Assessing The Impact of Devolved Healthcare Provision on Health Security: A Case Study of Mama Lucy Kibaki Hospital in Kayole Slums, Nairobi County, Kenya

Abstract

Health inequalities remain a major concern in Kenya’s devolved healthcare system, particularly in informal settlements such as Kayole in Nairobi County. Although the 2010 Constitution devolved health functions to county governments with the aim of improving accessibility, equity, and quality of healthcare, residents in underserved urban areas continued to face persistent challenges. Mama Lucy Kibaki Hospital, the main public health facility serving Kayole, experienced issues such as staff shortages, inadequate infrastructure, and weak accountability, raising critical questions about the effectiveness of devolution in promoting health security. This study sought to assess the impact of devolved healthcare provision on health security in Kayole, with a specific focus on accessibility, quality, equity, and residents’ experiences. The study was guided by decentralization theory and human security theory to examine the effectiveness of devolved systems in meeting the health needs of vulnerable urban populations. A mixed-methods case study design was employed, targeting a sample of 140 Kayole residents, 19 healthcare workers, and 10 Nairobi County health officials. Quantitative data were collected using structured questionnaires administered to residents across four county assembly wards, while qualitative data were gathered through key informant interviews and focus group discussions involving both service providers and community members. Quantitative data were analyzed using descriptive statistics, whereas qualitative data were analyzed thematically. The findings revealed both strengths and limitations in the implementation of devolved healthcare as experienced in Kayole. The study aimed to generate evidence-based insights to inform health policy reforms and contribute to the broader discourse on health equity and urban governance in Kenya. The study established that while devolution improved healthcare accessibility at Mama Lucy Kibaki Hospital through expanded infrastructure and localized management, significant challenges persisted in service quality, governance, and resource management. Most residents sought medical care only during emergencies due to dissatisfaction with long queues, drug shortages, poor staff communication, and limited emergency responsiveness. Although devolution brought decision-making closer to the people, its implementation was hindered by financial instability, delayed salaries, inadequate supervision, and political interference. Governance weaknesses, including favoritism and lack of accountability, further eroded public trust and limited equitable access to care, particularly among low-income groups. The study concluded that devolution’s success in achieving health security depended not only on decentralization but also on effective governance, adequate funding, and strong institutional capacity. It recommended that county governments strengthen accountability mechanisms, enhance supervision, ensure consistent funding, and promote merit-based staffing to improve efficiency and service quality. Additionally, greater community participation, transparent financial management, and investment in staff motivation and capacity building were proposed as critical steps toward achieving equitable, efficient, and people-centered healthcare in Kenya’s devolved health system.