The influence of of devolved governance on the performance of health sector in Homa Bay county in Kenya
Ong'ang'a, James paul miller
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Healthcare sector in Kenya has experienced a lot of challengessince independence under a highly centralized government system. Health management was guided by decisions made at the capital, affecting equitable distribution of health funds and creating inequalities in the provision of health services across the country. It is against this backdrop that devolution was considered under the 2010 constitution to change the management of health system in Kenya. However, this transformation which saw the transfer of responsibilities and authority of health service delivery to county governments has not improved the performance of the healthcare system in most Counties in Kenya. Probably, this could be attributed to the complexity of Kenya’s devolution framework, general mismanagement or the counties’ unpreparedness to deliver the services. Other reports have also indicated that political pressure from the newly elected county governments led to a bulk transfer of functions, irrespective of the counties’ level of preparedness. This study analysed the influence of devolved governance on the performance of health sector in Homa Bay County, Kenya. The study was guided by four objectives: To determine the influence of devolved governance on the level of access of health services in Homa Bay County, Kenya; establish the influence of devolved governance on the status of human resource management in the health sector in Homa Bay County, Kenya; evaluate the influence of devolved governance on healthcare infrastructure in Homa Bay County, Kenya and assess the influence of devolved governance on funding and expenditure in health care in Homa Bay County, Kenya. The study adopted the descriptive survey research design. The target population was 90 nurses, 42 Ward Administrators, 3 County Executive Health Officers, 9 Sub-County Health Superintendents’ from Homa Bay County. Purposive sampling method was adopted to come up with a sample size of 93 respondent’s reprsenting 9 Sub-County Health Superitendants, 58 nurses and 26 Ward Administrators. Primary data was collected using questionnaires and Key Informant Interviews. Key Informant interview guide was used to collect information from interviewees. Questionnaire was used to collect information from the 9 Sub-County Health Superitendants from Homa Bay County while questionnaire was used to collect information from the 26 Ward Administrators and 58 nurses. Secondary data was sourced from health sector reports in Kenya from the year 2010 to 2014, documentary reviews of the minutes of meetings, Homa Bay County Integrated Development Plan 2013-2017, Homa Bay County Fiscal Strategy Paper (2015), Homa Bay County Health Sector Strategic and Investment Plan 2013-2017, the Homa Bay County Referral Hospital strategic plan and notices and memos on the notice boards health sector reports in Kenya from the year 2010 to 2014. The collected data was then analyzed through frequencies and percentages to enable the research come up with conclusions and recommendations for the study. The researcher employed the assistance of some computer tools, including the Statistical Programmes for Social Sciences (SPSS) and excel version 16 to analyze the data quantitatively. The analyzed data was presented in the form of graphs tables and charts. The Study established that devolution process has not been fully implemented and its effect has not been fully experienced in the health sector. The study found out that devolution of the procurement process has enhanced access to drugs and equipment in hospitals, however, health facilities still serve low number of patients. Employment in healthcare sector in affected by better remuneration in private sector. It was recommended that the health sector players should improve in financing of critical health investment areas, particularly those relating to improving quality of care, purchase of specialized equipment so as to restore public perception of good quality care and achieve devolution goals on improvement of primary health care facilities.