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Edward Otieno Omondi - Student, Master Policy of Arts (Public and Administration), Kenyatta University Kenya

Felix Kiruthu - Lecturer, School of School of Law, Arts and Social Sciences, Kenyatta University, Kenya


Medical infrastructure is regarded as among key service delivery component in the health care system and it relates to all physical infrastructure (medical heath facilities), medical equipment (inpatient beds), transport system (Ambulance services) and Information, Communication and Technology (ICT) required for effective service delivery. Literature reviews reveal so little about devolution effects on medical infrastructure expansion as a number focus on administration, human resource and funding despite the uneven health care service distribution and coverage hence indicating scholarly gaps that need to be addressed. This study hence sought to examine the effect of devolution on the expansion of medical infrastructure in Nakuru County, the study sought to investigate devolution impact on medical infrastructure expansion in Kenya: case in study of Nakuru county. The investigation was guided by the following specific objectives: to investigate the effect of devolution on the expansion of medical laboratories, expansion of surgical theatres as well as to assess the effect of devolution on the expansion of maternity wards in Nakuru County, Kenya. The investigation adopted a descriptive research design. The population target was 4840 health workers in the purposively selected public hospitals in Nakuru County. The research employed Agency theory. Using purposive sampling technique the hospital heads were included in the sample size while the health workers were selected using a simple random sampling technique. Sampled size was 126. Primary data was obtained using Interview guides and questionnaires. The hospital heads were interviewed while the health workers responded to the questionnaires. Research supervisor was consulted in the review of content and predictive validity. Test- retest coefficient tested the reliability of research instrument; a reliability of 7ᵡ⅒ was accepted. SPSS helped analyze data obtained. Interpretation and discussion of the results were guided by the investigation objectives. The research findings revealed that devolved medical laboratories have an inverse and insignificant effect on Medical Infrastructure Expansion in Nakuru county (β1=-0.209, p-value= 0.322). The findings also showed that devolved surgical theatres have an inverse and insignificant effect on medical infrastructure expansion in Nakuru county (β2=-0.376, p-value= 0.063). The research further concludes that devolved maternity wards had a productive and remarkable impact on medical infrastructure expansion in Nakuru county (β3=0.938, p-value=0.000). Study concludes that there were limited maintenance and sustenance mechanism for the laboratory infrastructure leading to dysfunctional medical laboratory equipment and infrastructure. The research also indicated that limited number of reliable sources of power and power back-up plans negatively affected the expansion of surgical theatres. Study also indicates that devolution greatly influenced the establishment of more maternity wards in Nakuru county. The study recommends the Kenyan government and policy implementers to consider equipping surgical theatres and enforce already existing laws on medical equipment procurement and asset acquisition to help enhance devolved medical theatres in the devolved units and nationally. Devolved units through the Ministry of lands should also consider acquiring and utilizing idle public lands for the expansion of medical infrastructure. The study further recommends the Kenyan government to consider increasing funds and resources on research and innovation program including training for surgical and laboratory equipment operators as well as embark on a recruiting exercise for midwifery and nurses in Nakuru county as well as the country at large.

Full Length Research (PDF Format)