Effects of Devolution on Maternal Health Care: The Case of Level Four Hospitals in Nairobi City County, Kenya
Authors: Bulinda Hudson Shilibwa , Kiruthu Felix 
Published: July 2019

Maternal healthcare is an integral part of the Millennium development goals. However, most developing countries have been experimenting with different types of interventions to increase access and utilization of maternal care services. Health care devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. Thus, this study assessed the effects of devolution on maternal health care in Nairobi City County in Kenya. Particularly, the study examined the situation of maternal healthcare before and after devolution and how devolution as affected provision of maternal healthcare in Nairobi City County. The study also assessed how devolution affected maternal health care programs implementation and the challenges facing the devolved maternal health care in Nairobi City County. The study adopted the systems approach and the decentralization theorem. This study employed a descriptive research design and the population of the study was made up of the 4 level four hospitals in Nairobi County and all the 189 selected medical health workers in the hospitals. A sample of 57 respondents was selected through simple random sampling. Additionally, the study used questionnaires and an interviews guide to collect data. The questionnaires were administered to the sampled medical workers and the interviews schedules were administered to the key informants who comprised of the medical superintendent from every hospital. Quantitative data was collected through the use of the questionnaires was analyzed using descriptive statistics with the aid of the Statistical Package for Social Sciences. Qualitative data was analyzed using content analysis. The study found that the status of maternal healthcare infrastructure under devolution of health services in Nairobi was good. The findings also established that most health workers preferred that the national government should manage maternal health care infrastructure as opposed to county governments. The study further revealed that county governments had not instituted and implemented effective maternal healthcare programs formulated by the national government. Finally, the study concludes the major challenges influencing the implementation of maternal healthcare services include attitude and perception of health professionals, resistance of devolution by health workers, strikes by health workers, shortage of healthcare workers corruption and tribalism, increased pressure on hospital equipment and infrastructure and stock outs of essential commodities in the facilities affect devolved maternal health care. The study recommended that both the county and national government should work together and combine their efforts to enhance the devolved systems of healthcare so that they can enhance maternal healthcare.
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