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Rahima Yussuf Buro - School of Medicine, Kenyatta University, Kenya

Dr. Andrea Yitambe - School of Medicine, Kenyatta University, Kenya

Dr. Kenneth Rucha - School of Medicine, Kenyatta University, Kenya


Devolution is delegation of power, governance and resources from centralized government to local/subnational level jurisdictions. The Kenyan constitution allows two levels of government i.e. the national and county levels with each level having its mandate. Provision of standard and sustainable health services to the Kenyan citizens is one of the fundamental roles of devolution as stated in the Kenyan Constitution. This study examined the quality of healthcare services delivered before and after devolution in selected public health facilities in Garissa County as perceived by the healthcare users. The study employed cross-sectional descriptive research design to explore the rating of performance of the health care system after the devolution. Two key domains employed were accessibility and availability of services and adequate and competent workforce. The sample size was 379 respondents representing clients attending outpatient services. Data was analyzed using SPSS software version 22. Qualitative data was analyzed using thematic content analysis. Descriptive statistics was analyzed using frequencies and percentages and inferential statistics was analyzed using Chi-square and Fisher’s exact test to test for associations between variables. P<0.05 was considered significant. The study revealed that majority of the respondents were female (51.3%), had no formal education (47.6%), and were unemployed (57.6%). The mean age of the respondents was 33.49 years. The average time taken to reach the nearest health facility was 2.1 hours and average waiting time before service was 2.6 hours. Majority of the respondents 75.9% felt that there was a decline in healthcare service delivery and majority 56% said there was shortage of staff with devolution. The study established that majority of the respondents 52.1% missed services due to absence or shortage of staff during their last hospital visit. The study showed a significant association between perception of improvement of service delivery and level of health facility visited (Fisher’s exact test=21.342; p=0.001); and respondents missed service due to absence or shortage of staff and level of health facility visited (χ2=8.779; df=3; p=0.032). The study concludes that healthcare services have declined substantially with the introduction of devolution of healthcare services.

Full Length Research (PDF Format)