Assessing the effect of devolution on the number of healthcare workers in hardship areas: a case study of doctors, clinical officers, nurses and specialists in Wajir County

Kenya has had shortage of healthcare workers since independence, but this picture is worse in the hardship areas as majority of these workers tend to concentrate in urban areas. The Constitution of Kenya 2010 devolved management of health workers to the 47 counties. The aim of this study was to find out the effect of devolution on number of healthcare workers in a typical hardship area, with major focus on doctors, nurses, clinical officers and specialists in Wajir County. The specific objectives were to find out the effect of devolution on the number of healthcare workers, and their distribution in the sub counties and how devolution influenced budgetary allocation to health. Secondary data analysis of the payroll and budget of health department for 5 years was done to find out the number of healthcare workers in terms of absolute numbers, specialization, and amount paid in salaries, number on study leave, and health budget allocation as at 2012 (before devolution and from 2014 to 2017 under county government). Descriptive statistics of graphs was used to present the data. The study established that Wajir County has had tremendous improvement in the number of health care workers in the past 5 years. The study further established that under the devolved governance, the number of healthcare workers who have improved their skills by undergoing further training and specializing in different fields of nursing, medicine and clinical medicine has significantly increased. The study found out that Wajir County allocated significant amount of funds in the annual budget for health, which has availed enough funds to recruit enough health workers. Wajir County recruited its first medical specialist, a surgeon in 2017. The County has also given a substantial number of staff paid study leave to improve number of specialists among doctors, nurses and clinical officers. The study concluded that there was a positive relationship between devolution and improvement in the number of healthcare workers.
Submitted in partial fulfillment for the award of the degree of Masters in Business Administration Health Care Management (MBA-HCM)
Healthcare Workers, Devolved Management, Hardship Areas, Effect of Devolution