Sirite, James Kinjanzi2026-03-052026-03-052025-10https://ir-library.ku.ac.ke/handle/123456789/32652A Research Thesis Submitted to the School Of Law, Arts and Social Sciences in Partial Fulfilment of the Requirement for The Award of the Degree of Doctor of Philosophy in Public Policy and Management of Kenyatta University. October, 2025 Supervisors David Minja Jane Gakenia NjorogeTurkana County continues to face significant challenges in healthcare service delivery resulting in high rates of preventable diseases, maternal and infant mortality and limited access to essential healthcare facilities and practitioners. Despite evidence showing improvements in recent years, the healthcare indicators in Turkana County portrayed high disparities compared to national average. This study investigated how fiscal decentralization affected healthcare service delivery in Turkana County, Kenya. The specific objectives were to establish the effects of revenue decentralization, expenditure decentralization and technical support structures on healthcare service delivery in Turkana County. In addition, the study examined the effect of policy framework on the relationship between fiscal decentralization and healthcare service delivery in Turkana County. The study was guided by fiscal decentralization, community empowerment and resource-based view theories. The study adopted interpretivism as its research philosophy. It employed a descriptive survey design and adopted census sampling technique. The population of the study comprised of 271 individuals drawn from County department of finance and economic planning, County department of health and sanitation services, heads of departments in the Sub-County hospitals, Turkana County referral hospital board-lodwar, chairpersons of Sub-Counties (Turkana North, Kibish, Turkana West, Loima, Turkana Central, Turkana South and Turkana East) hospital committees, co-ordinators for community health volunteers (CHVs) and chairpersons of the health centres and dispensaries committees. The study used semi-structured questionnaires and interview guide in data collection. Qualitative data was analysed using content analysis, while quantitative data was analysed using descriptive, inferential and multiple regression modelling. Results indicated that revenue decentralization, expenditure decentralization, technical support structures had significant effects on healthcare service delivery in Turkana County. Additionally, Policy framework moderated the positive relationship between fiscal decentralization and healthcare service delivery. However, health communication system under technical support structures, depicted a negative effect on healthcare accessibility and affordability. As such the study recommends a targeted support on policy framework as it had the potential to accelerate the positive effect of fiscal decentralization on healthcare service delivery in Turkana County.enThesis