Date of Award


Document Type


Degree Name



Public Administration

Committee Chair

Thomas Shaw, Ph.D.


Kenya experienced a political metamorphosis in 2010 with the enactment of a revised constitution that was associated with a devolution of government starting in 2013. As a result, 47 county governments were created and healthcare shifted from the national to the county level. This study specifically focuses on the county level in an effort to understand how devolution has affected both healthcare inputs and outcomes within the post-devolution period of 2013 to 2019. There are studies that have assessed some aspects of devolution such as healthcare workforce and there are others that have focused solely on outcomes. The following healthcare inputs are valid for assessment as they can be useful in understanding healthcare outcomes: financing, human resources, governance, medicines/supply, service delivery, and monitoring systems. Healthcare outcomes are important to observe in order to identify trends and determine where intervention is needed. As such, this cross-sectional and retrospective study utilizes a mixed-approach by investigating both healthcare inputs and healthcare outcomes. A comparative analysis will be conducted utilizing secondary multi-county level data from global databases. A time series will be presented with secondary data from 1990 to 2019 to increase the validity of the study and to allow for comparison of trends over time.