STRATEGIC DECISIONS AND SERVICE DELIVERY OF DEVOLVED HEALTH CARE SERVICES IN NAIROBI CITY COUNTY, KENYA

Abstract

The goal of strategic decision making in health care services provision is to support the implementation of the Vision 2030 and to improve the health outcomes in population and, to respond to people’s expectations while reducing the inequalities in both health and responsiveness. However, even after devolution of the healthcare services, statistics demonstrate poor service delivery in the devolved healthcare units in Kenya. This study thus established whether strategic decisions are made in the healthcare units in the county governments, and if so, how they affect service delivery of devolved health care services. A descriptive research design was adopted where the target population comprised of medical superintendent, nursing officer in-charge and hospital administrator from the level 5 and 4 facilities, health facility officer in-charge from level 3 facilities as well as the County Health Management Team and Sub County Health Management Team from 10 sub counties. In total, this list comprised of 117 respondents who were obtained by stratified purposive method. A structured questionnaire was the preferred instrument to collect quantitative data which was analyzed quantitatively through descriptive and inferential statistics. The descriptive statistics were mean and standard deviations. on the other hand, inferential statistics were correlation and regression analysis. The main tool for data analysis was statistical package for social sciences version 24 which generated tables and figures that aided in interpretation. the study established that both rational strategic choices and consensus strategic choices have a positive effect on devolved healthcare service delivery. It was recommended that policy makers in the public health sector of Nairobi County to embrace rational strategic decisions such as embracing objective decision, use of logic in decision making, analyzing facts before decisions are made, ensuring that specific steps from problem identification to solutions are made before making decisions and encouraging employees to follow a formal process in solving a conflict. They can also accelerate the use of Consensus Strategic Decisions such as ensuring that common will is respected in decision making, reaching a consensus before making key announcements, respecting and considering the opinion of minority, respecting the opinion of all the employees irrespective of cadre as well as respecting it when employees advance a common goal.

Key Words: Rational Strategic Decisions, Consensus Strategic Decisions, Devolved Health Service Delivery, Kenya