcare, county governments in Kenya still grappled with inadequate capacity and resources to effectively deliver. Fewer current studies had been undertaken to examine the impact of devolved governance on health services in resource-deprived Arid and Semi-Arid counties such as Wajir. This study sought to address this gap by assessing the effect of devolved governance on the delivery of health services in Wajir County. The study determined the effect of devolved health staffing, devolved health financing and devolved hospital leadership/management on delivery of health services in Wajir County. The study was anchored on the systems theory and the theory of fiscal federalism. A convergent parallel research design was applied. Target population consisted of county health officials namely 33 county health management team members and 126 public health facility managers. 5 county health management team members were purposively sampled while a census of the 126 public health facility managers was taken. The primary data used was collected using an interview guide and a questionnaire. To analyze the data, qualitative and quantitative techniques were used. Data from interviews was analyzed using content analysis while quantitative data was analyzed through descriptive and inferential. A multiple regression model was used to show the relationship between the study variables. Qualitative findings were presented using narratives and appropriate verbatim quotes while quantitative findings were presented using charts and tables. The study established that devolved health staffing, devolved health financing and devolved hospital leadership/management positively and significantly affected health services delivery in Wajir County. Devolved hospital leadership/management was found to have the largest effect on the delivery of these services. The study therefore, concluded that devolved governance had a positive significant effect on the delivery of health services in Wajir County. Improved devolved governance would boost the delivery of health services in this county. Several recommendations for improvement were proposed. The study recommended that the county government should progressively increase funding to public health facilities. Increased budgets for recruitment of additional staff and facilitating their capacity development were also recommended. Formation of independent hospital management boards, institution of diversified motivation incentives for staff and adoption of efficient funds disbursement mechanisms that incentivized public health facilities to deliver quality and efficient health services were also recommended. It was expected that study findings would serve as a foundation for future studies.