Health Workforce Satisfaction and Motivation in the Devolved Healthcare System in Busia County, Kenya

Abstract

In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous County Governments. With this came the transfer of responsibility for public healthcare service delivery from the central government to the counties. The aim of this study was to investigate Health workforce satisfaction and motivation in the devolved healthcare system in Busia County, Kenya. Descriptive survey design was adopted and a mixed method approach used. The target population included health workers working in public health facilities in Busia County. Purposive sampling was used to select the health centres while stratified random sampling to select health workers. A total of 24 public healthcare workers were interviewed. Quantitative data was analyzed by the use of descriptive statistics using SPSS version 21 while, qualitative data from interviews and field notes were managed using Nvivo 10. The findings of the study indicated that the major source of funding for the health centres was the national government, the funds were always delayed, the funds available were not sufficient to run the facilities satisfactorily.  The study also found that the infrastructure was inadequate to be able to support the provision of quality healthcare to the patients. There was lack of enough health workers in most of the health facilities in Busia County and majority of the respondents were not satisfied with devolution of the health care services to the county governments. This had an effect on their motivation and satisfaction thus they thought that counties were not prepared to handle the devolved healthcare.  From the findings of the research the study recommends that, the County should introduce interventions to improve county level capacity for health sector planning, budgeting and financial management. On infrastructure, an inventory should be done to ascertain what is available in the facilities identifying those that needed repairs, those that need to be replaced or done away with all together if they have outlived their usefulness. Hiring, remuneration and promotion of staff should be rethought. The County governments should adopt effective remuneration systems that enhance staff motivation and better productivity.