Devolution, as other types of decentralization, profoundly changes governance relations in the health system. Devolution is meant to affect performance of the health system by transferring responsibilities and authority to locally elected governments. This study aimed to establish the effect of devolved governance on the performance of the health sector in Kenya. The guiding objectives included: To establish the influence of devolved procurement on the performance of the health sector; to determine the effect of devolved leadership on the performance of the health sector; to evaluate the effect of devolved resources on the performance of the health sector; and to establish the effect of devolved policy and regulatory framework on the performance of the health sector in Kenya. The study adopted the descriptive survey research design.  The target population was 572 patients and health care providers from Nairobi and Mombasa County. Stratified sampling method was adopted at the rate of 10% to come up with a sample size of 57 respondents. Primary data was collected using questionnaires from all the respondents. Secondary data was sourced from health sector reports in Kenya from the year 2010 to 2014. The collected data was then analyzed through frequencies and percentages to enable the research come up with conclusions and recommendations for the study. The researcher employed the assistance of some computer tools, including the Statistical Programmes for Social Sciences (SPSS) and excel version 16 to analyze the data quantitatively. The analyzed data was presented in the form of graphs tables and charts.

The Study established that devolution process has not been fully implemented and its effect has not been fully experienced in the health sector. The sector performance was averagely rated in the study and its contribution to GDP reduced by 0.5 percent by the end of the year 2013. The devolved procurement process, organizational leadership, resources allocation and availability as well as policy and regulatory framework had a significant influence on the performance of the level four hospitals and the overall health sector. It was recommended that the health sector players should improve in financing of critical health investment areas, particularly those relating to improving quality of care.

Full Text:



Atieno, P J, Nancy E.,& Spitzer, D., (2014) Kenyan Nurses Involvement in National Policy Development Processes Nursing Research and Practice Volume 2014 (2014), Article ID 236573, 10 pages

Bashaasha,B., Najjingo,M. M.i, & Nkonya, E., (2011). Decentralization and Rural Service Delivery in Uganda. kampala: International Food Policy Research Institute.

Bennett S, Corluka A, Doherty J, Tangcharoensathien V, Patcharanarumol W, Jesani A, Kyabaggu J, Namaganda G, Hussain AMZ, Aikins A-G (2012a) Influencing policy change: the experience of health think tanks in low- and middle-income countries. Health Policy Plan, 27(3):194-203

Bennett S, Corluka A, Doherty J, Tangcharoensathien V., (2012b) Approaches to developing the capacity of health policy analysis institutes: a comparative case study. Health Res Policy Syst 2012, 10:7

Birken S. , Lee S-Y., & Weiner B.,(2012) Uncovering middle managers’ role in healthcare innovation implementation. Implementation Sci, 7(1):28.

Bloom, G., (2011) . Building institutions for an effective health system: lessons from China’s experience with rural health reform. Social Science and Medicine;72:1302-9

Bolton, S C. & Haulihan, M. (2007) Management, work and organizations, Searching for the human in HRM, Palgrave Macmillan, New York

Briscombe, B., Suneeta S., and Margaret S., (2010). Improving Resource Allocation in Kenya’s Public Health Sector. Washington, DC: Futures Group, Health Policy Initiative, Task Order 1.

Chen M(2011) . A study on corporate governance of public hospitals in China. Chinese Journal of Hospital Administration;27:37-44

Chuma J, Musimbi J, Okungu V, Goodman C, Molyneux C., (2009) Reducing user fees for primary health care in Kenya: Policy on paper or policy in practice? Int J Equity Health 8:15.

Chuma J, Okungu V, Molyneux C., (2010) Barriers to prompt and effective malaria treatment among the poorest population in Kenya. Malar J, 9:144

El-Saharty, S., Sosena K., Olango, P. D., &Banafsheh S., (2009). Ethiopia: Improving Health Service Delivery. Washington DC 20433: The world bank.

Franklin, M.I. (2012). Understanding Research: Coping with the Quantitative-Qualitative Divide London and New York: Routledge.

Fulop L., & Day, G., (2010) From leader to leadership: clinician managers and where to next? Aust Health Rev, 34(3):344.

Government of Kenya. (2010). Kenya Health Situation Analysis, Trends and Distribution, 1994 – 2010 and Projections to 2030. Ministry of Medical Services and Ministry of Public Health and Sanitation.

Kenya Health Policy, 2012 - 2030

Kpmg. (2013). Devolution of healthcare services in Kenya. South Africa: kpmg services. Patrick, I. M. (2013, September 20). University of kwazulu -Natal. Retrieved from University of kwazulu -Natal website:

Kutzin J, Cashin C, Jakab M,(2010) Implementing health financing reform. Lessons from countries in transition. World Health Organisation, on behalf of the European Observatory on Health Systems and Policies; 2010.

Marchal B, Cavalli A, & Kegels G(2009) Global health actors claim to support health system strengthening—is this reality or rhetoric? PLoS Med , 6 (4):e1000059

Milward H. B, Provan K. G, Fish A, Isett K. R, Huang K., (2010) Governance and collaboration: an evolutionary study of two mental health networks. J Publ Adm Res Theor, 20(Suppl. 1):i125-i41.

Ministry of medical services (2010) Facts and figures on health and health related indicators. Nairobi

Ministry of Medical Services Republic of Kenya ( 2008) Ministry of Medical Services Strategic Plan 2008–2012. Reversing the Trends: The Second National Health Sector Strategic Plan. Nairobi

Muula A. S, Rudatsikira E, Siziya S., & Mataya R.H.,(2007) Estimated financial and human resources requirements for the treatment of malaria in Malawi. Malar J 6: 168.

Mwatsuma K., Mwamuye, 1., and Nyamu, H. M., (2014) Devolution of health care system in Kenya: A strategic approach and its implementation in Mombasa County, Kenya. International Journal of Advanced Research, Volume 2, Issue 4, 263-268

Noorein I.S, Pam W. A. O, (2010) Restructuring with the middle-management advantage. Health Care Manag, 29(4):305-317.

Nzinga J, Mbindyo P, Mbaabu L, Warira, A., English M., (2009) Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals. Implementation Sci., 4(44)

O’Neil M (2008) Human resource leadership: the key to improved results in health. Hum Resour Health, 6(1):10.

Patrick, I. M. (2013), september 20). University of kwazulu -Natal. Retrieved from University of kwazulu -Natal website:

Paul Mbua, P& Ole Sarisar, J., (2013). Challenges in the implementation of Performance contracting initiative in Kenya Public Policy and Administration Research Vol.3, No.2, pp 44

Republic of Kenya (2008) Vision 2030: Sector Plan for Health 2008-2012. Ministry of Medical Services and Ministry of Public Health and Sanitation

Republicof Kenya(2010) Accessible, Affordable and Quality healthcare services in Kenya: Financing options for universal coverage. Ministry of Medical Services and Ministry of Public Health and Sanitation, Nairobi

Sekaran, U., & Bougie, R., (2010). Research Methods for Business A Skill Building Approach (5th ed.). Chichester West Sussex UK John Wiley and Sons

Sihanya, B., ( 2013) Presidentialism and Administrative Bureaucracy: 1963-2013, Innovative Lawyering & Sihanya Mentoring, Nairobi & Siaya.

Silverman, D., (2011). Qualitative Research: Issues of Theory, Method and Practice, Third Edition. London, Thousand Oaks, New Delhi, Singapore: Sage Publications

Tam W., (2008) . Failing to treat: why public hospitals in China do not work. The China Review 2008;8:103-30.

Tam W.,(2010) Privatising health care in China: problems and reforms. Journal of Contemporary Asia;40:63-81.

Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid SM, Mukti AG, Akkhavong K, Banzon E, Huong DB, Thabrany H, Mills A., (2011) Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet, 377(9768):863-873.

Taylor C. A., Taylor J.C., & Stoller J. K., (2008) Exploring leadership competencies in established and aspiring physician leaders: an interview-based study. J Gen Intern Med, 23(6):748-754

Vaillancourt, D., (2009) Do Health Sector/Wide Approaches Achieve Results? Emerging Evidence and Lessons from Six Countries. Washington, D.C.: Independent Evaluation Group - The World Bank. 2009/4 2009/4.


  • There are currently no refbacks.