Determinants of implementation of county health programme: a case of Turkana west sub county, Kenya

Abstract

Centralization has been at the core of Kenyan governance since independence with power concentrated in the capital. As a result, Kenya has been marked by spatial inequalities during this period of time. It is against this backdrop that healthcare devolution is currently taking place in Kenya. The Kenya Health Policy 2012 – 2030 provides guidance to the health sector in terms of identifying and outlining the activities in achieving the government‘s health goals. Most Counties in Kenya, since the devolution of health sector, are faced with challenges ranging from the referral systems, decentralization of staffing roles and the implementation of the devolution process. It is important to recognize that implementation of County health programme is critical to the attainment of the highest possible health standards in a manner responsive to the population needs. The purpose of the study was to establish the determinants of implementation of County Health programme in Turkana West Sub County. The objectives of the study was to establish the influence of financial resources on the implementation of County health programme, explore the extent to which human resource capacities influence the implementation of County health programme, to determine the extent to which stakeholders support influence the implementation of County health programme and to establish the extent to which infrastructure influence implementation of County health programme. The study was conducted in Turkana West Sub County on 96 health facilities‘ staff and 4 Sub County Health Management Team members. The study employed a descriptive cross sectional design. Validity was ensured through pilot testing and seeking the experts‘ judgment while reliability was established through test pretest and checking the consistency of the responses to the questions. Data collection involved administration of questionnaires and conducting Key Informant Interviews. Quantitative data was coded, entered and analyzed using frequency counts and percentages, with the aid of SPSS Version 17 and Microsoft excel. The data was presented using tables. Qualitative analysis involved grouping the data with similar content as per thematic areas then analyzing by cross referencing. The study established that the County health programme is currently underfunded with 86 (90%) of the respondents stating that the funding level is inadequate to support the health programme. Further analysis showed that source of funding influence the implementation of the County health programme (P<0.05) and that adequacy of financial resources as a single factor may not significantly have any influence (P>0.05). The study also established that the health programme is understaffed with 69 (72%) of the respondents stating that staffing level is inadequate to support the health programme. The study revealed that stakeholders currently play an important role with 89 (93%) of the respondents acknowledging that stakeholders support the implementation of the County health programme. The study recommends that health planners should explore various healthcare financing reforms like improving allocation, proper management of existing health resources and increase the role of private sector in healthcare. Ensure equitable distribution of staff by numbers and cadres, their skills development and motivation. There is need for active engagement with stakeholders in planning and implementation health service delivery activities including resource mobilization to bridge financial gaps. Support infrastructure development for the County health programme and put in place mechanisms for regular maintenance of medical equipments. The researcher recommends that further studies need to be conducted on the factors influencing the effectiveness of Turkana County Health programme, determinants of health staff performance in the County and cost recovery health financing approach in hard to reach populations of Turkana County.