Effects Of Devolved Governance On Health Service Delivery At Thika Level Five Hospital In Kiambu County, Kenya

The study sought to assess the effects of devolved governance on health service delivery in Thika level five hospitals in Kiambu County, Kenya. The specific objectives of the study were to examine the influence of devolution of the health sector on health care service delivery in Thika level five hospital, assess various strategies that the Kiambu county government is using to support and improve health care service delivery in Thika Level Five Hospital, and explore the challenges affecting the governance of health care service delivery in the Thika level five hospital. The study was pinned on sequential theory and new management theory and adopted a mixed-method research design. The target population comprised 451 health workers working at Thika Level Five Hospital, 952,322 Citizen Adult population, and 87 Kiambu Members of County Assembly. Out of a recommended study sample of 199 the study analysed findings from 160  respondents indicating a 80% response rate. The study used a structured questionnaire to collect data from the general public, health practitioners, and Members of the County Assembly while the interview guide was used to collect data from County Executive Committee Member and the Chief Officer in charge of health services in the County. Qualitative data was then cleaned, sorted, coded into themes and   using SPSS, while quantitative was analysed using descriptive analysis and presented in the form of charts and tables for ease of interpretation. The results revealed that Kiambu level five hospital was not receiving enough allocation of funds from the county government, and the health workers were not paid their monthly salary on time, which affected the service delivery in the hospital. Furthermore, the counties are now shielded from political interference of the national Government. The Intensive Care Unit, emergency response services, CT scan, and the MRI scan services have been procured for the hospital as a result of devolution. The devolved governance has faced challenges such as the hiring of skilled staff and financing the hospital leading to a lack of adequate and skilled expertise to address medical needs. Among other challenges faced at Kiambu level five hospitals are persistent strikes, which lead to an abrupt stop in health service delivery and turnover of skilled and experienced employees. The study concluded that the devolution of governance of the health sector has brought positive effects to Thika Level Five Hospital in Kiambu County. The study recommends that more resources be allocated to the hospital for the purchase of more health equipment on time to help improve health service delivery and employment of more health workers in all healthcare centers be given priority in the county strategic plan to optimise service delivery. The study also recommends policy change by the national government to enable the hospital to retain some of the money collected for internal use.