Participatory Engagement as a Governance Factor Influencing Performance of Devolved Health Care in Kenya

Abstract

The purpose of devolving the sector was to give county governments the freedom to create novel models and interventions that were tailored to the specific health needs of their communities, to promote effective citizen participation, and to make independent, prompt decisions regarding potential problems with resource mobilization and management. However, the sector is today plagued by enormous problems including capacity gaps, human resource shortages, a lack of vital institutional and legal infrastructure, widespread corruption, and a tense relationship with the federal government. Overall, these issues have caused healthcare to stagnate and even reverse certain improvements, as measured by health indices. Without a question, adequate institutionalization is required to assure good governance and effective public participation in a rights-based approach to health service delivery. The objective of the study was to determine how citizen participation as a governance factor influences organizational performance of devolved health care sector in Kenya. Responsiveness by the county government was used as the moderating variable of the study. The current study utilized descriptive research design and involved cross-sectional collection of data in 47 counties across the country focusing on a number of selected officials who gave information regarding governance factors influencing devolved health care sector in Kenya.Since the study utilized census sampling, the 47 county referral hospitals were targeted. Further purposive sampling was used to arrive at the 188 selected respondents who became the sample size of the study. The study combined the elements of both quantitative and qualitative methods of data collection. Descriptive statistics was used to outline the fundamental characteristics regarding the collected information in the research.  Analysis of Variance (ANOVA)table techniques and beta coefficient tables were utilized in the presentation of regression analysis outcomes. The findings of the study revealed that participatory engagement of citizens had positive significant relationship with organizational performance of devolved health care sector. Moreover, with the inclusion of responsiveness by county governments the moderating effect on participatory engagement variable was found to be significant on the organizational performance of devolved health care sector. The study recommends that there is need for the health care sector function to be devolved to the counties to allow for more budgetary allocations, citizen inclusivity in decision making, timely response to health care needs, government planning and interventions and management accountability and transparency. The study also recommends further research on the challenges to involve citizens inthe successful execution of devolved health sector in Kenya. Education should be put as a requirement of participatory processes, since the public needs to be educated to participate in matters regarding health care.  Policy  makers  are also recommended to  encourage  participatory engagement  of  citizens  as  this  would  provide necessary feedback on what is working and not in order  to  promote  service  delivery.