Thesis:

Analysis of public policy implementation on the performance of healthcare devolution in Homabay county, Kenya

Despite ongoing efforts by the government and non-governmental organizations, Kenya's health infrastructure remains underdeveloped, prompting economists and public policy experts to explore ways to improve service delivery and enhance the quality of life. Devolution has emerged as a key strategy for achieving these goals, directly influencing people's quality of life and extending its effects beyond mere service provision. However, county governments often prioritize economic efficiency over effective service delivery. This study focused on the state of healthcare facilities in Homa Bay County, which face significant challenges such as inadequate ward spaces, insufficient beds, and a lack of specialized units like intensive care units (ICUs). The purpose of the study is to examine the public policy implementation on the performance of healthcare devolution in Homa Bay County, Kenya with specific objectives, to assess the effect of bureaucratic practices on the performance of healthcare devolution in Homa Bay County, Kenya, to determine the effect of citizen engagement approaches on the performance of healthcare devolution in Homa Bay County, Kenya, to evaluate the effect of health care infrastructure on the performance of health care devolution in Homa Bay County, Kenya and to examine the effect of funding and expenditure on the performance of healthcare devolution in Homa Bay County, Kenya. The research targeted public health professionals, including nurses and administrators from county and sub-county hospitals across nine constituencies. The researcher Employed descriptive survey design, the study used both qualitative and quantitative methods to gather data from 162 respondents, including hospital managers, clinical officers, nurses, and health record officers. The analysis involved descriptive statistics, such as frequencies and percentages, alongside inferential statistics, including Pearson correlation and multiple regression analysis. Findings indicate relationships among healthcare devolution, citizen engagement, bureaucratic practices, funding, and infrastructure. Notably, a moderate positive correlation exists between healthcare devolution and citizen engagement (r = .504, p = .000), suggested that increased devolution fosters community involvement. Additionally, significant correlations between funding and health infrastructure (r = .420, p = 0.000) highlight the importance of adequate financial resources for quality service delivery. Recommendations included streamlining bureaucratic processes, enhancing citizen engagement, improving financial oversight, and investing in healthcare infrastructure to ensure responsive and effective service delivery in Homa Bay County.