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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 accountability and good governance; and supply of essential drugs. 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. The study found out that majority of the respondents 53.4% were able to get the essential drugs during the last facility visit. The study established that the challenges facing hospital managers in implementing devolution were poor infrastructure, unskilled staff, stockouts of essential medical supplies, delay in resource allocation and lack of equipment. The study concludes that healthcare services have declined substantially with the introduction of devolution of healthcare services.

Full Length Research (PDF Format)