Discussion Paper No. 316 of 2023 on An Assessment of the Effect of Devolution on the Healthcare Service Delivery in ASAL Counties of Kenya

Abstract

Kenya ushered a devolved system of governance in 2013 leading to the formulation of two levels of governance, one national government and 47 county governments 27 of which are classified as ASALs. A total of 14 functions were devolved inclusive of healthcare. This study assessed the effect of devolution on the healthcare service delivery in the ASAL counties. This was achieved through a comparison of selected indicators of healthcare access before and after devolution. Wilcoxon signed-rank test is also applied to the data to help understand whether a significant change was experienced after devolution. Results indicate a significant increase in the number of health professionals, number of beds, and number of hospitals. However, individuals covered longer distances, drug unavailability in public health facilities increased, and there were higher incidences of catastrophic health expenditure. The number of patients satisfied with the privacy in outpatient and inpatient care also reduced significantly after devolution. Counties are encouraged to pass the facility improvement fund bill and embrace the digitalization of healthcare as a means of raising funds and reducing the distance to the health facilities. In addition, it is important to educate healthcare workers on the importance of maintaining patient confidentiality to improve acceptability. Also educate the masses on the importance of preventive healthcare to help curb the burden of catastrophic health expenditure.