FINANCIAL ALLOCATION AND HEALTH SERVICE DELIVERY IN LAIKIPIA COUNTY, KENYA
Keywords:
County Integrated Development Plan, Financial allocation, Health service delivery, Laikipia County
Abstract
The County Integrated Development Plan (CIDP) is a strategy framework for resource allocation, policy implementation, and service delivery in Kenya's devolved governance system. The study assessed the effects of financial allocation on health service delivery. the study was founded on the Resource-Based View theory. The study was carried out using a descriptive survey design where data collection and analysis methods included both qualitative and quantitative. From a target demographic of 800, 260 respondents were sampled for a survey using stratified, simple random, convenience, and purposive sampling methods. Questionnaires were administered to doctors, nurses, and clinical officers while interviews done for service recipients, caregivers, administrators, and directors in the Laikipia County health facilities besides and CECs. Data was summarized using means, percentages, standard deviations, and frequencies, while regression analysis used for inferential statistics. Thematic analysis was used to examine qualitative data. The study’s findings established a positive significant relationship between financial allocation (r=0.853) and health service delivery. The research showed that timely and adequate financial allocation has significant effect on the quality of health service delivery results for Laikipia County. The study suggested timely release of funds for health services as well development of spending monitoring systems to enhance accountability.
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African Union. (2025). Concept note: 8th session of the Specialized Technical Committee on Finance, Monetary Affairs, Economic Planning and Integration. African Union.
Barasa, E. W., Manyara, A. M., Molyneux, S., & Tsofa, B. (2017). Recentralization within decentralization: County hospital autonomy under devolution in Kenya. PLOS ONE, 12(8), e0182440.
Barney, J. B. (2000). Firm resources and sustained competitive advantage. In Economics meets sociology in strategic management (pp. 203–227). Emerald Group Publishing Limited.
Barney, J. B., Ketchen Jr., D. J., & Wright, M. (2021). Bold voices and new opportunities: An expanded research agenda for the resource-based view. Journal of Management, 47(7), 1677–1683.
Bhattacharyya, S., Issac, A., Girase, B., Guha, M., Schellenberg, J., & Avan, B. I. (2020). “There is no link between resource allocation and use of local data”: A qualitative study of district-based health decision-making in West Bengal, India. International Journal of Environmental Research and Public Health, 17(21), 8283. https://doi.org/10.3390/ijerph17218283
Boex, J., & Yilmaz, S. (2016). An analytical framework for assessing decentralized local governance and the local public sector.
Chege, M., Mutua, M. K., & Kimani-Murage, E. W. (2020). Health systems factors influencing utilization of health services in pastoralist communities in Kenya: A case of Laikipia North Sub-County. BMC Health Services Research, 20(1), 1–10.
Creswell, J. W., & Creswell, J. D. (2021). Research design: Qualitative, quantitative, and mixed methods approaches. Sage Publications.
Dieleman, J. L., Sadat, N., Chang, A. Y., Fullman, N., Abbafati, C., Acharya, P., et al. (2018). Trends in future health financing and coverage: Future health spending and universal health coverage in 188 countries, 2016–40. The Lancet, 391(10132), 1783–1798.
Dutta, A., Maina, T., Ginivan, M., & Koseki, S. (2018). Kenya health financing system assessment, 2018: Time to pick the best path. Palladium, Health Policy Plus.
Ghanad, A. (2023). An overview of quantitative research methods. International Journal of Multidisciplinary Research and Analysis, 6(8), 3794–3803. https://doi.org/10.47191/ijmra/v6-i8-52
Hanif, R., & Musvoto, W. S. (2023). An evaluation of funding challenges in the Malawian public healthcare delivery sector. Africa’s Public Service Delivery and Performance Review, 11(1), 654.
Ifeagwu, S. C., Yang, J. C., Parkes-Ratanshi, R., & Brayne, C. (2021). Health financing for universal health coverage in Sub-Saharan Africa: A systematic review. Global Health Research and Policy, 6(1). https://doi.org/10.1186/s41256-021-00190-7
Kairu, A., Orangi, S., Mbuthia, B., Ondera, J., Ravishankar, N., & Barasa, E. (2021). Examining health facility financing in Kenya in the context of devolution. BMC Health Services Research, 21, 1–13.
Kenya National Bureau of Statistics. (2019). 2019 Kenya population and housing census. https://www.knbs.or.ke/?p=5621
KIPPRA. (2020). Creating an enabling environment for inclusive growth in Kenya: Kenya economic report 2020. Kenya Institute for Public Policy Research and Analysis. https://kippra.or.ke/wp-content/uploads/2021/02/Kenya-Economic-Report-2020.pdf
Laikipia County Government. (2018). County Integrated Development Plan 2018–2022. Laikipia County Government.
Lewis, J. I. (2014). When decentralization leads to recentralization: Subnational state transformation in Uganda. Regional & Federal Studies, 24(5), 571–588.
Maina, J., Kithuka, P., Mwaniki, P., Kariuki, J., & Gichangi, A. (2019). The role of community health volunteers in primary healthcare: A cross-sectional study in two rural areas of Marsabit County, Kenya. BMC Health Services Research, 19(1), 944. https://doi.org/10.1186/s12913-019-4824-7
Mcpake, B., Normand, C. E. M., Smith, S., & Nolan, A. (2020). Health economics: An international perspective. Routledge.
Muriithi, M. K., & Ogendo, S. W. (2020). Budgeting for primary healthcare services in Kenya: A study of Laikipia County. Journal of Public Administration and Governance, 10(1), 1–16. https://doi.org/10.5296/jpag.v10i1.16844
Nyamongo, I. K., Aagaard-Hansen, J., & Evjen-Olsen, B. (2018). Policy implementation evaluation of the health sector strategic plan II in Kenya: A case study of the Nairobi, Nyanza, and Rift Valley provinces. BMC Health Services Research, 18(1), 209. https://doi.org/10.1186/s12913-018-2991-0
Office of the Controller of Budget. (2020). County governments budget implementation review report for the FY 2019/20. Office of the Controller of Budget.
Oraro-Lawrence, T., & Wyss, K. (2020). Policy levers and priority-setting in universal health coverage: A qualitative analysis of healthcare financing agenda setting in Kenya. BMC Health Services Research, 20, 1–11.
Organisation for Economic Co-operation and Development. (2022). Understanding differences in health expenditure between the United States and OECD countries. OECD Publishing.
Paim, J., Travassos, C., Almeida, C., Bahia, L., & Macinko, J. (2011). The Brazilian health system: History, advances, and challenges. The Lancet, 377(9779), 1778–1797. https://doi.org/10.1016/S0140-6736(11)60054-8
Republic of Kenya. (2012). County Governments Act, No. 17 of 2012. Government Printer.
Scott, G. K. (2021). Linking revenue mobilization practices to service delivery in decentralized governments in Ghana. In Modern perspectives in economics, business and management Vol. 11 (pp. 37–55). Book Publisher International. https://doi.org/10.9734/bpi/mpebm/v11/1919C
Sumah, A. M., & Baatiema, L. (2018). Decentralisation and management of human resource for health in the health system of Ghana: A decision space analysis. International Journal of Health Policy and Management, 8(1), 28.
Tsofa, B., Molyneux, S., Gilson, L., & Goodman, C. (2017). How does decentralisation affect health sector planning and financial management? A case study of early effects of devolution in Kilifi County, Kenya. International Journal for Equity in Health, 16(1). https://doi.org/10.1186/s12939-017-0649-0
World Bank. (2020). Evaluating the effects of medical equipment improvements on health outcomes in Africa: A longitudinal study. World Bank.
World Bank. (2025). Current health expenditure (% of GDP). World Development Indicators.
World Health Organization. (2010). The world health report 2010: Health systems financing: The path to universal coverage. World Health Organization.
World Health Organization. (2018). The impact of physical infrastructure on health service delivery: A mixed-methods study. World Health Organization.
World Health Organization. (2020). Global health system equipment and its impact on service delivery: A mixed-methods study. World Health Organization.
World Health Organization. (2022). Universal health coverage partnership annual report 2020: Implementing a primary health care approach towards universal health coverage in the COVID-19 era. World Health Organization.
World Health Organization. (2023). Global oral health status report: Towards universal health coverage for oral health by 2030: Regional summary of the African Region. World Health Organization.
Zeng, W., Musiega, A., Oyasi, J., Di Giorgio, L., Chuma, J., Lu, R., & Ahn, H. (2022). Understanding the performance of county health service delivery in Kenya: A mixed-method analysis. Health Policy and Planning, 37(2), 189–199.
