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Provider perspectives on the Strengths and Weaknesses of the Devolved Health Care in a Rural County in Kenya

Author: Kodhiambo M.O. , Ogweno J.O.
Is Part Of: Pharmaceutical Journal of Kenya, Volume 23, No. 4 (2018)
Background: Devolution of health services in Kenya was intended to enhance access to health care services. It is not clear to what extent this has been achieved.
Objective: To establish the perspectives of health care managers on the impact of devolution on health systems within Homa Bay County.
Methodology: We performed a health facility based qualitative study, adopting a phenomenological approach. The study population comprised all health care managers in eight public health facilities in Homa Bay County. The study used quota sampling involving different cadres of health care providers. Seven informants were interviewed in each sub-county leading to a total of 56 informants. Data was collected by use of structured interview guides and analyzed by a thematic approach.
Results: Progress of devolution was reported to be experiencing several challenges. The factors that were cited as bottlenecks to achieving full benefits of devolution were poor medical supplies, poor human resource recruitment and retention practices, remuneration uncertainties, corruption, nepotism and political interference. The main positive outcome of devolution was cited as enhanced community participation in health care issues. Opinion was divided as to whether devolution of health care should stay or be reversed.
Conclusions: From the foregoing, it is evident that devolution of health care is yet to be embraced fully by health care managers. Further studies to enhance evidence informed decision making is necessary.

Keywords: Devolution, health care, provider perspectives, Homa-Bay County.
Publisher: The Pharmaceutical Society of Kenya
ISSN: 2411-6386