Implementation of Devolution of Healthcare System, Quality Perspective in Selected Public Hospitals in Garissa County, Kenya
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Date
2021
Authors
Buro, Rahima Yussuf
Yitambe, Andrea
Rucha, Kenneth
Journal Title
Journal ISSN
Volume Title
Publisher
IAJHMN
Abstract
Devolution is delegation of power,
governance and resources from centralized
government to local/subnational level
jurisdictions. The Kenyan constitution
allows two levels of government i.e. the
national and county levels with each level
having its mandate. Provision of standard
and sustainable health services to the
Kenyan citizens is one of the fundamental
roles of devolution as stated in the Kenyan
Constitution. This study examined the
quality of healthcare services delivered
before and after devolution in selected
public health facilities in Garissa County
as perceived by the healthcare users. The
study employed cross-sectional descriptive
research design to explore the rating of
performance of the health care system
after the devolution. Two key domains
employed were accessibility and
availability of services and adequate and
competent workforce. The sample size was
379 respondents representing clients
attending outpatient services. Data was
analyzed using SPSS software version 22.
Qualitative data was analyzed using
thematic content analysis. Descriptive
statistics was analyzed using frequencies
and percentages and inferential statistics
was analyzed using Chi-square and
Fisher’s exact test to test for associations
between variables. P<0.05 was considered
significant. The study revealed that
majority of the respondents were female
(51.3%), had no formal education (47.6%),
and were unemployed (57.6%). The mean
age of the respondents was 33.49 years.
The average time taken to reach the
nearest health facility was 2.1 hours and
average waiting time before service was
2.6 hours. Majority of the respondents
75.9% felt that there was a decline in
healthcare service delivery and majority
56% said there was shortage of staff with
devolution. The study established that
majority of the respondents 52.1% missed
services due to absence or shortage of staff
during their last hospital visit. The study
showed a significant association between
perception of improvement of service
delivery and level of health facility visited
(Fisher’s exact test=21.342; p=0.001); and
respondents missed service due to absence
or shortage of staff and level of health
facility visited (χ2=8.779; df=3; p=0.032).
The study concludes that healthcare
services have declined substantially with
the introduction of devolution of
healthcare services.
Description
Article
Keywords
Access to care, Devolution, Essential drugs, Equity, Quality of care, Health, Governance
Citation
Buro, R. Y., Yitambe, A., & Rucha, K. (2021). Implementation of devolution of healthcare system: a quality perspective in selected public hospitals in Garissa County, Kenya. International Academic Journal of Health, Medicine and Nursing, 2(1), 142-156.