Effect of devolution on healthcare administration in Murang'a County, Kenya
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The health administration managers play a critical role in healthcare decision-making, and their susceptibility to local and regional politics is noteworthy. This is despite the need for channeling more resources towards the devolution of healthcare in the 47 counties in Kenya. While an expansive body of literature has explored the implications of devolution on certain aspects of an economy, little has been published on the effect it has on healthcare administration. There is a little empirical study on the effect devolution has on the administration of health services in Gatanga Sub-county in Murang'a County despite having a population of 95,601 people. According to the agency theory, an agent ought to serve in the best interest of the principal. By extrapolation, regional healthcare administrators ought to serve better their principals after they are empowered by devolution. To that effect, this study ought to examine the effect of devolution on healthcare administration in Gatanga Sub-county. The study sought to achieve three key objectives, namely (a) to assess the effects of devolution on healthcare financial planning, (b) to examine the effects of devolution on the management of healthcare facilities; and (c) to evaluate the effects of devolution on healthcare human resource management. A randomly selected sample of 91 healthcare practitioners, 46 healthcare beneficiaries, and 19 healthcare administrators in the county was involved in the study. Data was collected using semistructured questionnaires and analysed using descriptive analysis. It was observed that the county government primarily funds healthcare service with minor support from grants from the national government and donors. They experienced a range of financial challenges, namely unreliable, delayed, and insufficient funding, lack of sufficient equipment. It was also observed that devolution had improved administration through expanding managerial space and improvement in overall service delivery. However, operational challenges, such as poor involvement of stakeholders in day-today operations and decision-making, were rampant. Lastly, devolution has allowed healthcare facilities to attract qualified workers, perhaps from local societies, although staff challenges such as staff demotivation and inadequacy of CPD opportunities were observed. This study recommends fostering capacity building for local healthcare facilities to help in bolstering the skills of healthcare administrators and the need for awareness among administrators concerning the welfare of healthcare practitioners.