Citizen Participation in Management of Devolved Healthcare Funds in Embu County, Kenya
Watetu, Kabeu Emma
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Devolution of healthcare in Africa has been advocated as a response to most healthcare ills, and to facilitate greater citizen participation. Kenya, driven by the need to bring services closer to people has now joined countries like United Kingdom, Italy and Spain in having devolved health care system, hopefully to be like South Africa and Rwanda which have successful devolved healthcare in Africa. The main objective of this study was to investigate citizen participation in management of devolved healthcare funds in Embu County. This study used cross sectional descriptive design and mixed research design. The sample comprised of 20 Members of County Assemblies, 39 chiefs, 109 sub chiefs and 1,537 voters drawn from a population of 309,468 community members aged 18 years and above. Data analysis was done using descriptive statistics, correlation and regression analysis. The study drew a response rate of 91.3%. The average age of the respondents was 41.44 (SD ± 15.83) and having lived in Embu county an average of 40.22 years. On gender, males were 53.1% and females 46.9%. Manyatta constituency had 32.0% respondents, Runyenjes 28.1% Mbeere North 23.4% while Mbeere South had 16.5%. Majority were married (54.7%) with the least being divorced (5.8%). Respondents were almost evenly distributed among casual laborers, self-employed/business and farming (24.9%, 24.1%, 23.3%). The unemployed were 12.8%. Over 70% had attained secondary education and above while 5.1% lacked formal education. Level of citizen participation was low (27.2%) with voting being the activity that showed greatest extent of participation/involvement (44.7%). Groups and organizations which influenced participation were non-governmental organizations (p = 0.012; OR=0.609) and political leaders (p=0.006; OR=0.706). Individual characteristics that significantly influenced participation in management of devolved health care funds were constituency of residence (p = 0.004; OR=1.186), occupation (p = 0.005; OR=0.866) and highest level of education (p = 0.001; OR=0.788). Budgeting and planning was the only positively significant area of citizen participation (p = 0.000; OR = 0.28). Community‘s level of awareness on legal, policy and institutional frameworks was less than 30% across all 15 frameworks examined, where five were statistically significant. The strongest was Constitution of Kenya, 2010 Article 232(1)(d) with (p=0.000; OR=3.832) others were Constitution of Kenya, 2010 Article 27 (p=0.000; OR 0.203), Constitution of Kenya, 2010 Article 33(p=0.033; OR=3.315), County Governments Act section 91(p=0.038; OR=2.104) and Public Procurement and Disposal Act 2015 Section 68(3), 125(5), 138, and 179(p=0.004; OR=0.428). M&E was the only statistically significant institutional frameworks (p<0.01; OR=0.384). On Community perception and experiences, process legitimacy and adequate access to information aspects were statistically significant with p<0.01; OR of 0.354 and p<0.05; OR of 1.298 respectively. The study concluded that Constituency of residence, awareness of the constitution of Kenya and adequate access to information were factors that greatly influence citizen participation with an OR of 1.186, 3.832 and 1.298 respectively. The study recommends that public participation needs to be facilitated and enhanced to improve service delivery in county governments in Kenya. Findings will be useful to County and National Governments policy designers as they formulate Legal and Institutional frameworks enabling Citizen Participation.