STRATEGY IMPLEMENTATION DETERMINANTS, EXTERNAL ENVIRONMENT AND PUBLIC HEALTH FACILITIES SERVICE DELIVERY IN WESTERN REGION, KENYA

Abstract

Every organization’s aim is to reaAliBzSe TaRnAd CuTph old great performance in service delivery, which leads to progression and growth for the organization. In order to improve effectiveness and safeguard higher performance, organizations have enhanced their strategy implementation process. There have been complaints about poor service delivery in public hospitals in devolved units from its citizenry; this is in spite of the reality that county governments obligate themselves to offering these services in their strategic plans, county integrated development plans, as well as in their service delivery charters. This study sought to establish the extent to which strategy implementation determinants influence public health facilities service delivery in county governments in the Western Region of Kenya. In order to achieve this purpose, it was hypothesized that public health facilities service delivery in county governments is determined by participative leadership style, human resource capacity and organizational culture. It was also hypothesized that this relationship was moderated by external environmental factors. Taking a positivist approach, the study was anchored on the McKinsey 7-S Model Framework, participative leadership theory, human capital theory, and organizational culture theory. Descriptive survey and explanatory research designs were adopted with a target population of 966 respondents, consisting of the 16 top management leaders in the Ministry of Health, 264 medical personnel and 686 patients admitted, treated, and discharged who had been selected to form the study sample through stratified and simple random sampling techniques. Structured questionnaires and interview schedules were the main tools for data collection. The validity and reliability of these instruments were established through conducting a pilot study, conducting Cronbach alpha tests, and getting expert opinions. The questionnaires for medical personnel gave Cronbach alpha coefficients of α = 0.807, an indication of a high level of reliability. The collected data was then coded and analyzed using the SPSS version 26 computer program. Data was analyzed using descriptive statistics such as frequencies, percentages, means, and standard deviations and inferential statistics such as Pearson’s correlation coefficient test, simple, multiple, and hierarchical regression analysis, analysis of variance (ANOVA), and exploratory factor analysis. Multiple regression analysis results showed that strategy implementation determinants significantly influenced public health facilities service delivery. From the results, participative leadership explains 62.4% (R2 =0.624), human resource capacity explains 51.2% (R2 =0.512) and organizational culture explains 80.1% (R2 =0.801) of the variance in public health facilities service delivery. Therefore, the hypotheses were rejected. The external environment moderated the relationship between strategy implementation determinants and public health facilities service delivery in the Western Region of Kenya. The study concluded that strategy implementation determinants influenced public health facilities service delivery in the Western Region of Kenya. Participative leadership style, human resource capacity and organizational culture were the major determinants of public health facilities service delivery. External environmental factors did not moderate the relationship between participative leadership style and public health facilities service delivery. However, external environmental factors moderated the relationship between human resource capacity, organizational culture and public health facilities service delivery. The study recommends that the county governments in the Western Region of Kenya should enhance the operation of strategy implementation determinants for better public health facilities service delivery.