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Norah Ameliah Mwongera - Student, Master Policy of Arts (Public and Administration), Kenyatta University Kenya

Wilson Muna - Lecturer, School of School of Law, Arts and Social Sciences, Kenyatta University, Kenya


The inefficiencies in healthcare service delivery witnessed in most parts of the country has prompted the study to investigate the effect of fiscal decentralization on access to healthcare services. Fiscal decentralization plays a key role in service delivery in the public sector by ensuring that services are taken close to the people. The accountability of both levels of governments ensures effective service delivery in key sectors such as health, education and water service. In Kenya, fiscal decentralization is realized through devolution as anchored in the Constitution of Kenya 2010 following the promulgation on August, 2010, however, the process has not been effective due to inadequacy of funds, lack of accountability at both levels of government leading to inefficient healthcare service delivery despite the national government launching universal healthcare for all in four counties namely; Kisumu, Nyeri, Machakos and Isiolo. The study seeks to achieve three research objectives; first, to examine the relationship between revenue decentralization and access to healthcare, secondly, to examine the relationship between expenditure decentralization and access to healthcare and lastly, to analyze the effect of grants on access to healthcare services in Kenya, Machakos County. The study is anchored on fiscal decentralization theory because the theory shows the relevance of the fiscal decentralization in promoting service delivery to the public remotely. The study employs non-experimental research design with a panel data from Machakos County for a period of 2013-2022. The study found that revenue decentralization insignificantly affect healthcare services access, expenditure decentralization significantly affect healthcare services access negatively while grants plays a positive and significant role in access to healthcare services in Machakos County. The study recommended that more resources should be allocated towards the development of the sector to enhance services delivery to the public and the resources should be used prudently and every coin accounted for so that the value for money is realized to all.

Full Length Research (PDF Format)