Effects of devolution on healthcare system performance in Machakos County Level 5 Hospital, Kenya

Background: Globally, there has been a trend of devolving services from the National governments to local governments in order to enhance efficiency, effectiveness, equity, responsiveness, and community participation at the grass root levels. This study evaluated the effects of devolution on healthcare system performance in Machakos Level 5 Hospital in Machakos County. Specifically, it evaluated the effects of devolution on healthcare systems performance on healthcare infrastructure, workforce adequacy and workforce satisfaction.Methods: Descriptive cross-sectional study design was used, with mixed methods of data collection of data collection (quantitative and qualitative).Results: The analyzed results revealed that healthcare infrastructure, workforce adequacy and workforce satisfaction improved post devolution period to a great extent. From the inferential statistics analysis, there was a significant improvement in all the three objectives post devolution i.e., p<0.05.Conclusions: Devolution of healthcare system improved the performance of Machakos County Level 5 Hospital. Recommendations were made to roll out the UHC program countrywide, equip all departments, employ more staff, enforce the referral system, similar study be conducted in other county referral hospitals, and similar study be conducted with a focus on other healthcare building blocks. 