Establishing the Effect of Democratic Governance on the Performance of Public Hospitals in Selected Counties in Kenya

Background The study critically evaluates the effect of democratic governance on the performance of public hospitals in Kenyan counties, following the 2010 Constitution that introduced devolved governance. This shift aimed to enhance local decision-making, accountability, and service delivery, specifically in the health sector, by empowering county governments. Democratic governance principles, such as transparency, accountability, and citizen participation are critical for addressing long-standing challenges like inequitable resource distribution, underfunding, and inefficiencies in public health services. This study explored the effect of democratic governance on the performance of public health hospitals in Kenya.  Methodology A mixed-methods approach was employed combining quantitative data from surveys with qualitative insights from interviews with county officials. Factor analysis was used to assess the relationship between democratic governance indicators - transparency, accountability, citizen participation, and public health service performance. Qualitative data, were gathered through interviews and content analysis of responses from county officials complemented the quantitative findings.  Results The study revealed that while democratic governance positively influences the performance of public hospitals in delivering health services in Kenyan counties, there are discrepancies in implementation across counties. Most respondents agreed that public participation and transparency in decision-making are strong, but the accessibility of financial records and county documents remains limited. Factor analysis confirmed that democratic governance significantly impacts health service outcomes, but qualitative findings indicated moderate transparency in financial matters, with only 8.3% of respondents rating transparency as high.  Recommendations To improve the performance of public hospitals in the delivery of health services, county governments should enhance the accessibility of public records, strengthen financial reporting and transparency, and foster deeper citizen engagement in governance. Improved oversight mechanisms and better governance practices are essential for leveraging the benefits of devolved governance.