Authors: Isaiah Maket a,b,* , Remmy Naibei c,d,*
The study examined the effect of fiscal decentralization on healthcare availability outcomes from 23 Kenyan counties during the 2013–2022 devolution period. The results from different robust non-endogeneity econometric methods indicate a significant deleterious effect of fiscal decentralization on the availability of human and technical healthcare resources (number of medical personnel and number of hospital beds per 10,000 people). The study also reveals the significant beneficial role of county gross domestic product in enhancing the avail ability of healthcare resources. Nevertheless, the paper demonstrates that county revenue impedes realizing adequate availability of healthcare resources in Kenyan counties. The study results point to the need to implement proactive decentralized fiscal policy interventions to realize an efficient healthcare system where human and technical healthcare resources are available. Specifically, enacting policy interventions that target effective financial allocation toward infrastructural development and building human resource capacity could enhance overall healthcare availability at the grassroots level.
Over recent decades, FD has been operationalized by several economies in the form of devolution, becoming an integral component in public sector reforms (Manor, 1999; Cavalieri and Ferrante, 2016). In this broader process, healthcare services have occupied a pivotal position (Costa-Font and Greer, 2016). In general, the devolution of healthcare functions to the lower cadre of governance occurs under diverse forms. For example, there are National Health Service systems in Scandinavian countries, the United Kingdom, Spain, and Italy; those for federal states in countries such as Australia, Canada, and Switzerland; and those for counties/administrative provinces in developing nations such as Kenya, Tanzania, China, India, and the Philippines (Cavalieri and Ferrante, 2016). Although intriguing reasons for devolution and decentralization are fully country-specific, the overall persuasion is that transfers of functions, responsibilities, and powers to the regional government can enable an ideal match between people’s priorities and state policies (Oates, 1972). In other words, such actions are entrenched in the inherent rationale of improving welfare mobility (Weingast, 2009; Zhang and Hewings, 2018).