KENYATTA UNIVERSITY

POLICY IMPLEMENTATION AND SERVICE DELIVERY IN HOMA BAY

COUNTY HEALTH SECTOR, KENYA

DAVID OCHIENG’ GEORGE

C153/CTY/PT/25962/2018

A RESEARCH PROJECT SUBMITTED TO THE SCHOOL OF HUMANITIES

AND SOCIAL SCIENCES IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF
PUBLIC POLICY AND ADMNISTRATION, KENYATTA UNIVERSITY

SEPTEMBER, 2021
 DECLARATION AND RECOMMENDATION PAGE

Declaration by candidate

This research project is my original work and has not been presented for a degree in any
other university.

Signature _____________________ Date __________________

David Ochieng’ George

C153/CTY/PT/25962/2018

This research Project has been submitted for examination with my approval as the
University Supervisor.

Signature ______________________ Date __________________

Dr. Hannah Bula
Department of Business administration

ii
 DEDICATION

This research is dedicated to my family; Mr. and Mrs. Otieno, Edgar, Steve, Grace,
Shalom and Moses.

iii
 AKNOWLEDGEMENT

This research is a product of concerted efforts by individuals, institutions and

organizations in varied proportions. It may be impossible to thank here all parties who

contributed to this maiden body of work with invaluable inputs, but I do take this earliest

opportunity to convey my sincere gratitude to all those who participated and saw me

through this journey. However, there are a few who played special roles which I wish to

singly acknowledge.

The first acknowledgment is to my family; Dad and mum for the financial and divine

cover at every stage of this study, my siblings for providing great moral support and their

fervent prayers. To my supervisor Dr. Hannah Bula who I believe was God-sent, she took

me through this journey from the start when I was a novice up until now. This work could

not have taken shape and content were it not for your due diligence and dedicated

guidance.

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 TABLE OF CONTENTS
DECLARATION AND RECOMMENDATION PAGE ............................................... ii
DEDICATION.................................................................................................................. iii
AKNOWLEDGEMENT.................................................................................................. iv
TABLE OF CONTENTS ................................................................................................. v
LIST OF TABLES ......................................................................................................... viii
LIST OF FIGURES ......................................................................................................... ix
ABBREVIATIONS AND ACRONYMS ......................................................................... x
DEFINITION OF TERMS.............................................................................................. xi
ABSTRACT ..................................................................................................................... xii
CHAPTER ONE: INTRODUCTION ............................................................................. 1
1.1 Background of the study ........................................................................................... 1
1.1.1 Policy Implementation........................................................................................ 1
1.1.2 Service delivery .................................................................................................. 6
1.1.3 Health sector in Homabay County.................................................................... 10
1.2 Statement of the problem ........................................................................................ 10
1.3 Objectives of the study ............................................................................................ 12
1.4 Research questions .................................................................................................. 12
1.5 Justification and significance of the study .............................................................. 13
This study is significant to decisionmakers and the academia. ................................. 13
1.5.1 Government/Policymakers ............................................................................... 13
1.5.2 Scholars ............................................................................................................ 14
1.5.3 The community ................................................................................................. 14
1.6 Scope and Limitations of the study ......................................................................... 14
CHAPTER TWO: REVIEW OF RELATED LITERATURE ................................... 15
2.1 Introduction ............................................................................................................. 15
2.2 Bureaucratic Practices and Service Delivery .......................................................... 15
2.3 Citizen engagement approaches and service delivery ............................................. 18
2.4 Resource mobilization and service delivery............................................................ 21
2.5 Theoretical Framework ........................................................................................... 22

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 2.5.1 Max Weber’s Bureaucracy ............................................................................... 23
2.5.2 Participatory Democratic Theory ..................................................................... 24
2.5.3 Resource Mobilization Theory ......................................................................... 25
2.6 Conceptual Framework ........................................................................................... 26
CHAPTER THREE: RESEARCH METHODOLOGY ............................................. 28
3.1 Introduction ............................................................................................................. 28
3.2 Research Design ...................................................................................................... 28
3.3 Variables/Categories of Analysis ............................................................................ 28
3.4 Site of the Study ...................................................................................................... 29
3.5 Target Population .................................................................................................... 30
3.6 Sampling Techniques and Sample Size .................................................................. 30
3.7 Sampling frame ....................................................................................................... 31
3.8 Research Instruments .............................................................................................. 31
3.9 Validity .................................................................................................................... 32
3.10 Reliability .............................................................................................................. 32
3.11 Data Collection Techniques .................................................................................. 33
3.12 Data Analysis Procedures...................................................................................... 34
3.13 Logistical and Ethical Consideration .................................................................... 35
CHAPTER FOUR: RESEARCH FINDINGS AND DISCUSSION .......................... 36
4.1 Introduction ............................................................................................................. 36
4.2 Response Rate ......................................................................................................... 36
4.3 Background Information ......................................................................................... 37
4.3.1 Gender .............................................................................................................. 37
4.3.2 Age of respondents ........................................................................................... 37
4.3.3 Level of education ............................................................................................ 38
4.3.4 Work experience ............................................................................................... 39
4.4 Descriptive Analysis of study variables .................................................................. 39
4.4.1 Bureaucratic practices....................................................................................... 39
4.4.2 Citizen engagement approaches ....................................................................... 41
4.4.3 Resource mobilization ...................................................................................... 42
4.4.4 Service delivery ................................................................................................ 44

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 4.5 Inferential Statistics ................................................................................................. 44
4.5.1 Regression analysis........................................................................................... 44
4.5.2 Analysis of Variance (ANOVA) ...................................................................... 45
4.5.3 Coefficients Analysis ........................................................................................ 46
4.6 Qualitative analysis ................................................................................................. 48
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS .. 50
5.1 Introduction ............................................................................................................. 50
5.2 Summary of findings ............................................................................................... 50
5.2.1 Bureaucratic practices....................................................................................... 50
5.2.2 Citizen engagement approaches ....................................................................... 51
5.2.3 Resource mobilization ...................................................................................... 51
5.3 Conclusions ............................................................................................................. 51
5.4 Recommendations ................................................................................................... 52
5.5 Suggestions for further Study.................................................................................. 53
REFERENCES ................................................................................................................ 54
APPENDICES ................................................................................................................. 58
Appendix I: Letter of Introduction ............................................................................. 58
Appendix II: Questionnaire for patients ...................................................................... 59
Appendix III: Interview Schedule for Hospital Health Records officers and Hospital
administrators ....................................................................................... 66
Appendix IV: Approval of Research Project Proposal from Kenyatta University
Graduate School ................................................................................... 68
Appendix V: Research Authorization from Kenyatta University Graduate School ... 69
Appendix VI: Research Authorization Letter from Ministry of Education ................. 70
.............................................................................................................. 70
Appendix VII: Research Permit from NACOSTI ........................................................ 71

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 LIST OF TABLES
Table 3.1 Target Population .............................................................................................. 30
Table 3.2: Sample size ...................................................................................................... 31
Table 3.3 Reliability Test Results ..................................................................................... 33
Table 4.1: Bureaucratic Practices ..................................................................................... 41
Table 4.2 : Citizen engagement approaches...................................................................... 42
Table 4.3: Resource mobilization ..................................................................................... 43
Table 4.4: Service delivery ............................................................................................... 44
Table 4.5: Model Summary .............................................................................................. 45
Table 4.6: ANOVAa .......................................................................................................... 45
Table 4.7: Coefficientsa..................................................................................................... 46

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 LIST OF FIGURES

Figure 2.1: Conceptual Framework .................................................................................. 27

Figure 3.1: Map of the study area ..................................................................................... 29
Figure 4.1: Age of the respondents ................................................................................... 37
Figure 4.2: Level of education of respondents.................................................................. 38
Figure 4.3: Work experience............................................................................................. 39

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 ABBREVIATIONS AND ACRONYMS
AU African Union
CDF Constituency Development Fund
CIDP County integrated Development Plan
CPSI Center for Public Sector Innovation
CSO Client Service officers
DOL Department of labor
ERS Economic Recovery Strategy
HIV Human immunodeficiency virus
ICU Intensive care unit
IEA Institute of Economic Affairs
KMA Kumasi Metropolitan Assembly
MES Managed equipment services
MTP Medium Term Plan
MTPS Medium Term Plans
NACOSTI National Commission for Science, Technology and innovation
NARC National Rainbow Coalition
OECD Organization for Economic Co-operation and Development
PPP Public Private Partnership
PSDIS Public Service Delivery Innovation Strategy
RBM Result based management
SME Subject Mater Expert
UHC Universal Healthcare
UN United Nations
UNDP United Nations Development Programme
WSP Water service provider

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 DEFINITION OF TERMS
Citizen engagement approaches: These are forms of interactions between citizens and
their authorities. It happens across the phases of the
development or government policy implementation and public
service delivery.

Health services: An array of medical services that influence health, they

comprise mental and physical illnesses.

Policy implementation: Executing laws or decisions in which various stakeholders and

organizations work collaboratively to ensure policies are put
into effect with the main aim of attaining policy goals.

Public policy; Refers to the guide action to remedy certain social problems.

Quality of service: This is the degree by which health services provided to the
citizenry are aligning to the of projected health outcomes

Resource mobilization: This refers to the how the government organizations obtain and
mobilize or allocate and raise revenue to the benefit of the

Service delivery: Set institutional frameworks that are adopted by administration

to provide public goods and services to its countrymen.

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 ABSTRACT
Kenya lags in various global health sector targets one of them being the implementation
of 2001 Abuja declaration pledge that sought to ringfence 15 percent of government
budgets on public healthcare. For the year 2001/02, it only managed a high of 8 percent
share, after which the share was at about 5 to 7 percent range from 2013/2014 to
2015/2016. Kenya also performed way below the World Health Organization (WHO)
benchmark for annual expenditure on basic healthcare of $64 per person. Kenya's annual
per capita health expenditure in 2015/16 was estimated at US$25.1 per person. In the
Homa Bay health sector, there are a range of problems ranging from underfunding of the
sector to 24 percent and 27 percent in the 2016/17 and 2017/18 financial years,
respectively, scarcity of workers in health facilities, deficits of drugs. This study sought
to interrogate the influence of policy implementation on service delivery of the healthcare
sector in Homa Bay County. Particularly, the study sought to establish the effect of
bureaucratic practices, citizen engagement approaches and resource mobilization on
service delivery in health sector in Homa Bay County. The research was based on the
1921 Bureaucracy Theory of Max Weber, Carole Pateman's Participatory Democratic
Theory and Buechler's Resource Mobilization Theory (1995). A descriptive research
design was adopted by the research. Hospital staff, medical record officers and patients
were the target population. It will target a total of 1100 respondents. A 110-sample size
was used. Collected data was then analyzed using inferential and descriptive methods and
illustrated in figures and tables, a structured questionnaire and interview schedule was
used. For this research, a multivariate regression analysis was then adopted. The results
revealed that bureaucratic practices, citizen engagement approaches and resource
mobilization are key determinants of service delivery in the healthcare sector in Homa
bay county. The study recommends that the county government should prioritize timely
payment of salaries to healthcare workers so as to enhance the morale to provide quality
services to the people. Further, the county should enhance technology in the healthcare
facilities to assist both in records management and revenue collection.

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 CHAPTER ONE

INTRODUCTION

1.1 Background of the study

This study’s background is founded in terms of global, regional, local and Homa Bay

County perspectives of policy implementation and service delivery. The needs and wants

that informed this study is outlined in the problem statement. The following also forms

part of this chapter: Specific objectives which will guide the study, research questions

which will be answered in the study justification of the study where the target

beneficiaries are outlined and the scope of the study.

1.1.1 Policy Implementation

In the United States, policy implementation crucial research began in the 1970’s as a

response to the very soaring concern over the execution and effectiveness of wide-

ranging programs on reform (Futzl and Oliver, 2007). As policies were lagging behind

the policy expectations the process of translating policy into reality attracted more focus

(Barrett, 2004). Various studies on public policy implementation have always given

much attention to describe the gaps in policy implementation. Although the issue of

policy implementation gaps has been of greater concern to most social scientists, it has

not been the case for decision makers who have invariably equated proposing policy to its

disposal (Dunsire, 1978). The idea that the process of policy making is divided into

stages was developed in 1970. Whereas there have been discussions as to the meaning

and the number of phases, conclusively they comprise agenda setting, policy formulation,

implementation and evaluation. The phases allow research to give attention to specific

1
parts of the policy process and have proved to be useful as an analytical took in research

(Laswell, 1970).

Studies in implementation thrived after the pathbreaking seminal publications in early

1970’s and 1980’s by resource scholars such as (Pressman and Wildavsky, 1973). This

aided in understanding various approaches in policy implementation including top down

and bottom-up approaches which was of importance prior to trying to analyze and

understand the process of policy implementation. Top-down approach in the

understanding of public policy implementation started off with Pressman and Wildavsky

(1973 and 1984) who came up with policy as goal setting and policy implementation

study as exploring what makes the goals difficult to attain. Their proposed remedy

involved the concept of ‘implementation charm’ positing that the more fragmented the

cooperation among organizations required to function collaboratively to execute policy

the more probably there would be issues arising in the implementation phase.

Van Meter and Van Horn (1975) advanced higher by proposing a model approach that

was grounded on the assumption that policy implementation is expected to be realized

when there is a high goal consensus and only marginal shift is needed. In this approach

there was alignment between goals (objectives and standards) that leads to the

considerable variables influencing implementation outcomes. Studies on implementation

approaches continued to be undertaken by various scholars such as Sabatier and

Mazmanian (1980) who took a prescriptive approach in which emphasis was made on the

important aspect of feedback process (Sabatier, 1986). It also included a clear deviation

between formulation of policy and its implementation. Hjern and Porter (1981) gave

focus on structures of implementation. They focused on street level actors who make

2
decisions autonomously on implementation, while policy networks address general ideas

of formulation. The concern here was on how accountability might be improved.

When African states began sliding into economic crisis it became commonplace that the

causes of the economic doldrums lie in the life public policies. Just the mere existence of

well formulated policies does not necessarily result in the successful execution. In South

Africa, since 1994, the department of health and the post-apartheid government

administration have formulated policies and legislative pieces that directly or indirectly

impact on the delivery of health service in the country. A considerable number of policy

documents are received timeously by hospitals from the national offices, the provincial

departments and local government, however, most of these policies have not been

implemented as required. These health policies have a direct bearing on delivery of

services in the health sector health personnel financial matters, acquisitions of medium

and food stuffs (Couper, 2000).

In Nigeria, the country is perceived to be currently deep in poverty, there is absence of

primary social amenities and underdevelopment not because of lack of suitable public

policies but because implementation is the Achilles Heel in the Nigerian republic. An

excursion into the history of public policy in Nigeria shows that if all the formulated

policies were accordingly implemented, Nigeria would no doubt be on the fast lane of

development. It is however, a quandary that most of these policies only exist on paper

and are never given life to actualize their objectives as stipulated. Policy implementation

field in Nigeria is adversely overlooked by lack of political goodwill, poor policy design

and conception, poor leadership and management, corruption, lack of adequate resources,

3
culture and religion and misplaced priorities. This is the puzzle of public policy that has

ailed Nigerian state in the past and the present (Paki and Ebiefna, 2011).

Ggoobi (2016) while discussing implementation of policy in Uganda, noted that policy

fail in the country due to various reasons including neglecting the rural regions, policy

design and planning devoid of proper leadership. Further, the government also imposes

policies without putting consideration whether it meets the need of the citizenry or not.

However, the current fashion in Africa is adoption of foreign remedies to its issues and

the execution of such policies more often than not end up undermining the local

intellectual resource capacity to intervene on local problems. This has deepened further

the deprivation of local skills and denied them of the opportunity to solve issues arising

on their own terms. This also includes failure of decision makers to consider political,

social, administrative and economic environment hence leading to policy dilemma.

If all the socio-economic public policies established in Kenya after independence were to

be completely enforced, there is no doubt that the economy of the nation would be among

the newly individualized economies not only on the continent but worldwide. The

enforcement of those policies would have resulted in a thriving manufacturing sector, an

increase in the number of job opportunities and an enhanced health care system, a well-

developed transport system, access to clean water and sanitation, low levels of poverty in

the country and other positive changes in the evolving economy. There is an excellent

consistent feature in the analysis and evaluation of a number of these past and present

policies that clearly distinguishes the policy making process in Kenya. This is an aspect

of the problem of strategy. The policy cycle includes a variety of steps, with formulation

and execution being the most pronounced. The state of formulation simply requires

4
stakeholder contributions and the implementation cycle depends on the productivity rate

of states, agencies, ministries and state departments (Wasilwa, 2017).

Session paper No. 10 of 1965: Kenya's first all-encompassing development blueprint:

African socialism and its application to planning in Kenya narrowly highlighted the

courses of action to be taken to direct the developing economy of the country, with the

public sector and private sectors playing an integral role in the implementation phase.

This policy was to solve three major challenges namely; poverty, ignorance and disease

this implied on a large scale that every Kenyan was to access education, better living

standards and affordable healthcare. Many gains were made from this initiative however,

its implementation was sabotaged by both internal and external forces along the way

(Zeleza, 1991).

Fast forward to 2003, Narc’s administration, great heed was paid in resuscitating the

country’s economy. To realize this a policy document was created ‘The Economic

recovery strategy (ERS) for wealth creation’ for the period between 2003 and 2007. The

policy paper projected an economic growth rate of 7% upon the completion of the

administration first term in which it was implemented. In the year 2007 the country’s

economy soared by 7%, this was a clear token that the policy framework was

implemented effectively (UNDP, 2012).

As the period of time ERS implementation was elapsing, the sessional paper No.10 of

2012 on Kenya’s vision 2030 was composed. Its main objective was to catapult the

county into a middle-income economy by mainly investing in key infrastructural projects

and the manufacturing sector. The implementation of vision 2030 was planned to occur in

5
three phases christened as Medium-Term Plans, MTPS. Earliest MTP was for the period

between the years 2008 and 2012, the subsequent MTP was between 2013 and 2017. To

this extent some major progress is taking place particularly the construction of

infrastructural projects certain ground playing has been overlooked for example the

government has not been committed in heavily investing in the manufacturing sector to

achieve the objectives of vision 2030 remains an illusion. Considering how the process of

implementation is being executed. With proper policy implementation it is without a

doubt that most of the recurrent issues in the county will fully be solved (RoK, 2012).

1.1.2 Service delivery

The society is facing challenges both social and economic which are complex and are

majorly, characterized by disease pandemics, conflict, poverty, food insecurity, and

unemployment and environment degradation. Whereas governments over the years have

formulated policies and programs to alleviate these ever increasing, challenges, their

complexity need more innovative models in order to assuage human suffering and

achieve social and economic advancement. Until now, governments globally embarked

on a journey to transform public service, to ensure its responsive and effective in

realizing social and economic growth. Many countries globally have formulated policies

and strategies to promote service delivery innovation and improve the capability of the

civil service as a government institution. These countries have made impressive

milestones. Singapore has emphasized on improvement and innovation through

continuous empowerment, engagement and personal responsibility. South Africa

established the center for public sector innovation (CPSI) which was mandated to identify

6
measure and support innovation in the civil service to improve on the country’s public

service delivery (RoK, 2017).

In administrative studies, the concept of service delivery has occupied a very important

space. Providing services to people, optimizing social benefits and improving social

interests are the objectives of a public institution which derives its authority from the law.

A government's primary responsibility is to deliver goods and services to citizenry, such

as education, security, health and social protection (Ruchelman, 1989). In Democracies

world over, governments are obligated, by central bodies and legal governments, to

ensure the delivery of these services. Public services are described as those services that

are primarily and entirely financed by taxation. These services vary in different ways and

forms from the commercially focused private sector. Public services are generally based

on services rendered by the government through its agencies without being profit-

oriented (Humperes, 1998).

UNDP (1990) propounds service delivery is defined as a set of structures deployed by

governments to provide its people with public goods and services. Seidle (1995) notes

that, the requirements of efficiency, accessibility and responsiveness provide reliable

delivery of public services to residents. If the above requirements are missing in service

delivery systems, it cannot be regarded as a quality public service delivery. There are

various general models of service delivery arrangements used by states everywhere and

have been implemented worldwide. They consist of direct service delivery, privatized

service delivery, decentralized, and alternative service delivery model (Pradeep, 2011).

7
According to Convention 21 (2) of the UN Declaration of Human Rights, all persons

have express rights to enjoy fair public services. The provision of public services is also

seen as a basic way of fulfilling their rights and freedoms (Waldt, 2004). The OECD

(1990) has also defined the rights of citizens who pay government taxes. Citizens have

the right to be adequately informed, supported and listened of their problems, the right to

privacy, right to appeal, right to protection, confidentiality and privacy. In every

situation, service providers misuse these rights or there is a crisis in the receipt and

enjoyment of public services.

In Sri Lanka, for example, the country like many other states both developed and

developing over the last century, occupies a crucial position. The number of institutions

at the national level in the provision of public services can be immense, influencing the

daily citizen actions at the grassroots. Many civil service bodies are set up to manage the

vast majority of citizenship obligations. They either directly/indirectly have a duty to the

government and people. In Sri Lanka, under the central government, government

agencies and departments work to provide public services. They include ministries,

authorities, parastatals, administrative offices and others. However, each public office

offers services to the public in accordance with government policy, they face a multitude

of disadvantages in order to efficiently carry out their mandate (Abdul and Fathima,

2014).

In a policy sense, during the period between 1995 and 1996, South Africa underwent a

major review of its policies. This is regarded as the age of white paper. The era was

succeeded by a time of an emphasis on the provision of services between 1997 and 2003,

with a focus renewed towards implementation by the then head of state, Thambo Mbeki,

8
much emphasis has recently been allocated to public service delivery, especially in local

government. (Brynard, 2005).

In Tanzania, access to fundamental public services is regarded as a major factor of human

development and productivity. It is a prerequisite for ensuring the wellbeing of the

country’s citizens. However, access to basic services by the public servants is an anguis

herba in many developing economies. Regardless of the steady economic growth

averaging 7% the past decade, Tanzania has continued to encounter substantial

development drawbacks. The government has instituted a variety of measures consistent

with its undying commitment to the National development Vision, 2025. Among other

models the government has sought to enhance significantly the delivery of public services

through legal, administrative, labor and financial amendments whose focus is on

performance of civil servants, transparency and accountability (Lufunyo, 2013).

In Kenya, local authorities were mandated with the responsibility of service delivery that

cut across infrastructural development, garbage collection, maintenance of roads, and

development of markets with limited responsibility in education and health. The new

devolved units which were introduced in 2013 after March general elections assumed

most of these functions and some more. The desire to enhance service delivery in Kenya

originated from the economic recovery strategy 2003 – 2007. The economic strategy was

taken up by the NARC Government which had taken over the reins on the platform of

reforms this was due to a decline in economic performance and public service delivery in

the previous regime and the quality of life (GoK, 2003).

9
Hasnain (2010), states that since there was a continued outcry in the delivery of public

services the current government introduced Huduma Centre Kenya which was its flagship

initiative that sought to address the Kenyan constitution need which is based on

admission and quality to government services. According to Oyugi (2015), Huduma

services were introduced by the government so as to improve the accessibility of public

services by all and sundry. Therefore, this is attained by creating a link between digital

devices like mobile phones, computers, tablets among others state departments.

1.1.3 Health sector in Homabay County

According to PIMA (2017) study report in 2015 almost 59% of the population had

malaria.40% of children were not delivered from health facilities making it even more

difficult follow up maternal and child health needs in the county. Almost half of the

children between the ages of 12-23 months were not immunized fully hence complicating

the health needs of the communities and families. The county also bears burden of the

HIV scourge (second highest in the nation) with adult prevalence of 26% in 2013 relative

to countrywide 6% average and this figure is 4.6 times higher. New infections were

15003 which constitute the national figure and the mother-to-child HIV transmission rate

was 9 percent. Out of the 1.6million people living with the virus in Kenya 10% are from

Homa Bay.

1.2 Statement of the problem

Kenya lags in various global health sector targets one of them being the implementation

of 2001 Abuja declaration pledge that sought to ringfence 15 percent of government

budgets on public healthcare. For the year 2001/02, it only managed a high of 8 percent

share, after which the share was at about 5 to 7 percent range from 2013/2014 to

10
2015/2016 (AU, 2001). Kenya also performed way below the World Health Organization

(WHO) benchmark for annual expenditure on basic healthcare of $64 per person. Kenya's

annual per capita health expenditure in 2015/16 was estimated at US$25.1 per person

(KIPPRA, 2018).

According to the Homa Bay County CIDP (2018) Homa Bay health sector is faced with a

variety of problems ranging from underfunding of the sector at 24% and 27% in the

2016/2017 and 2017/2018 financial years, respectively. There was inadequate workforce

in health facilities, shortage of drugs allowing the healthcare facilities to issue only

prescriptions, inadequate water and power supply, most of health facilities lack maternity

wards, inadequate referral and ambulance services, perennial health workers unrest, poor

referral system and inaccessible health facilities are some of the issues that face the

healthcare sector in the county. This has consequently undermined effective delivery of

health services, hence the rationale of this study was premised on the above-mentioned

adverse features of the service delivery state in Homa Bay County health sector.

A research on devolved governance in Kenya by Khaunya, Wawire and Chepng'eno

(2015) revealed that counties have experienced a multitude of obstacles that erect in the

way of policy implementation. Certain instances have also been reported where the

national government's executive arm is perceived to be reluctant to devolve certain funds

intended for county development initiatives that curtail delivery of services, for instance

the county governments' payment of salaries and a host ground level innovation .

Akacho (2014) contends that lack of facilities had an influence on quality health care

service provision. A study by Barker et.al (2014) on the evaluation of the readiness of the

11
county healthcare system in Kenya noted that Marsabit County was one of the devolved

units that are ill prepared to enhance accessibility of healthcare services under devolution.

The above-mentioned studies have created links between devolved governance, presence

of health facilities and readiness of counties’ healthcare systems and health service

delivery but none has interrogated the link between policy implementation and service

delivery with particular focus on health sector in Homa Bay County, Kenya which this

study seeks to undertake hence filling the arising gaps.

1.3 Objectives of the study

The study was premised on specific objectives as listed below:

i) To assess the effect of bureaucratic practices on healthcare sector service

delivery in Homa Bay County.

ii) To determine the effect of citizen engagement approaches on healthcare sector

service delivery in Homa Bay County.

iii) To assess the effects of resource mobilization on healthcare sector service in

Homa Bay County.

1.4 Research questions

The study was premised on the following research questions:

i) What is the effect of bureaucratic practices on service delivery in health sector in

Homa Bay County?

ii) How does citizen engagement approaches influence service delivery in healthcare

sector in Homa Bay County?

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 iii) How does resource mobilization affect service delivery in health sector in Homa

Bay county?

1.5 Justification and significance of the study

Provision and access to quality and affordable primary healthcare is a fundamental

human right as provided for in the Kenyan constitution. In the Kenyan blueprint

christened vision 2030, the government projects having the whole population have access

to effective, responsive and quality health services. Equally, the current administration

has emphasized on Universal Health Care (UHC) coverage as a top priority in its ‘Big

Four’ Agenda spearheaded by the president. Devolving the health function has donated

to the county administrations the responsibility of management and coordination of

county health service delivery including public health, sanitation, primary healthcare,

ambulance services, and disease surveillance (KIPPRA, 2018). Homa Bay County still

remains a vulnerable county in health service delivery. This therefore study explored the

effect of policy implementation on healthcare service delivery.

This study is significant to decisionmakers and the academia.

1.5.1 Government/Policymakers

This study will assist both the national government and the devolved unit of Homa Bay in

drawing new policies that will ensure delivery of proper and quality services in the health

sector. The revelations from this research will aid senior leaders tasked with planning and

managing the health sector to improve on their service delivery by giving heed on

distinctive fields that provide value and high quality to monitor the delivery process.

13
To policy makers, this study will enable them to make informed decisions when

formulating policies to enhance effective delivery of public services. This research will

again heighten policy changes in the health sector in particular health policy both

nationally and at the county level in realignment with vision 2030.

1.5.2 Scholars

This study will also be of great benefit to other scholars and researchers who may

consider the study with summing to their present body of understanding deeply policy

implementation and service delivery. Academicians and researchers who will endeavor to

conduct further research in this area may review the literature of this study and point out

gaps for extensive studies.

1.5.3 The community

The community will also benefit from this study by approaching their day-to-day

activities this is in regards to access to public services in its entirety. This will enable

amenity of information sharing amongst people who will create better matches among

diverse sectors of the society and hence improve social productivity.

1.6 Scope and Limitations of the study

Focus was directed on influence of policy implementation on service delivery in 10

health facilities in Homa Bay County. The respondents included the very recipients of

health services, hospital administrators and health record officers. Precisely, it focused on

bureaucratic practices, citizen engagement approaches and resource mobilization.

14
 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.1 Introduction

Available literature review related to policy implementation and service delivery in the

healthcare sector. The reviewed articles include published theses and dissertations, online

journals, and literature reviews on relevant studies by other researchers and academic

scholars. This chapter is divided into two subsections namely, empirical review,

theoretical review and conceptual framework.

2.2 Bureaucratic Practices and Service Delivery

Kwame (2011) investigated the influence of bureaucracy on service delivery in Kumasi

Metropolitan Assembly (KMA), Ghana. The study pointed out the bureaucratic

difficulties faced by the Assembly in delivery of services to what degree the established

challenges impact on the services provided the established challenges impact on the

services provided to the Metropolis Citizens and also formulate, raft of measures to

pacify excessive bureaucracy in the course of the officials work in the assembly. The

study revealed among other things that albeit there is clear practicing of division of labor,

departments lack medical equipment that assist in coordinating their activities effectively

hence resulting in delays when meeting the expectation of the clients in need of service.

Moreover, there was an agreement that the assembly lost its productivity that arises from

extreme bureaucracy and could adversely have an influence on the performance of the

National government. The study investigated how public service delivery are influenced

by bureaucracy in Kumasi Metropolitan Assembly, Ghana whereas this current study

15
aimed to fill the arising contextual and conceptual gap by investigating effect of policy

implementation on service delivery in Kenya.

Ziad (2014) investigated the effect of bureaucracy on service delivery from the cost

servants’ perspective in Gaza Strip, Palestine. The study’s aim was to assess the

bureaucratic barriers to service delivery in public institutions. Objectives were to identify

bureaucratic bottlenecks that block service delivery, determine the impact of excessive

bureaucracy on the public and to find ways by which bureaucracy can be improved to

enhance public service delivery to people. Descriptive analytical approach was adopted

which tried to described and evaluate the role played by bureaucracy on service delivery

in Gaza. A comprehensive survey method was adopted on the authority of the territories

in Gaza, whereby the population comprised (68) employees and (66) employees were

sampled since they had a direct deal with the people. The findings showed that the

Palestinian government is advised to formulate a written service delivery policy, enhance

departments that have direct contact with citizen’s conduct periodic reviews on desires

and needs of citizens, ensure all employees of the organization should be trained

appropriately on effective service delivery. This study adopted a descriptive analytical

approach while the current study will employ descriptive research design, this

methodological gap will be filled by the study.

Adziambei (2014) explored how bureaucracy affects the service delivery in Johannesburg

City, South Africa. The study determined the influence of internal bureaucratic practices

on provision of services and further interrogate how it adversely impacts on the city’s

drive to provide quality services to its people. The study found out that service delivery

still remains to be on herculean challenge in most municipalities, major issues of

16
corruption, lack of transparency, dysfunctional ward committees, institutional capacity

constraints which most times relate to availability of required competencies and staff.

Further, that study revealed that state officials are very arrogant; the councilors are not

well capacitated and equipped enough to address their concerns, view bureaucratic

structures as the main challenge that needs be reforms; and the IDP process is seen as

only benefitting those from the ruling party since its only their opinion that is valued. The

survey paid attention to the impact of internal bureaucracy on delivery of services in

South Africa conversely the current study will be on policy implementation and service

delivery in the health sector by this the study will fill the conceptual gap.

Ajibade and Ibietan (2016) undertook study that interogated the influence of state

bureaucracy on service delivery in Nigeria by using a neo-Weberian explanation. On

secondary data, the paper observed that service delivery rests on public bureaucracy and

the organizations of allied mandates as the pivots. The neo-Weberian model proved to be

useful in highlighting inefficiencies in public service delivery in Nigeria. This means that

for the mandate of quality service delivery to be achieved by Nigerian Public bureaucracy

the national government should harness professionals in providing public services as the

neo-Weberian model reinforced. The study recommended that the government should

embark on initiatives that enhance working conditions of bureaucrats since this would

build their dedication, commitment and morale to provide service effectively. This study

used secondary data while the current study will employ primary data.

Musonda (2016) study focused on bureaucracy and the coordination challenges in service

delivery this was by having a comparative approach that was done on Kabulonga and

Kamanga Primary Schools in Lusaka City, Zambia. In the period between 2010 and 2014

17
with the major aim of investigating the challenges faced in coordinating primary

education in Lusaka. It also all attempted to draw lessons and get to understand why is it

that schools in the save district and having the same level (primary) were recoding

different performances. Study adopted a comparative approach. Among the major main

findings was the location of the schools had a big impact on how they operate one school

had the ability to plan for a long term something the other did not. Furthermore, the

available platforms used in communication within the district had poor feedback

mechanisms on information. While this study adopted a comparative approach in

carrying out the study the current study will employ a descriptive research design, this

study therefore will fill this methodological gap.

2.3 Citizen engagement approaches and service delivery

Ngondo (2014) undertook a study to explore the influence of social project running

activities on participation, which is a catalyst for the CDF projects completions in,

Kirinyaga Central and Kanyekimi ward within the projected period. The findings

revealed that the project beneficiaries were not involved directly in the CDF project

activities; throughout the project planning and implementation. Nevertheless, wherever

participation was undertaken, their input was factored in and completion timelines were

attained per the set calendar. Whereas the study investigated the influence of participation

on the community in project running activities, the current study will investigate effects

of policy implementation on service delivery on health sector by this the current study

will fill both contextual and conceptual gap.

Papa (2016) conducted a study which focused on problems affecting community

participation in project design and execution in Busia County. He investigated effects of

18
training and governance, on the beneficiary involvement in project development. The

findings revealed that leadership in the County administration demonstrates poor decision

which includes citizen participation. Further, the respondents stated that there were poor

democratic social links and gender inclusivity when formulating citizen participation

program (s). The income levels also had a major power influence on the process. While

this study focused on problems affecting community involvement in project management

in Busia County, the current study will investigate effects of policy implementation on

service delivery on healthcare sector in Homa bay. By this the current study will fill both

a conceptual and contextual gap.

A study by Kugonza and Mukobi (2016) sought to determine the impact of community

engagement in project delivery in the Buikwe district municipal government, Uganda.

The research pointed out three issues affecting public participation in local leadership,

including the ability to effectively incorporate knowledge, awareness of the roles of the

public and accountability. The revelations were that these challenges had a positive effect

on the residents’ involvement in local programs. In addition, the findings revealed that

information is not a fact available to individuals and that it is not used entirely for the

preparation and evaluation of local initiatives. This study focused on the effect of

community involvement in the project service delivery in the municipal government in

Buikwe District in Uganda while the current study will investigate effects of policy

implementation on service delivery on health sector in Homa Bay Kenya.

Fortuin (2018) undertook a study on how citizen participation impact service delivery at

the grass root level in Elsies River, Cape Town. The study was an investigation into the

barriers to meaningful citizen participation. It explored the community and public

19
servants’ perception on public participation and development planning practices and

service delivery, assessed existing models and framework for public participation and

such as IDP and Cape Town’s citizen participation policy so as to assess the effectiveness

of the available frameworks. The study used qualitative research techniques. The results

revealed that there was a host of challenges and major barriers to public participation

which include lack of engagement of the community on the IDP process, political

conflict, and lack of resources for citizen mechanism to assess how public participation is

effective in the city of Cape Town. The focus of the study was on the effectiveness of

public participation on service delivery in Elsies River, Cape Town while this current

study will deal with effects of policy implementation on service delivery on health sector

in Homa Bay, Kenya.

Yussuf (2018) conducted a study to interrogate the effects of citizen involvement delivery

of healthcare service delivery in Garissa County. Precisely, he aimed at establishing how

public education, collaborative stakeholder planning, public private partnerships (PPPs)

and consultation on Kenyan healthcare service provision. Findings showed that citizen

participation in form of public education, consultation, collaborative stakeholders

planning and PPPs in the County is moderate. Further, the study recommended that

Garissa County Citizens should enhance information exchange with the county

administration through access of the county website and involving themselves more in

workshops and mutual partaking in order to enhance the quality of services they deliver

in the healthcare sector.

20
2.4 Resource mobilization and service delivery

Adesuwa (2017) conducted a study on resource mobilization and health outcomes in

Nigeria. The study sought to establish whether domestic resource mobilization is

important in health outcome, determine extent to with agricultural activities assist in the

resource mobilization and to investigate the nexus between domestic resource

mobilization and health are outcomes. The results showed that there is a link between tax

revenue and under five mortality, agricultural activities have inverse relationship with

under five mortality and there is a positive link between gross capital formation and

under five mortality rates.

A study by Kimutai (2017) on various mobilization approaches and their impact on

country socio-economic advancement in Kenyan north rift region. It interrogated the

impact of county collections, training on revenue mobilization, stakeholder collaboration

and revenue mobilization technology on socio-economic advancement. The study also

investigated the challenges faced by county governments in implementing revenue

mobilization approaches. The findings revealed that most of the financial mobilization

approaches in devolved governments are business finances, natural resources, rents,

market dues and fees. The study propounded that counties need to ensure effective

automation mechanisms of business, financing. It further suggested that increased

sensitization, mobilization and publicity to the community about the importance of

revenue collection.

Kyunyu (2014) conducted a study on how resource mobilization approaches impact

performance of Community based organizations (CBOs) in Tseikuru, Kitui County. The

study sought to investigate how effective communication, contribution of local

21
communities and sources of resources influence the performance of community-based

organizations in Tseikuru sub-county. Descriptive survey designed was employed. The

findings indicated that CBO’s utilize the available avenues to solicit resources

adequately.

A study by Okuto (2018) in Kiambu County on decentralized governance systems and

financial resource mobilization. The study sought of investigate how institutional

capacity, stakeholder engagement and fiscal policy implementation affect revenue

mobilization in Kiambu County. The study used resource mobilization theory and

political process theory. It also employed descriptive research design. The results

revealed that the county government training and empowerment programs that promote

participation of employees on county financial resource mobilization.

A research conducted by Scott (2018) explored the effectiveness of revenue mobilization

practices on public service delivery assemblies in Ghanaian district. The study found that

revenue mobilization activities had a significant and optimistic impact on service delivery

at the district assemblies. The study recommends that DA authorities carry out audits and

review automated revenue collection tools to ensure maximum gains in parliament from

these automations, and DAS is also urged to review and consider the current legal

structure for financial management to ensure a quicker transfer of funds to Das and to

define penalties for national government officials who misappropriate or delay funds.

2.5 Theoretical Framework

This subsection examines relevant theories to the variables of the study. Theoretical

framework is a group of interlinked ideas that are grounded on a theory (Komb and

22
Tromp, 2009). A theoretical review therefore is a set of propositions that are reasoned out

and they attempt to provide clarity to why phenomena are the way they appear to be

basing on the underlying theories .A theory is a statement underpinned by evidence that

tries to explain a specific phenomenon. A theory is a clear explanation that systematically

explains the link between phenomena.

2.5.1 Max Weber’s Bureaucracy

In his groundbreaking work on economics and society in 1921, Max Weber promoted the

concept of the ideal form of bureaucracy. Sager and Rosser (2009), propounded that the

most logical way of organizing a state together with its institutions was bureaucracy.

"The "dominant institutions of industrial society" are seen to be bureaucratic

organizations. Weber argued that a bureaucracy includes management, communication

and control problems in a diverse collection of tasks (Evans and Rauch, 1999). The

theory defined the features of a bureaucracy as, inter alia, "a hierarchy and authority of

paid, full-time employees forming a chain of command."

Hierarchical systems and chains of command is a key feature of bureaucracy

dispensation. Adherence to rules and regulations, impersonality, separation of labor, and

office continuity are other functions. In addition, the functionaries of the bureaucracy are

selected and assigned on a merit-based basis, ensuring they have the requisite credentials

to perform their duties.

The Bureaucratic theory of Weber has various consequences for this review. The

hierarchy's availability helps the bureaucrats to decide who to report to and who reports

to them. There is a good definition of contact networks in this situation, which in turn

23
eliminates cases of conflicts of roles. In other words, because of the presence of a

hierarchy and authority, health officers know their positions, the individual to report to

and how to air their concerns. In addition, since health officers have the skills needed to

provide care, they will provide patients with the right quality services. In describing the

link between bureaucracy and service delivery that is based on in this report, this theory

goes a long way.

2.5.2 Participatory Democratic Theory

The theory's proponent was Carole Pateman. The principle states that the presence of

citizens inside a country is a theoretical statement. It reveals the obsession of an

opinionated sociology with the functionalist theory reminiscent of steady political

organization. The theory presents the boundaries of interaction within a social culture

between the individual and the nation. It introduces the Participatory Democratic

Theory's four basic doctrines. The theory points out, first of all, that the capacity,

knowledge and individuality of individuals are associated with forms of administrative

arrangements such as participation. In other languages, individuals recognize that they

contribute by executing their role within the autonomous systems.

Additionally, the participatory democratic case is an instance of sovereignty over certain

reforms that will ensure individual collective and political existence autonomous in an

equivalent manner as individuals in their personal lives or as individuals in the general

public. Furthermore, if there is a need for creating a contributory society, a consequential

participatory democratic theory exists. Finally, the variations needed are typically

structural. They need to restructure autocratic socio-political systems that slow down

participatory activities. In describing the impact of public engagement on the outcome of

24
service delivery, the theory is applicable to the analysis. The theory states that when the

public is engaged in the provision of services, there is a nexus between public support

and delivery of services.

2.5.3 Resource Mobilization Theory

Buechler (1995) advanced this theory and explained that an integral professional

community in a social movement institution works to bring capital, followers, media and

donor coverage, alliances with those who are highly placed in society and to refine the

organizational structure. This is so because, in order to be successful, social movements

need support because opposition and complaints alone do not produce social change. The

theory emphasizes the capacity of the participants of the movement to accumulate capital

and organize people to achieve the aims of the movement. This theory suggests that

people are rational and hence measure the costs and benefits of participating in

movements and can only act if the benefits outweigh the costs.

It assumes social organizations as result-oriented, but since a resource is simply a means

to the end, organization is more important than resources. The theory relates to this study

because the connections and relationships between county government and other

organizations, corporations, governments, private sector, local communities, well-wishers

and religious institutions are required by the county government; and for the effectiveness

of healthcare service delivery. Different kinds of services are needed, successful

strategies for resource mobilization and the participation of contributions from local

communities are key issues that can impact the community's proper service delivery.

25
2.6 Conceptual Framework

According to Frinchman (2008), a conceptual framework is model that contains

assumptions classifying independent and dependent variables. The dramatic

representation of the predictor and outcome variables that is to be illustrated further in the

figure below. The predictor variable here is policy implementation whereas the outcome

variable is healthcare service delivery in Homa Bay County.

Healthcare service delivery is operationalized as the speed of service, availability of

drugs, customer satisfaction and responsiveness to patient concerns. Provision of

enhanced public healthcare services which are characterized by sufficient medical

supplies, a decrease in waiting time as defined by (Alford, 2009). The study measured

Policy implementation using bureaucratic practices, citizen engagement approaches and

resource mobilization.

The figure below shows a representation of these variables.

26
Independent Variables Dependent variables

Bureaucratic practices
 Technical capacity
Healthcare Service
 Rules and regulations
Delivery
 Procedures
 procedures  Speed of services
Citizen engagement  Availability of
approaches drugs
 Consultation  Customer
 Public education satisfaction
 Collaborative  Responsiveness to
planning patient concerns

Resource mobilization
 Revenue collection
 Allocations
 Timely transfer
 Human resource

Figure 2.1 Conceptual Framework

27
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

Ways and means by which the research will be carried out to get the necessary

information will be discussed in this section. The study’s design, study population, the

sample size selected and sampling techniques used in calculating sample size of the study

will be presented. Further, data collection method, data analysis and presentation will

also be discussed. A systematic discussion is undertaken to explain what the research

strategies adopted are to address the study's goals (Laurakas, 2014).

3.2 Research Design

The research deployed a descriptive study design. It is deemed appropriate for use in

circumstances where an obvious problem needs to be clarified. As it helps the researcher

to collect both quantitative and qualitative data, this study design will also be important,

because a lot of data will be collected. In addition, the design allows the results to be

applied to a wider population (Orodho, 2013).

3.3 Variables/Categories of Analysis

The study aimed at establishing the effect of policy implementation on service delivery in

Kenya with healthcare sector of Homa Bay County being the case study. The independent

variable in this study are bureaucratic practices, citizen engagement approaches and

resource mobilization. The dependent variable is service delivery.

28
3.4 Site of the Study

Ellis (2008) put forward that study site is a particular area that the study is undertaken

and hence impacts the usefulness of the gathered information. The county of Homa Bay

is among the 47 devolved units in the Kenya. It covers a total area of 4,760Km2 which is

inclusive of the water surface area that covers 2064Km2 .It consists of eight

constituencies/ Sub Counties namely, Homa Bay Township, Kasipul, Suba, Ndhiwa,

Mbita, Rangwe, Karachuonyo and Kabondo Kasipul. According to KNBS (2019), the

county’s total population is 1,131,950 in 2019.The County is located South West of

Kenya along Lake Victoria where it borders Siaya and Kisumu to the North, Nyamira and

Kisii to the East and Migori County to the South. The county headquarters is located

approximately 420 km from Nairobi city county (Homa Bay County Integrated

Development Plan, 2018).

Figure 3.1: Map of the study area

29
3.5 Target Population

Politic and Beck (2003) puts forward that a population is the aggregate of people who

subscribe to a set of specifications. This study targeted hospital administrators, health

record officers and patients. Mugenda and Mugenda (2013) argue that a study population

should have certain features in which the researcher is interested.

Table 3.1 Target Population

Stratum Target Population Percentage (%)

Hospital administrator 50 4.54%

Health records officer 50 4.54%
Patients 1000 90.91%
Total 1100 100%
Source: Researcher 2021

3.6 Sampling Techniques and Sample Size

For determining representative respondents for the study, a simple random sampling

technique was used. It ensures that population members have a fair opportunity to be

picked (Jilcha, 2019). To classify reasonable and most desirable results, a sample size

determination technique will be used. A sample size of 10 to 30 percent is sufficient

enough if well-chosen and the components in the sample are more than 30 (Mugenda and

Mugenda, 2003). A 110 sample size was derived from the target population to represent

10% of the total population (see table 3.2). The researcher was confident that the

population would be well served by a total of 110 components.

30
Table 3.2: Sample size
Stratum Target Population Sample Percentage
Hospital administrator 50 5 4.54%
Health records officer 50 5 4.54%
Patients 1000 100 90.91%
Total 1100 110 100%
Source: Researcher 2021

3.7 Sampling frame

The sampling frame of this study comprises diverse respondents derived from Homa Bay

County constituting hospital administrators, health records officers and patients. The

listed respondents are involved directly in the policy implementation and service delivery

in Homa Bay County and are deemed to own information that leads to the importance of

this very study. Orodho (2009) defines sampling frame as a set of targeted respondents

from which a sample will be drawn and it constitutes all the constituents of the target

population.

3.8 Research Instruments

Primary data was used because the main purpose of the researcher is to obtain data that is

raw. Therefore, it is upon this necessity that the researcher adopted primary data that

represents the perceptions as well as the views of specified respondents. A questionnaire

was used to obtain data. According to Ngumi (2013), questionnaire is a tool that requires

a responder to provide answers to a host of queries or to respond to a set of statements.

This study used both open and closed ended questions to collect both qualitative and

quantitative data respectively. Further, key informant interviews were conducted for

hospital administrators and health record officers in Homa Bay. Secondary data was

31
adopted in this research. Secondary sources included data from county integrated

development plan reports, journals, books, policy documents and newspaper articles.

3.9 Validity

Validity refers to the measure to which evidence and subject matter experts (SME’s)

underpin the interpretations of test scores. This study adopted the validity of content. In

order to ensure the content validity, health providers, professionals in the sector of

service delivery and the university supervisor were used to aid in assessing concepts in

the questionnaire and establish whether they do measure what they purport to. The advice

encompassed propositions, clarifications and other inputs. Mugenda (2008) notes that

validity reveals the accuracy and truthfulness of data and inferences from the information

obtained. Bryman and Bell (2013) posit that instruments authenticity is raising the

appropriate questions that are framed from the ways that are less ambiguous and based on

the research objectives.

3.10 Reliability

According to Cronbach (1951), reliability measures the consistency of instruments, as to

whether they can yield same outcomes when they are subjected to comparable conditions.

Mugenda and Mugenda (2013) notes that a reliable decision-making data is that which

has been collected by a researcher and have yielded same results when they are applied

repeatedly over a certain period of time. This study applied reliability analysis so as to

assess the internal consistency of variables in the study. Cronbach’s Alpha coefficient of

0.7 and over was calculated and accepted on all elements of the questionnaire. The

determinant used was Alpha O.T. as the acceptable reliability.

32
Table 3.3 Reliability Test Results

Variable Ite N Cronbach

ms Alpha
Bureaucratic practices 5 10 .771

Citizen engagement 5 10 .782

approaches
Resource mobilization 5 10 .825

Service Delivery 5 10 .755

Source: Researcher (2019)

From the finding in the above table the study variables had Cronbach Alphaof;

Bureaucratic practices α = .771; Citizen engagement approaches α = .782; Resource

mobilization α =.825; and Service Delivery α = .755. This indicates that all the

variables had alpha scores over 0.7 thereby considered for the research.

3.11 Data Collection Techniques

Data collection was undertaken after a permit was granted from the university graduate

school, the National Commission of Science Technology and Innovation (NACOSTI),

county director of education and Homa bay county Ministry of health. An appointment

was also sought so as to administer questionnaires to the respondents of the study. In

collecting data, both closed and open-ended questions were used and chronologically

arranged in order to match the code and variable. In regards to the accuracy of the duly

filled questionnaire and for purposes of ascertaining comprehensiveness the collected

data was cleaned since it was susceptible to errors.

33
3.12 Data Analysis Procedures

Data analysis according to Kothari, (2004) is the process that comes immediately after

the execution of data collection and it lasts to a point whereby data interpretation is done.

The study used descriptive statistics to analyze data. From Mugenda and Mugenda

(2010), they stated that descriptive statistics is that which entails the process of

computing a massive raw data from the field into charts, tables, with percentage and

frequency distribution.

The study findings were presented using pie charts, graphs and tables so as to depict the

findings of the study when looked at. The questionnaire was thoroughly scrutinized to

ensure completeness and if they have been dully filled as expected. Information gathered

by questionnaire will be analyzed organized and then coded by a computer. The edited

information was then be organized by statistical package for social science program

(SPSS) V22.The program also refined the data retrieved from the field by use of multiple

regression analysis demonstrating the relationship present between dependent and

independent variables. Saunders (2009) contends that regression analysis is adopted when

a researcher is seeking to establish whether a dependent variable is predicted by an

independent variable

The proposed multivariate regression model will assume the format as illustrated

hereunder:

Y = β0 + β1 X 1 + β2 X2 + β3 X3 + ἐ

Y = Service delivery

β0 = Constant

34
 β1to β3 = Regression co-efficient

X1 = Bureaucratic practices

X2 = Citizen engagement approaches

X3 = Resource mobilization

β = Parameters to be estimated

ὲ = Error Term

3.13 Logistical and Ethical Consideration

The researcher sought permission from key authorities before heading to the field to

obtain data. The respondents were given a guarantee that the study is implied only for

academic purposes as it is. Respondents were treated with utmost privacy; they were

additionally be met on their willingness. The researchers obtained a letter from the

NACOSTI, The County Director of Education and Homa bay county Ministry of health.

hitherto commencing the data collection initiative.

35
 CHAPTER FOUR

RESEARCH FINDINGS AND DISCUSSION

4.1 Introduction

This penultimate chapter details the presentation of the research revelations and

discussion with regard to previous empirical literature. The chapter particularly presents

the background information, the descriptive then the inferential analysis. Quantitative

data was coded, computed, and analyzed descriptively using frequency tables,

percentages, mean, standard deviation and graphs. Content analysis was deployed to

analyze descriptive data and then presented thematically in prose.

4.2 Response Rate

The research sought to collect data from 110 respondents drawn from the healthcare

centers within Homabay County. The research obtained a 73% response rate (N=110)

which was deemed correct for statistical analysis. The researcher targeted 110

respondents; however, 80 out of the 110 respondents filled and returned the

questionnaires. The response rate is consistent with Mugenda and Mugenda (2003) who

provided the following classification of response rate: over 85% denotes excellent, 70% -

85% denotes very good, 60% -70% denotes acceptable while below 50% implies not

acceptable. Equally, 10 hospital administrators and 10 hospital record officers who were

purposively sampled were interviewed. This reveals a response rate of 100% from the

interview. Therefore, the response rate was a good reflection of the entire population.

36
4.3 Background Information

Here, the gender, age distribution, gender, education level of the respondents and the

length of service within the health facilities is presented.

4.3.1 Gender

The respondents were asked to indicate their gender. Gender of respondents results

indicate that 58% of the respondents were male while 42 % were female. This shows that

both genders were well represented in this study.

4.3.2 Age of respondents

The study further sought to determine the age distribution among the respondents of the

research. The findings are shown on Figure 4.2 below;

Age of respondents
70.0% 65.5%
60.0%
50.0%
40.0%
30.0%
20.0% 10.9% 12.3% 9.1%
10.0% 1.8%
0.0%
Below 21years 21 – 30 years 31 – 40 years 41 – 50 years Over 50 years

Figure 4.1: Age of the respondents

The findings indicate that majority of the respondents 66% were between 21-30 years,

12% were between 31-40 years, 9% were aged between 41-50years, 11% were below 21

years while only 2% were below 25 years. This implies that the respondents are

knowledgeable on the constructs of the research. The findings buttress KNBS (2019)

37
survey which revealed that Kenya has a youthful population. The survey revealed that

35.7 million Kenyans which is 75.1% are below the age 35 years.

4.3.3 Level of education

The study also examined the education attainment of the respondents and the results are

presented on figure 4.3 below;

Level of education of respondents

70.0% 65.5%
60.0%
50.0%
40.0%
30.0% 23.6%
20.0%
9.1%
10.0%
1.8%
0.0%
None Primary Secondary Tertiary

Figure 4.2: Level of education of respondents

The findings analysis show that most of the respondents 66% had attained tertiary level

education, 24% had secondary level education, 9% had primary level education while 2%

had no academic qualification. This indicates that the health workers in the health

facilities have attained formal education hence implying a well skilled workforce and

knowledgeable patients. These findings align to Jatto, (2012) who averred that there is

need to engage with respondents who hold high education level that emboldens the

aptitude in decision making and consequently spurring growth and development.

38
4.3.4 Work experience

The study further established the period the respondents have worked. The results are

shown on table 4.4 below;

Work Experience

Over three years 45.5%

Three years 10.9%

Two years 5.5%

One year 10.9%

Below one year 27.3%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

Figure 4.3: Work experience

The findings indicate that most of the respondents 46% had worked over 3 years, 27%

had below one year, 11% had worked for three years another 11% had worked for one

year while only 5.5% of the respondents had only worked for 2 years. This implies that

the respondents had enough experience in the county healthcare facilities which is

fundamental in to offering meaningful responses for answering the study problem.

4.4 Descriptive Analysis of study variables

The study sought to examine the effect of the policy implementation on healthcare

service delivery within Homabay County, Kenya. The study depended on tables, pie

charts and bar graphs in presenting the research results.

4.4.1 Bureaucratic practices

The study sought to determine to what degree the respondents agree about the

Bureaucratic practices affecting healthcare service delivery in Homabay County. The

39
findings are as indicated in Table 4.4. Findings indicate that there is an agreement

procedure are duly followed by health officials this as indicated by 60% while 55%

agreed that rule and regulations eliminate favoritisms. Results also indicate that 56%

agreed that there are procedures in the facility delay processes while 80% agreed that the

available procedures guide every department works. Further in regard to health officers

providing services in a specified time there was an agreement among respondents

indicated by 55% response. Concerning health officers having sufficient information to

answer questions and inquiries 62% were in agreement to that assertion.

The findings also reveal that 68% of the respondents were in agreement that healthcare

workers carry themselves with high codes of conduct while 70% agreed that health

workers are professional in carrying out their duties. Finally, concerning the attitudes of

the healthcare workers make me recommend the facility to others there was an agreement

among respondents with a response of 59%. These results are consistent with Ajibade and

Ibietan (2016) that contend that the government should embark on initiatives that enhance

working conditions of bureaucrats since this would build their dedication, commitment

and morale to provide service effectively.

The results also buttress Kwame (2011) study which revealed that among other things

that albeit there is clear practicing of division of labor, departments lack medical

equipment that assist in coordinating their activities effectively hence resulting in delays

when meeting the expectation of the clients in need of service.

40
Table 4.1: Bureaucratic Practices

Bureaucratic practices SD D (%) N A SA Mean Std.

(%) (%) (%) (%) Dev
Procedures are duly followed by 2 27 11 44 16 3.45 1.119
health officials

Rule and regulations eliminate 9 15 22 40 15 3.36 1.176

favoritisms

Procedures in the facility delay 13 16 15 40 16 3.31 1.289

processes
Available procedures guide 2 7 11 49 31 4.00 .943
every department works
Health officers provide 4 24 18 35 20 3.44 1.167
services in a specified time
Health officers have sufficient 10 15 15 47 15 3.44 1.183
information to answer questions and
inquiries
Healthcare workers carry themselves 6 13 15 53 15 3.58 1.066
with high codes of conduct
Health workers are professional in 10 7 13 39 31 4.04 .860
carrying out their duties
The attitudes of the healthcare 11 16 15 33 26 3.45 1.331
workers make me recommend the
facility to others

4.4.2 Citizen engagement approaches

The study sought to establish to what degree the respondents are in agreement about

citizen engagement approaches affecting healthcare service delivery in Homabay County.

The results are as shown in Table 4.6. Firstly, 53% of the respondents disagreed that the

there is high participation in public forums while 49% disagreed that there is participation

in project implementation. Further, 47% agreed that there are civil group visits while

40% agreed that there is county communication exchange. while 53% agreed that there is

presence of collaborative resource management. Further, 59% disagreed that citizens

participate in attitude surveys. Again, 49% disagreed that citizens are well represented in

41
the public forums. Finally, 44% disagreed that local community participate in initiation

and implementation of public projects whereas 49% also disagreed that minorities and

marginalized are involved in project implementation. This is in line with Yussuf (2018)

study who averred that citizen participation that takes the form of public education,

consultation, collaborative stakeholders planning affect healthcare service delivery.

Table 4.2: Citizen engagement approaches

Citizen engagement approaches SD D (%) N A SA Mea Std.

(%) (%) (%) (%) n Dev
There is high participation in public 20 33 9 26 13 2.78 1.370
forums
There is participation in project 9 40 22 27 2 2.73 1.027
implementation

There are civil group visits 9 16 27 36 11 3.24 1.138

There is county communication 9 16 35 29 11 3.16 1.118

exchange

There is collaborative resource 7 24 16 38 15 3.29 1.197

management

Citizens participate in attitude surveys 24 35 15 24 4 2.49 1.200

Citizens are well represented in 16 33 20 20 11 3.02 1.284
public forums
Local community participate in 22 22 20 29 7 2.78 1.287
initiation and implementation of
public projects
Minorities and marginalized are 29 20 16 24 11 2.67 1.402
involved in project implementation

4.4.3 Resource mobilization

The study sought to examine to what degree the respondents agree about resource

mobilization affecting healthcare service delivery in Homabay County. The results are as

presented in Table 4.6. To start with, 46% of the respondents disagreed that financial

42
resources are equitably allocated to healthcare sector while 51% disagreed that there is

enough collection of county revenue. With regards to technology assists in revenue

collection 51% disagreed with the assertion. Further, 56% of the respondents were in

disagreement that there is timely transfer of funds from government to healthcare

facilities whereas 67% disagreed that allocated funds match the healthcare needs.

Again, 65% also disagreed that there are enough personnel in the facility while 80%

agreed that the health personnel are well trained. Finally, 41agreed that the medical staff

have their welfare taken care of. The results and consistent with a study by Scott (2018)

which found that revenue mobilization activities had a significant and optimistic impact

on service delivery at the district assemblies. The findings are also in line with Okuto

(2018) who contended that the county government training and empowerment programs

that promote participation of employees on county financial resource mobilization.

Table 4.3: Resource mobilization

Resource mobilization SD D (%) N A SA Mean Std.
(%) (%) (%) (%) Dev
Financial resources are equitably 15 31 20 25 9 2.84 1.229
allocated to healthcare sector
There is enough collection of county 40 11 20 9 20 1.24 1.170
revenue

Technology assists in revenue 11 40 13 22 15 3.35 1.205

collection
There is timely transfer of funds from 27 29 24 15 5 2.42 1.197
government to healthcare facilities
Allocated funds match the healthcare 36 31 18 11 4 2.15 1.145
needs
There are enough personnel in the 29 36 13 16 6 2.33 1.218
facility
The health personnel are well trained 2 9 9 51 29 3.96 .962
The medical staff have their welfare 18 7 35 15 26 3.48 1.134
taken care of

43
4.4.4 Service delivery

The study also aimed at examining to what degree the respondents agree with the

effectiveness of service delivery in Homabay County. Findings indicate that with regards

to speed of services the 46% of the respondents noted that the speed is fair while 76%

responded that the availability of drugs was least effective. Again, 57% mentioned that

they were least satisfied with the service delivery whereas 40% asserted that the

responsiveness to patient concerns was fair. Lufunyo, (2013) propounds that among other

models the government should enhance significantly the delivery of public services

through legal, administrative, labor and financial amendments whose focus is on

performance of civil servants, transparency and accountability.

Table 4.4: Service delivery

Service delivery NE LE F ME ME Mean Std.
(%) (%) (%) (%) (%) Dev
Speed of services 18 22 46 9 6 2.62 1.063
Availability of drugs 40 36 13 9 2 1.96 1.036
Customer satisfaction 31 26 31 7 6 2.31 1.153
Responsiveness to patient concerns 7 16 40 18 18 3.24 1.154

4.5 Inferential Statistics

Inferential statistics was conducted in this subsection. It entailed the regression analysis.

4.5.1 Regression analysis

The study further aimed at establishing the degree of the relationship between the

predictor and outcome variables. The study adopted regression analysis and the findings

are shown below;

44
 Table 4.5: Model Summary

Std. Change Statistics

Adjuste Error of R
R dR the Square F Sig. F
Model R Square Square Estimate Change Change df1 df2 Change
1 .887a .750 .733 0.123 .750 2.999 3 51 .039

a. Predictors: (Constant), Resource mobilization, Bureaucratic practices, Citizen

engagement approaches
b. Dependent Variable: Service delivery
Source: Researcher (2021)
The findings of the study indicate that bureaucratic practices, citizen engagement

approaches and resource mobilization, accounts for 75.0% (R2=.750) variations in the

healthcare service delivery in Homa bay County. As such, there are factors that are not

considered in this study that contribute to the other 25% of healthcare service delivery.

This is in line with Okuto (2018) who revealed that the county resource mobilization

programs and bureaucratic practices contribute to proper service delivery.

4.5.2 Analysis of Variance (ANOVA)

The Anova table in table 4.9 shows that the overall model having a good fit since (F-

value=2.999 and p-value=0.039<0.05).

Table 4.6: ANOVAa

Sum of Mean
Model Squares df Square F Sig.
1 Regression 5.512 3 1.837 2.999 .039b
Residual 61.245 51 .613
Total 66.757 54
a. Dependent Variable: Service delivery

45
c. Predictors: (Constant), Resource mobilization, Bureaucratic practices, Citizen
engagement approaches

The research examined the statistical significance of the study model. The study used the

F-statistic findings as the grounds of testing the significance of the regression model. The

results of the model show F-statistic of 2.999>2.36 (F-Critical) and a Sig =.039<.05 as

presented in the above table.

4.5.3 Coefficients Analysis

The study further examined the significance of the nexus between the research variables,

the regression coefficients (β), the model intercept (α) and the significance of all the

coefficients.

Table 4.7: Coefficientsa

Unstandardized Standardized
Coefficients Coefficients
Model B Std. Error Beta t Sig.
(Constant) .863 .673 1.281 .006
Bureaucratic practices .079 .203 .059 .390 .018
Citizen engagement .180 .177 .168 1.014 .035
approaches
Resource mobilization .303 .221 .227 1.368 .027

46
Dependent Variable: Service delivery
Source: Researcher (2019)
From the results from the table above the equation (Y = β0+ β1X1+ β2X2+ β3X3 + ε) therefore
becomes:

Y= 0.863+0.079X1 +0.180X2 + 0.303X3

Where Y = Service delivery

X1 = Bureaucratic practices

X2 = Citizen engagement approaches

X3 = Resource mobilization

The results above present a constant α = .863 which is significantly different from 0

since the p- value .006<.05. The beta value is (β) = .079 and is significantly different

from 0 since the p- value .018<.05. This implies that there is a statistically significant

positive effect of Bureaucratic practices on service delivery. A unit change in

bureaucratic practices will prompt a .079-unit change in service delivery

The beta value is (β) = .180 and is significantly varied from 0 since the p-value

.035<.05. This therefore shows that there is a statistically significant positive effect

of Citizen engagement approaches on service delivery. A unit change in Citizen

engagement approaches will prompt a .180 -unit change in service delivery.

The beta value is (β) = .303 and is significantly varied from 0 because the p-value

.027<.05. This means that there exists a statistically significant positive effect of

resource mobilization on service delivery. A unit change in resource mobilization will

prompt a .303 - unit change in service delivery.

47
4.6 Qualitative analysis

When asked to comment on the general remark on the quality of healthcare services as

issued by this health facility. Majority of the key informants asserted that the quality of

services delivery in their facilities was fair. They also mentioned that with the limited

resources they still manage to serve the citizenry however they noted that there is still

much to be done to enhance the quality of services rendered. Some also pointed out that

the devolved system of governance has set out structures that have improved healthcare

provision in the county.

On bureaucratic practices, majority of the respondents mentioned that all attributes of

bureaucracy were present in their facilities and that has ensured smooth operation and

efficient service delivery to the patients. They also noted that the service delivery charter

is a good guideline to follow across all departments. However, some propounded that

some procedures and processes delay crucial services to be rendered to patients that need

them most.

When asked whether they thought citizen engagement approaches in Homa Bay County

healthcare sector is sufficient enough in providing services effectively. The key

informants responded that there is little citizen engagement on matters healthcare service

delivery. They mentioned that the only time the citizens are approached on matters

healthcare service delivery is when there are certain projects that need corporation of the

masses such as vaccination and distribution of malaria nets.

On whether resource mobilization is sufficient enough to ensure provision of services

effectively, the respondents put forward that as much as the county government with help

48
of some donors are trying to ensure resources are availed in the health facilities. They

however decried the fact that their facilities lack enough human resource, drugs forcing

them to give prescription. Lack of functional technology such as Xray machines and lack

of eye services infrastructure among other crucial resources that facilitate proper service

delivery were also missing in most facilities especially the subcounty hospitals.

On measures that the County can institute in ensuring effective service delivery to her

citizens, the respondents mentioned that the following would aid proper service delivery;

they include timely remuneration of healthcare service providers, hiring of more staff,

hiring of specialists especially in the sub county hospitals, infrastructural enhancement

and availing funds to the facilities bot in time and in sync with the demands of the

facilities. Allocation of funds and timely renumeration of healthcare workers was fronted

as the top measures that would facilitate effective and efficient service delivery.

49
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Introduction

This final chapter focuses on the summary of findings, conclusion, recommendations

and suggestions for further research are also fronted. This was done consistent with the

three study objectives.

5.2 Summary of findings

The main focus of the research was to examine the effect of policy implementation on

service delivery in Homa bay county health sector, Kenya. The study deployed a

descritpive research methodology by use of structured research questionnaire and

interview schedules for key informants. The findings indicate that there was 73%

response rate with 66% of the respondents being between 21-30 years of age while

66% had attained tertiary level education. The results further show that the majority of

the respondents 58% were male.

5.2.1 Bureaucratic practices

Concerning the bureaucratic practices variable in the research the results indicate

agreement among respondents that procedures are duly followed by health officials,

rule and regulations eliminate favoritisms and procedures in the facility delay

processes. The results also indicate that health officers providing services in a specified

time. Results show that there is a significant and positve effect of bureaucratic practices on

service delivery (P=.079, Sig =.018<.05).

50
5.2.2 Citizen engagement approaches

Concerning the second variable on citizen engagement in the research, the results

indicate disagreement among respondents that there is high participation in public

forums, there is participation in project implementation and there is presence of county

website materials that are easily accessible. Results also indicate respondents disagreed

that local community participate in initiation and implementation of public projects

and minorities and marginalized are involved in project implementation. Results reveal

that there is a significant and positive effect of Citizen engagement approaches on

service delivery (P=.180, Sig =.035<.05).

5.2.3 Resource mobilization

Concerning the resource mobilization variable in the study, the results indicate

disagreement among respondents that there exists enough collection of county revenue,

technology assists in revenue collection, there is timely transfer of funds from

government to healthcare facilities, and allocated funds match the healthcare needs.

The results also show that the personnel in the facilities are not enough and medical

staff welfare are not taken care of. Findings show that there is a significant and positve

effect of resource mobilization on service delivery (P=.303, Sig =.027<.05).

5.3 Conclusions

From the study findings, it can be concluded that bureaucratic practices, citizen

engagement approaches and resource mobilization are key predictors of service

delivery in the healthcare sector in Homa bay county.

Resource mobilization was the best predictor of service delivery (βeta=0.303).

51
Resource mobilization had a statistically significant positive effect service delivery

(β=0.303, p=0.027<0.05). This meant that one unit change in resource mobilization

explained 30.3% unit increase in service delivery.

Citizen engagement approaches was the second-best predictor of service delivery

(βeta=0.180). citizen engagement approaches were established to have a

statistically significant positive effect on service delivery (β=0.180,

p=0.035<0.05). Here, one unit change in citizen engagement approaches results in

20.1% unit increase in service delivery. This meant that a unit change in citizen

engagement approaches accounted for18% unit increase in service delivery.

Bureaucratic practices was the least predictor of service delivery (βeta=.079).

Bureaucratic practices also had a positive linearly significant influence on service

delivery (β=0.079, p=0.018<0.05). This implied that a unit change in bureaucratic

practices will account for a 7.9% -unit change in service delivery.

5.4 Recommendations

Firstly, the study recommends that there should be a policy framework that provides for

the participation and engagement of citizens on matters of healthcare service delivery.

Secondly, there should be timely transfer of funds that meet the demands of the facilities

from the county government. Equally, the county government should prioritize timely

payment of salaries to healthcare workers so as to enhance the morale to provide quality

services to the people. Further, the county should enhance technology in the healthcare

facilities to assist both in records management and revenue collection. Lastly, the

implementation of effective service delivery should be reviewed independently regularly

in order to grant assurance that organizational practices properly reflect the policy plans

52
and programs, and that it is feasible and effective.

5.5 Suggestions for further Study

The study suggests that further inquiry should be carried out to examine how

coordination between national county governments affects delivery of healthcare in

the wake of COVID-19 pandemic. Further, there is need to cascade similar survey in

other devolved units especially in one of the Arid and semi-arid lands (ASALs)

counties which are deemed to be marginalized for comparative analysis.

53
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 APPENDICES

Appendix I: Letter of Introduction

DAVID OCHIENG’ GEORGE

KENYATTA UNIVERSITY

CITY CAMPUS

POSTAL ADDRESS, 43844-00100

NAIROBI, KENYA

Dear Respondent,

RE: POLICY IMPLEMENTATION AND SERVICE DELIVERY IN HOMA BAY

COUNTY HEALTH SECTOR, KENYA

I am a postgraduate student in Kenyatta University pursuing Masters of Public Policy and

administration and currently conducting a study titled, Policy Implementation and

Service Delivery In Homa Bay County Health Sector, Kenya. Kindly assist in this

endeavor by duly filling the attached questionnaire/interview schedule -as will be

directed.

The gathered information will be strictly for purposes of academia and whose revelations

will greatly aid Homa bay County in improving their management of their Healthcare

development and services. Also, be sure to note that your feedback will certainly be

regarded with utmost confidentiality and can be divulged only after your approval.

Yours Sincerely,

David Ochieng’ George.

58
 Appendix II: Questionnaire for patients

QUESTIONNAIRE

Kindly fill your responses in the space given and tick appropriately.

SECTION 1: Background information

Bio data

1. Age

Below 21years [ ]

21 – 30 years [ ]

31 – 40 years [ ]

41 – 50 years [ ]

Over 50 years [ ]

2. Sex

Male [ ]

Female [ ]

SECTION 2: LEVEL OF FORMAL EDUCATION

None [ ]

Primary [ ]

Secondary [ ]

Tertiary [ ]

SECTION 3: WORK EXPERIENCE

Below one year [ ]

One year [ ]

Two years [ ]

Three years [ ]

Over three years [ ]

59
Section Two: Bureaucratic practices

Indicate your degree of concurrence with the remarks hereunder relating to bureaucracy

and the quality of public healthcare services delivered in healthcare facilities managed by

the Homa Bay County administration. Do place a tick [√] to the degree you prefer. Using

a scale of 1 to 5 whereby; 1 denotes Strongly Disagree (SD), 2 denotes Disagree (D), 3

denotes Undecided (U), 4 denotes Agree (A), and 5 denotes Strongly Agree (SA).

No Bureaucratic practices Degree of concurrence with

remarks

SD D U A SA

1 2 3 4 5

1. Procedures are duly followed by health officials

2. Rules and regulations eliminate favoritisms

3. Procedures in the facility delay processes

4. Available procedures guide how every

department works

5. Health officers provide services in a specified

time

6. Health officers have sufficient information to

answer questions and inquiries

7. Health officers carry themselves with high codes

of conduct

8. Health officers are professional in carrying out

their duties

9. The attitudes of the health officers make me

recommend facility to others

60
10. What other ways can bureaucratic practices influence health care service delivery in
Homa Bay County?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________

61
Section Three: Citizen Engagement approaches

Indicate your degree of concurrence with the remarks hereunder relating to citizen

engagement approaches and the quality of public healthcare services delivered in

healthcare facilities managed by the Homa Bay County administration. Do place a tick

[√] to the degree you prefer. Using a scale of 1 to 5 whereby; 1 denotes Strongly Disagree

(SD), 2 denotes Disagree (D), 3 denotes Undecided (U), 4 denotes Agree (A), and 5

denotes Strongly Agree (SA).

No Citizen Participation Degree of concurrence with

remarks

SD D U A SA

1 2 3 4 5

1 There is high participation in public forums

2 There is participation in project implementation

3 There are visit of civil groups

4 County communication exchange

5 There is collaborative resource management

6 Presence of county website materials that are

easily accessible

7 Citizens participate in attitude surveys

8 Citizens are well represented in public forums

9 Local community participate in initiation and

implementation of public projects

10 Minorities and marginalized groups are

involved in project implementation

62
11. What other ways can citizen engagement approaches influence health care service
delivery in Homa Bay County?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________

63
Section Four: Resources Mobilization

Indicate your degree of concurrence with the remarks hereunder relating to resource

mobilization and the quality of public healthcare services delivered in healthcare facilities

managed by the Homa Bay County administration. Do place a tick [√] to the degree you

prefer. Using a scale of 1 to 5 whereby; 1 denotes Strongly Disagree (SD), 2 denotes

Disagree (D), 3 denotes Undecided (U), 4 denotes Agree (A), and 5 denotes Strongly

Agree (SA).

No Resources Mobilization Degree of concurrence with

remarks

SD D U A SA

1 2 3 4 5

1. Financial resources are equitably allocated to

healthcare sector

2. Contracts fairly allocated through procurement

methods

3. There is enough collection of county revenue

4. Technology assists in revenue collection

5. There is timely transfer of funds from government

to healthcare facilities

6. Allocated funds match the healthcare needs

7. There are enough personnel in the facility

8. The health personnel are well trained

9. The medical staff have their welfare taken care of

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10. What other ways can resource mobilization influence health care service delivery in
Homa Bay County?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Section Five: Service delivery

Kindly give a rating of the efficacy of Homa Bay County administration in the provision
of public healthcare services with aid of the following parameters. Using of a scale of 1
to 5 whereby: 1 denotes Not Effective; 2 denotes Least Effective; 3 denotes Fair; 4
denotes More Effective; and 5 denotes Most Effective

NO. Service Delivery Degree of concurrence with

remarks

1 2 3 4 5

1 Speed of services

2 Availability of drugs

3 Customer satisfaction

4 Responsiveness to patient concerns

Thank you for taking time to answer this questionnaire

65
Appendix III: Interview Schedule for Hospital Health Records officers and Hospital
administrators
1. What is your general remark on the quality of healthcare services as issued by

this health facility?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

…………………………………...

2. Comment on the bureaucratic practices in this healthcare facility?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………

3. Do you think citizen engagement approaches in Homa Bay County healthcare

sector is sufficient enough in providing services effectively?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

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4. Do you think resource mobilization in Homa Bay County healthcare sector is

sufficient enough to ensure provision of services effectively?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

5. What are some of the measures that the County can institute in ensuring effective

service delivery to her citizens?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

6. In the measures above which one would you regard as the most appropriate and

why?

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

7. Suggest recommendations on how Homa Bay County government can improve

healthcare service provision in its facilities.

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

67
Appendix IV: Approval of Research Project Proposal from Kenyatta

University Graduate School

68
Appendix V: Research Authorization from Kenyatta University Graduate

School

69
Appendix VI: Research Authorization Letter from Ministry of Education

70
Appendix VII: Research Permit from NACOSTI

71