Governance of County Revenue, Leadership and Delivery of Health Services in Kenya’s Level 5 Public Hospitals
DOI:
https://doi.org/10.47604/ijlg.3645Keywords:
County Revenue, Health Service Delivery, Devolution, Public Health Financing, Level 5 HospitalsAbstract
Purpose: Kenya’s devolved governance system has empowered counties to generate and manage their own-source revenue, with the aim of improving public service delivery, particularly in healthcare. Nonetheless, persistent gaps in service quality, availability and access in public hospitals underscore critical weaknesses. This raises fundamental questions about the role of county revenue governance in translating fiscal inputs into tangible health service delivery. Thus, the study aimed to investigate the influence of governance of county revenue on delivery of health care services in Kenya’ level 5 public hospitals. As well as the moderating effect of leadership on the relationship between governance and service delivery.
Methodology: A descriptive cross-sectional approach utilizing quantitative data was employed to collect data from 252 healthcare personnel in 13 Level 5 public hospitals across 10 counties in Kenya. Data was collected from key county hospital staff members, including nurse practitioners, pharmacists, doctors, physical therapists, medical technologists, and administrators. Descriptive statistics and regression analyses were used to analyze the quantitative data.
Findings: The findings revealed that strengthening governance of county revenue leads to better service delivery with governance quality explaining nearly one third (28.1%) of the variation in service delivery outcomes when controlling for other factors. Furthermore, the results demonstrates that the relationship between governance and health service delivery is moderated by leadership orientation. The study concludes that while county revenue governance is a significant determinant of health service delivery, its effectiveness is moderated by the extent of public value leadership orientation. Therefore, the most impactful approach is not revenue generation alone, but its strategic governance through its core dimensions of fiscal autonomy, allocation efficiency, and predictability, which, when coupled with strong public value-oriented leadership (ethical stewardship, strategic direction, equitable advocacy), translates directly into measurable improvements in citizen satisfaction, access to public health services, and availability of critical healthcare services.
Unique Contribution to Theory, Practice and Policy: Given the cross-sectional design and reliance on healthcare personnel perspectives, future research should adopt longitudinal approaches, incorporate external stakeholder such as patients, county finance officers, and national regulators and extend the scope to lower-tier health facilities. This research contributes to the discourse on public financial management and health governance by proposing a context-specific framework that integrates governance quality and leadership to explain service delivery outcomes in devolved systems. Moving beyond isolated fiscal analysis, it offers an integrated governance–leadership contingency model, thereby enriching the literature on adaptive and accountable public service delivery. Practically, the study provides county leadership and health policymakers with an evidence-based blueprint focusing on strengthening revenue governance while cultivating leadership ultimately aiming to enhance service delivery.
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Copyright (c) 2026 Shem Odhiambo Ochola, Prof. Jack Busalile Mwimali (PhD), Dr. Susan Wekesa (PhD), Dr. Mary Omondi (PhD)
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