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Fiscal devolution has gained prominence as a policy approach in many developing countries, aiming to enhance healthcare accessibility. This study focused on the influence of Fiscal devolution on healthcare accessibility in Homabay County. The study employed a mixed-methods approach to assess the impact of fiscal devolution on public sector efficiency, combining quantitative data analysis and qualitative observations. With an emphasis on metrics like service quality, punctuality, and accessibility, quantitative data were gathered via questionnaires and administrative records. Key stakeholders, such as representatives of the local government, prominent members of the community, and recipients of services, were interviewed in-depth and participated in focus groups to get qualitative data. The data were analyzed using appropriate SPSS version 27 statistical techniques and thematic analysis to identify patterns and relationships. Results showed that fiscal devolution had both positive as well as negative effects on healthcare accessibility in Homabay County, underlining the importance of effective local government and resource allocation processes. Preliminary data indicate that fiscal devolution in Homabay County has had a mixed effect on healthcare accessibility. On one hand, decentralization has empowered local authorities to make decisions tailored to local needs, resulting in improved service responsiveness and community engagement. On the other hand, challenges related to inadequate financial resources, capacity constraints, and intergovernmental coordination have hindered the efficient delivery of public services. Effectiveness of fiscal devolution largely depends on the presence of effective local governance structures, transparent resource allocation mechanisms, and capacity building initiatives.
Otieno et al. (Sat,) studied this question.