Following the adoption of the new constitution in 2010, devolution in Kenya was motivated by the

need for greater efficiency in the delivery of public services (International Institute for Legislative
Affairs, 2015). The County Governments Act 2012, which was ratified in 2012, provided for the
establishment of two distinct and interdependent levels of government, namely the county and
national governments, the implementation of which is seen as a better way of promoting
accountability, technical equity, and efficiency in the control of public resources in Kenya 2012.
Devolution not only gives communities the right to manage their own social and development affairs,
but it also protects the interests of marginalized groups.

Devolution also promotes equitable resource sharing and the decentralization of state organs and
services (McCollum et al., 2018). Chapter 11 of Kenya's Constitution empowers county governments
to provide social services, including education. This is due to the fact that the provision of public
services through decentralized units can have an impact on governance due to the availability of
resources and the authority to make resource choices (McCollum et al., 2018). As Murkomen (2012)
points out, county governments are responsible for providing a "enormous" portion of public services,
which is reflected in their allocations in the national budget.

The devolution of the health system in Kenya was expected to serve several purposes. It was expected
to improve access to health services across the country, eliminate disparities in healthcare quality
between urban and 'low potential areas, and eliminate bureaucracy in health-care administration,
particularly in procurement (Murkomen, 2012). Furthermore, devolved healthcare was viewed as a
means of increasing efficacy in healthcare service delivery while also improving healthcare quality.

The importance of Kenya's devolved governments in the administration of healthcare services cannot
be overstated. These governments are not only the custodians of healthcare funding, but they also
have deterministic powers over the human resources providing these services. Article 235 grants
county governments the authority to: "establish and abolish offices in its public service," "appoint
persons to hold and act in those offices," and "exercise disciplinary control over and remove persons
holding or acting in those offices." The constitution also states that county governments are
responsible for all aspects of healthcare delivery, including the procurement of medical supplies.

However, devolved governments' ability to provide quality healthcare services is primarily determined
by the nature of governance or administrative efficiency of semi-autonomous healthcare centers
(McCollum et al., 2018). The importance of governance in the performance of the health sector and
the achievement of long-term goals like Universal Health Coverage (UHC) is widely acknowledged
(Fryatt, 2017). County governments are also in charge of dealing with any challenges related to
healthcare services, such as capacity building and overcoming labor strikes (Murkomen, 2012).

Health administration is intended to improve efficiency and coordination in the delivery of healthcare
services and supplies. This could entail a group of people working together to manage various levels
of a healthcare system. The importance of health administration in county hospitals cannot be
overstated. This health-care organ influences the accessibility and availability of healthcare for all
people. It is also the responsibility of healthcare administrators to ensure that physicians and other
healthcare providers practice in a safe environment. It cannot be overstated how important
healthcare administration in county-level hospitals is. Not only do healthcare administrations make
important decisions in a specific hospital, but they also have an impact on the implementation of
national policies.

Healthcare administrators have an impact on community health services, which are critical to
achieving UHC, by promoting public awareness and uptake of healthcare services while countering
health-related beliefs in their immediate societies (McCollum et al., 2018). They are the foundation of
healthcare delivery and community involvement, particularly in the aftermath of devolution. This
explains why healthcare has been a popular topic in devolution-related debates. The state of
governance in a region can thus influence planning and financial management in the region's health
sector (Tsofa et al., 2017). This is why it is critical to include devolution in the debate over hospital
administration in Kenya.
Healthcare has been a recurring theme in most governance-related debates, making health-care
administration a critical concern. The Kenyan government, in collaboration with the United Nations
(UN), aims to achieve the UHC, which is concerned with providing all people with access to
preventive, rehabilitative, curative, promotional, and palliative health services (Magnusson, 2017).
Kenya's government is focused on providing adequate quality healthcare that is affordable to all
citizens. The third pillar of Kenya's Big Four Agenda outlines the government's ambition to "address
inequality in access to healthcare and improve health outcomes" (Parliamentary Service Commission,
2018). The government aims to achieve 100 percent UHC by 2022, anchored by widespread adoption
of National Hospital Insurance.

To achieve this goal, the national government must expand the NHIF system to rural areas, as
opposed to the previous case, where adoption was concentrated in urban areas (Parliamentary
Service Commission (PSC), 2018). This is largely dependent on the effectiveness and efficiency of the
community health center's health administration system. Previous research has shown that
decentralization of authority and resources can have an impact on the delivery of health services. In
the Philippines, for example, health centers faced enormous administrative challenges such as a lack
of medical equipment repairs, understaffing, and poor resource management only five years after
devolution (Tsofa et al., 2017). Similarly, rural districts faced staffing challenges as a result of
decentralization of health human resources, prompting re-centralization.

The national government, in collaboration with the county governments, has put in place mechanisms
to ensure that specific hospitals, particularly Level 5s, are equipped with medical equipment.
However, several obstacles have prevented such efforts from being realized, according to (Zulu, et al.,
2014). The main challenge is a lack of comprehensive and coordinated investment, as well as limited
investment in medical equipment maintenance. Concerning transportation, county governments have
purchased ambulances for hospitals and health centers. However, there are significant gaps in utility
vehicle availability.

To supplement these efforts, the government must invest in the maintenance of these investments
(Zulu, et al., 2014). In Kenya, there are four major sources of health funding: public, private, donor
household, and insurance schemes. Households account for approximately 35.9% of total funding,
with the government and donors each accounting for 30%. The Abuja Declaration, adopted by African
governments in 2001, requires African nations to set aside a minimum of 15% of GDP for health-care
provision (Kibua & Mwabu, 2008).

The government implemented the Health Financing Strategy in 2010 to ensure that everyone has
access to high-quality health care. This strategy resulted in social solidarity mechanisms, the primary
goal of which was to protect the poor and vulnerable (Government of Kenya, 2015). Furthermore, the
Kenyan government demonstrated its commitment to this agenda by revising the NHIF act, which
improved access and benefit to its users. The new constitution established a legal framework to
ensure the provision of comprehensive medical care services that are people-centered.

It is critical that any plans recognize the need for more input from other players in the health sector in
order to reverse the trends in health provision (Munge & Briggs, 2013). As a result, there is a need for
all stakeholders to actively participate in the provision of healthcare, and their efforts should be
directed toward providing an efficient health system. Finally, the system should take a sector-wide
approach, emphasizing flexibility for quick disbursement and constant monitoring of budgetary
resources. A well-trained and well-supported healthcare workforce is required for effective and high-
quality healthcare delivery.

All personnel involved in improving health services are included in the healthcare workforce. These
professionals include technicians, management personnel, doctors, nurses, and laboratory specialists,
among others, and while they do not interact directly with patients, their services are critical to the
health sector's smooth operation. Healthcare personnel are in charge of providing healthcare
services. They are an essential component of Kenya's healthcare system, according to the Kenyan
government (2008). Human Resources for Health (HRH) are divided into two categories: Human
Resource Development (HRD) and Human Resource Management (HRM) (HRM).
The two form a lifetime pathway for all health workers, beginning with training and continuing until
they leave the health workforce. The level of success of a country's health sector is determined by the
coordination of the two (Kumar, 2014). To effectively assess the health market, it is critical to examine
the demand and supply sides of the health labor market (Kumar, 2014). The supply side is made up of
a trained and qualified healthcare workforce such as nurses and physicians, among other caregivers,
who work in the health sector for a set wage. Demand for healthcare providers is inextricably linked
to demand for healthcare services. It is determined by the rate at which public and private health care
facilities hire professional healthcare workers.

According to the 2012-2030 report, the Kenyan government committed to improving citizens' access
to quality medical services by providing affordable, equitable, and high-quality services (Linda, 2018).
The policy covers major health guidelines for the health sectors of both the national and county
governments. The government has made significant investments in the health sector since
independence, but there are still numerous challenges facing the health workforce. The situation has
primarily contributed to the long-term population growth. This has put a strain on the available
workforce. As a result, it is critical for the government to increase financial allocations for human
resources in the health sector, as well as provide incentives and better working conditions to
encourage retention and recruitment.