The Role of Career Development Management on Health Sector Service Delivery in Devolved Units in the Western Kenya Region

Abstract

The reformation of the healthcare system in Kenya is anchored on the objectives of Articles 10, and 232 of the Constitution of Kenya promulgated on 27th August, 2010. However, these reforms have not achieved the envisioned results due to the transfer of functions to counties before building capacity at the county level to enable them to undertake the devolved functions effectively and efficiently, especially in the health sector despite the major policy, system, and infrastructural changes to 'fix' the health system to increase access, improve service delivery, reduce costs and increase accountability and improve responsiveness. The health sector in the county governments is still facing a myriad of challenges like delayed or lack of promotion, a severe shortage of staff in essential cadres, workers' strikes, and diminishing productivity among health workers. There is evidence of failure to provide sustainable access to quality and affordable healthcare occasioned by frequent strikes by HRH. Their major grievances have been lack of promotion and poor remuneration among cadres disrupting the only health system accessible to the poor majority. This informs the study's objective of assessing the influence of career development management on the health sector service delivery in devolved healthcare units in western Kenya. The study was anchored on Hertzberg's two-factor theory and agency theory. The study targeted a population of 3,547, and a sample size of 367 (201 HRH and 166 inpatients) was obtained based on the sample size determination table proposed by Krejcie and Morgan (1970) and Proportional allocation. Simple random sampling was used to obtain sample sizes for each stratum. Multi-stage, purposive and simple random sampling procedures were used to get the health facilities to participate in the study. Stratified cluster sampling, purposive and simple random sampling were used to include pre-described sample targets. Structured questionnaires were used to obtain data from the human resources for health and inpatients, whereas interview schedules were used to collect data from the in-charge of cadres. An explanatory research design was used. Data were analysed using descriptive and inferential statistics, which included correlational and Simple Linear Regression Analysis on SPSS (version 23). The results of the regression coefficient indicated that b= 0.108, t =0.966, p=0.000<0.05. It showed that career development management significantly influenced service delivery in the health sector in the devolved units. The study recommends that promotion decisions should be based on employee performance to encourage fairness. Adequate training opportunities be provided to all employees to prepare them to do their job efficiently. It proposes policies and frameworks for the welfare of health care workers and improves service delivery to the citizens of these counties. County governments should have a clear succession plan so that healthcare providers can align their productivity to their career goals and aspirations.