Policy capacity and healthcare service delivery in Kenyas County Government

This study examines the influence of policy capacity, the finding of the first objective in a study that assessed the influence of governance capacity on healthcare service delivery in county governments in Kenya. The study had four capacity independent variables: policy, coordination, resource, and learning. Healthcare was the dependent variable, whereas an enabling environment was the moderator. A mixed-method study of correlational design and qualitative interviews. With a sample size (N = 317; 8 counties) with County Health Management Team (CHMT) and managers in county referral hospitals were respondents. Probability stratified and purposive sampling were used. Descriptive statistics, correlation, and regression analysis were used to analyze data, while content analysis was used for qualitative data. Findings: a positive and significant relationship (r = 0.715, p < 0.001; multivariate Beta = 0.466, p < 0.001; R² ≈ 0.51–0.54) of the influence of policy capacity on healthcare service delivery was established. That political acumen played an important role in healthcare delivery, yet was constrained due to policy competence gaps in coalition building, agenda setting, advocacy, and negotiations with county assemblies. There were policy gaps in the implementation of non-communicable disease (NCD) policies compared to communicable diseases, due to disproportionate investment in vertical health programs and donor funding. Policy capacity significantly influenced healthcare delivery. Key words: Decentralisation, policy, political capacity, healthcare, counties.