Effects of devolution on childbirth services in level four public hospitals in Nairobi County, Kenya

Abstract

Internationally devolution has been advocated as a response to most healthcare challenges, and African countries have increasingly adapted it as a strategy to improve governance and remedy institutional deficiencies which highly centralized governments have experienced. The overall objective of the study was to find out the effects of devolution on childbirth services in level four public hospitals in Nairobi County. The study used Principal Agent Theory as advocated by Bossert (1998) as the main theory and the supporting theory being the Stewardship Theory (Davis, Donaldson and Schoorman, 1997). The study adopted descriptive research design and mixed methods research. Data collection involved administration of questionnaires and conducting Key Informant Interviews. The target population was 134 staff working at Mama Lucy ‗Kibaki District Hospital, Mbagathi District Hospital and Mutuini Hospital from whom a sample of 67 respondents was obtained using a stratified random sampling. The key informants were 6 practicing medical doctors, the 3 Hospital Administrators, one representative from the County Directorate of Health Services and the National Government Directorate of Medical Services. Ethical issues such as confidentiality and informed consent were considered. Reliability was ensured through a pilot study, whereas validity was achieved through proper formulation of questions and assessment by experts. Data analysis for quantitative data was carried out using descriptive statistics with the help of SPSS version 22. Thematic analysis was used to analyze qualitative data. The findings revealed that childbirth services in level four public hospitals in Nairobi County were greatly underfunded with 61(100%) of the respondents stating that the funding level is inadequate. Respondents noted that inadequate financial resources negatively affected delivery in the maternity sections and the hospitals are not able to finance procurement of equipment and supplies required for childbirth services. The study also found that childbirth services were understaffed, with 61(100%) of respondents stating that human resources for childbirth services were inadequate. Staff inadequacy led to overloading of some of the staff especially in the maternity sections that runs for 24 hours a day. The study also established that maternity facilities were inadequate, which negatively affects service delivery this is according to 61(100%) of respondents. The study further revealed that the hospitals had indicators of quality assurance with 61(100%) of respondents indicating that the quality measures were effective. The study concludes that though there has been some improvement in childbirth services in level four public hospitals since devolution, however, challenges still abound that need addressing. This study therefore recommends that the National and County governments should come up with a policy to ensure consistent, constant and adequate funding of childbirth services. In addition, the hospitals management should come up with strategies that can help improve financial resources to fund facilities improvement and purchase of equipment and supplies. The study recommends that County and National Governments cooperate in the area of infrastructure development as well as streamlining procurement procedures. Further, the hospitals management in collaboration with the national and county governments should employ adequate staff in the hospitals.