Framework for Health Care Services Delivery Under the Devolved System of Government in Kenya: An Empirical Review of Literature

This paper presents literature review seeking to establish a framework for management of health care services under the devolved system of government in Kenya. The key variables investigated included: health care systems structure; health care ecosystem; health care delivery operations; and management of health care services under the devolved system of government. The rationale for the study was based on inefficiencies reported, perennial shortage of staff, strikes and inequitable distribution of resources in public hospitals in Kenya. There are those who feel that management of health services should be taken back to the national level since its implementation was rushed and has made management of health service provision at the county level worse. There is still a belief that devolution has contributed to the significant inefficiencies and confusion of health service management in the county. The target population for the study were all the all-county referral hospitals in Kenya. Census sampling was adopted since the entire target population of eleven county referral hospitals and a population of 180 was used. The research philosophy adopted was a triangulation of both qualitative and quantitative methods. Hence, the research philosophy is a blend of phenomenological and positivist approach. A cross-sectional survey design was used as the research design for the study. Qualitative data analysis was done using content analysis with the help of computer-based softwares such as NVIVO. The quantitative part of the data analysis was done using descriptive statistics and multiple regression analysis using statistical methods such as multiple regression analysis and diagnostic tests such as heteroscedasticity and multicollinearity tests. The findings of the study should be able to influence policy on the management of health care services under the devolved system of government in Kenya, as well as form a body of theory in the study of health care as a complex adaptive system.