Revenue Decentralization and Healthcare Service Delivery in Turkana County, Kenya
DOI:
https://doi.org/10.47672/ajppa.2734Keywords:
Revenue decentralization, Healthcare service deliveryAbstract
Purpose: This study examined the effect of revenue decentralization on healthcare service delivery in Turkana County, Kenya.
Materials and Methods: Using a mixed-methods approach, the research collected data from 271 respondents, including county health and finance officials, hospital administrators, and community health representatives.
Findings: The findings reveal that revenue decentralization significantly improves healthcare service delivery, with a one-unit increase in revenue decentralization leading to a 0.49-unit improvement in healthcare outcomes. However, delays in budget disbursement (averaging 5.11 months) and reliance on external revenue sources (36.9% tax autonomy) highlight challenges in financial sustainability and resource allocation. Qualitative responses underscore both the benefits of increased autonomy and access to funding, as well as the drawbacks of concentrated financing and disparities in rural healthcare access. The study concludes that optimizing tax autonomy mechanisms, strengthening intergovernmental grants, and improving financial management are critical to enhancing the positive effects of revenue decentralization. These findings contribute to the broader discourse on fiscal decentralization and its potential to address healthcare inequities in marginalized regions.
Unique Contribution to Theory, Practice and Policy: To improve healthcare in Turkana County, enhance revenue decentralization by refining tax autonomy, increasing equitable intergovernmental grants, and addressing rural disparities. Implement 'nomadic health vouchers' using 15% of decentralized revenues and 'fiscal health compacts' to reduce budget delays. Ensure autonomy, accountability via blockchain, and drought-responsive budgets work together to boost accessibility and patient support, transforming fiscal policy into a tool for healthcare justice, especially for mothers and herders facing long waits and travel for care.
Downloads
References
Alharahsheh, H. H., & Pius, A. (2020). A review of key paradigms: Positivism VS interpretivism. Global academic journal of humanities and social sciences, 2(3), 39-43.
Assefa, D. (2015). Fiscal Decentralization in Ethiopia: Achievements and Challenges. Public Policy and Administration Research, 5(8), 27-40.
Barasa, E. W., Manyara, A. M., Molyneux, S., & Tsofa, B. (2017). Recentralisation within decentralization: county hospital autonomy under devolution in Kenya. PloS one, 12(8), e0182440.
Barasa, E., Mbau, R., & Gilson, L. (2023). Operationalizing accountability in decentralized health systems: Evidence from Kenya. Health Policy and Planning, 38(2), 215-228.
Bashaasha, B., Najjingo Mangheni, M., & Nkonya, E. (2013).decentralization and rural service delivery in Uganda.
Beazley, I., Dougherty, S., James, C., Penn, C., & Phillips, L. (2019). Decentralisation and performance measurement systems in health care.
Buchanan, J. M., & Tullock, G. (1962). The calculus of consent: Logical foundations of constitutional democracy. University of Michigan Press. https://doi.org/10.3998/mpub.7687
Castleberry, A., & Nolen, A. (2018). Thematic analysis of qualitative research data: Is it as easy as it sounds?. Currents in pharmacy teaching and learning, 10(6), 807-815.
Cooper, D., & Schindler, P. (2010). Business Research Methods New York: McGraw.
Jensen, M. C., & Meckling, W. H. (1976). Theory of the firm: Managerial behavior, agency costs and ownership structure. Journal of Financial Economics, 3(4), 305-360. https://doi.org/10.1016/0304-405X(76)90026-X
Mabokova, E. (2020). Revenue Decentralization and the Quality of Healthcare in Tanzania. African Development Review, 32(2), 357-373.
Mabokova, E. (2020). Revenue Decentralization and the Quality of Healthcare in Tanzania. African Development Review, 32(2), 357-373.
Mejia Acosta, A., & Tillin, L. (2019). Negotiating universalism in India and Latin America: Fiscal decentralization, subnational politics and social outcomes. Regional & Federal Studies, 29(2), 115-134.
Musgrave, R. A. (1959). The theory of public finance: a study in public economy (Vol. 658). New York: McGraw-Hill.
Mwamba, C., Lemba, J., & Bwalya, K. (2022). Digital platforms for decentralized health systems in Africa: Evidence from six countries. The Lancet Global Health, 10(4), e543-e553.
Oates, W.E. (1972). Fiscal Federalism. Harcourt Brace Jovanovich, New York.
Oppong, F. (2020). Fiscal Decentralization and Autonomy of Subnational Entities in Ghana (Doctoral dissertation, University of Pretoria).
Organisation for Economic Co-operation and Development. (2023). Subnational government financial management in health decentralization.
Panda, B., & Thakur, H. P. (2016). Decentralization and health system performance–a focused review of dimensions, difficulties, and derivatives in India. BMC health services research, 16(6), 1-14
Tambulasi, R. I. C. (2011). Policy transfer and service delivery transformation in developing countries: the case of Malawi health sector reforms. The University of Manchester (United Kingdom).
Wanjau, K. N., Muiruri, B. W., & Ayodo, E. (2012). Factors Affecting Provision of Service Quality in the Public Health Sector: A Case of Kenyatta National Hospital; International Journal of Academic Research in Business and Social Sciences, 2(13), 114–125.
World Bank. (2023). decentralized health systems in Sub-Saharan Africa: Lessons from 15 countries (Report No. 135791). World Bank Group.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 James Kinjanzi Sirite, Prof. David Minja, Dr. Jane Njoroge
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
