Functional devolution and access to maternal healthcare services: Evidence from marsabit county, kenya

Statement of the Problem: Kenya’s devolution of healthcare was intended to improve responsiveness and bring essential services closer to communities. In Marsabit County, however, the benefits of transferred service-delivery functions are constrained by a vast geographical area, dispersed pastoralist settlements, transport limitations, healthcare-worker shortages, and uneven facility capacity. These conditions make it important to establish whether functional devolution has translated into improved access to maternal healthcare rather than merely transferring responsibility from the national to the county level. Purpose of the Study: The study examined the effect of functional devolution on access to maternal healthcare services in Marsabit County, Kenya. Research Methodology: The study used a cross-sectional mixed-methods design. The target population comprised 9,600 women of reproductive age seeking maternal healthcare services in four county-managed Level Four hospitals. A sample of 384 respondents was selected proportionately through stratified random sampling. Quantitative data were collected using structured questionnaires and complemented by key informant interviews with healthcare stakeholders. Descriptive statistics were used to summarize respondents’ perceptions, while correlation and multiple regression analysis were used to test the relationship between functional devolution and maternal healthcare access. The functional-devolution coefficient was interpreted from the thesis multiple-regression model controlling for fiscal, governance, and administrative devolution.