Effect of Devolution on Health Care Delivery in Kenya

Abstract

The introduction of devolution in Kenya after the promulgation of the new constitution in 2010 was touted as the panacea to the social, political and economic problems the country had faced since independence. The objectives and rationale of devolution included promoting democracy and accountability, achieving economic development and improving access to public services. Since 2013, there have been unending discussions on whether devolution has achieved the intended objectives given the high hopes the country had in the system. Among the services that were transferred to the counties in the new system include health services and agricultural services. This study has attempted to assess the effect of the different aspects of devolution on the delivery of health services in Kenya. The study has evaluated the degree of fiscal decentralisation, administrative decentralisation and health care financing and how they have affected immunisation coverage over the period 2012 to 2017. We have explored the trends in immunisation coverage over the period 2003 to 2017 and health healthcare financing by the government over the period 2006 to 2017. The study utilised a quantitative research approach by using descriptive and econometric estimation techniques to present the results. The data used in the study comprised a panel of variables covering immunization coverage (2003-2017, budget information (2006-2018) and social economic factors (as of 2013) for the county and national aggregates. The data sources mainly comprised government reports especially Economic Surveys, statistical abstracts, annual budget reports and reports by development partners and non-state actors. The findings from the study showed that healthcare financing by the government has not been affected by devolution with counties allocating more than 30 per cent of their budgets to the health sector and the total allocation by both levels averaging about 6 per cent. On the other hand, devolution has negatively affected the provision of immunisation coverage with the full immunisation coverage declining from over 80% in 2012 to 63 % in 2017. The study established that fiscal decentralisation measured by the percentage of local revenue to the counties has a positive relationship with immunization coverage. This clearly calls for policy reforms to address the shortcomings of the devolution framework to address the gaps in key service delivery challenges in the health sector. Efforts must be geared towards ensuring proper coordination between the two levels government and ensuring clear service provision standards across all counties. There is also a need to strengthen devolution by improving the capacity of the counties to generate their own revenues.