Effectiveness of County Government in Delivery of Outpatient Health Care Services in Kilifi North Sub County, Kenya

Abstract

Decentralized system of governance has been implemented in many parts of the world with a view of improving service delivery to citizens. The Health sector in Kenya was one of the functions that was devolved. Despite devolution of healthcare the sector is still in the process of actualization of effective service delivery. This study sought to examine the effectiveness of Kilifi County Government in delivery of outpatient services in Kilifi North Sub-County. The study was guided by three key research objectives comprising of: To establish level of satisfaction among the recipients of outpatient healthcare services, to examine the adequacy of resources allocated by county government for provision of quality outpatient healthcare and to establish measures that the County Government can put in place to improve outpatient service delivery. The decentralization theory and health service quality delivery model of Donabedian informed the study. The study adopted a descriptive research design where respondent’s attitudes, opinions and habits were established. Outpatient healthcare seekers, county elected leaders and policy makers estimated at 1680 made up the target population. A sample size of 323 was used. The study mainly relied on primary data collected using a structured questionnaire and an interview guide. Questionnaires were analyzed using descriptive statistics while the information from interview guides was analyzed using content analysis. The research findings revealed that poor satisfaction levels with outpatient healthcare services were registered. This was mainly attributable to lack of drugs in the county pharmacies and long duration of waiting to be attended while seeking outpatient healthcare services. Majority of the respondents were undecided on whether resources allocated by Kilifi County Government towards provision of healthcare were adequate because of lack of public participation during the budget formulation process. Proper supervision mechanisms to ensure healthcare givers attend to their clients and better incentives to encourage health professionals to take up appointments in remote areas were considered as the most appropriate measures for improved healthcare service delivery. Recommendations for policy include county elected leaders to enact legislation to ensure increased resource allocation to support infrastructure development initiatives; strengthening of referral mechanism to address emergencies especially hard to reach areas of the County. The role of public participation in the governance of healthcare service provision should be strengthened. Recommendations for practice include: County health administrators need to address the staffing problems at the health facilities in order to reduce the waiting duration while seeking services. Staff should be equitably distributed based on numbers and specialties, mechanisms for skills development, and motivation for staff at the various health facilities in the sub county. Health administrators should actively engage stakeholders in the development and implementation of health programs plans. Further research should also be conducted on the impact of politics on the effectiveness of health management in Kilifi County. A research on the factors affecting patient satisfaction with outpatient healthcare services in all the 47 counties should be conducted.