Effects of Devolution on Technical Efficiency of Healthcare Services Delivery in Bomet County, Kenya
Sang, Kipronoh Victor
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Devolution has been seen by its proponents as a way of improving access and efficiency in the delivery of services to the people since the decisions are made close to the people, hence decision makers are more accountable to them. With the onset of Kenya’s devolution in March 2013 as provided for in the Constitution of Kenya of 2010, healthcare resources have been at the dispensation of the counties together with all the devolved functions. However, there is no assurance of any efficiency gains brought about by this phenomenon in the health sector as alluded by the devolution literature. Therefore, determining the current efficiency levels in the devolved units (counties) and comparing them with the levels before devolution onset brings out a picture on the extend these reform affects efficiency. The broad objective of this study was to assess the effects of devolution of healthcare on the technical efficiency of healthcare services delivery in Bomet County, Kenya. A cross-sectional study design was used where secondary and quantitative data was collected using a data checklist from the ministry of health and the county’s information platforms. ‘Ex-ante’ and ‘ex-post’ data from the devolution periods were used to calculate the technical efficiencies using a non-parametric econometric technique, Data Envelopment Analysis (DEA). Key informant interviews were done after analyses of data to get the views of the county’s health managers on the results. The findings indicated that there was an increase in the number of hospitals in the county from 3 before devolving healthcare to 8 in 2015. The number of primary healthcare facilities too increased from 109 to 132. The staff numbers show 87.2% increase from 553 in 2012 to 1035 by 2015. Staff changes also saw employment of new specialists to the county government who were not there before devolution. The mean constant returns to scale technical efficiency (CRS TE) scores for the county increased from 92.4% in 2012 to 96.1% in 2015, while the varied returns to scale technical efficiency (VRS TE) score showed an increase of 3.4% from 96.6% to 100%. The county mean scale efficiency scores increased from 95.7% before devolution to 96.1% after devolution. It therefore indicates a general increase in technical efficiency from the period before devolution to the period after devolution. For the county to realize efficiency, the health outputs should be increased rather than cut down on investments, thus the need for monitoring and evaluation to meet the output targets and the creation of demand for the public healthcare services through improving on the quality of services and increased involvement of the community units.