Thesis:

Influence of institutional capacity on implementation of the universal health care in Kenya: case of social health authority

The implementation of Universal Health Care (UHC) in Kenya has faced critical setbacks despite the government's commitment through the Big Four Agenda. The purpose of the study is to assess how key dimensions of institutional capacity, including human resource capacity, financial capacity, healthcare infrastructure, and policy and governance, affect the successful implementation of UHC. Guided by four specific objectives, the study aims: to assess the influence of human resource capacity, to evaluate the effect of financial capacity, to examine the role of healthcare infrastructure, and to analyze the influence of policy and governance on UHC implementation in Kenya. The significance of this research lies in its potential to inform policy adjustments, institutional reforms, and strategic investments necessary for realizing universal, equitable, and affordable healthcare access. It is particularly valuable to government entities, healthcare administrators, development partners, scholars, and the general public. The research is grounded in two complementary theories: the Public Policy Implementation Theory, which explains the translation of policy intentions into actionable outcomes, and Systems Theory, which provides a holistic understanding of how various institutional components interact to influence policy execution. A descriptive research design was adopted, targeting 268 employees of SHA's headquarters in Nairobi. Using stratified random sampling, a sample size of 160 respondents was determined through Yamane’s formula. Data was collected using semi structured questionnaires, organized to capture the core variables of the study. Piloting, as well as reliability and validity checks, were conducted to ensure quality and credibility of the research instruments. Data analysis was done using SPSS version 23.0 and MS Excel. Descriptive statistics such as frequencies and means were used to summarize the data, while inferential statistics, including Pearson correlation and multivariate regression, were employed to test relationships between variables. Results are presented in tables, charts, and graphs for clarity and interpretation. The findings revealed a strong, positive relationship between institutional capacity components human resource capacity, financial capacity, healthcare infrastructure, and policy and governance and the successful implementation of UHC. Specifically, human resource capacity (β = 0.236, p < 0.05), financial capacity (β = 0.215, p < 0.05), healthcare infrastructure (β = 0.198, p < 0.05), and policy and governance (β = 0.221, p < 0.05) were all significant predictors of UHC outcomes. The model explained 73.6% of the variance in UHC implementation, underscoring the critical role of institutional readiness in health system reforms. The study concluded that strengthening institutional capacity is essential for effective UHC implementation. Gaps in staffing, delays in financial disbursements, inadequate infrastructure, and weak governance mechanisms continue to hinder service delivery under SHA. Accordingly, the study recommended the recruitment and retention of qualified personnel, enhancement of financial planning and budget utilization, investment in modern health infrastructure, and establishment of robust policy and governance frameworks. These measures are crucial for achieving equitable, accessible, and sustainable healthcare services across Kenya.