Fiscal decentralization and devolved healthcare service availability outcomes in Kenya: Evidence from panel dynamic approach

The study examined the effect of fiscal decentralization on healthcare availability outcomes from 23 Kenyan counties during the 2013–2022 devolution period. The results from different robust non-endogeneity econometric methods indicate a significant deleterious effect of fiscal decentralization on the availability of human and technical healthcare resources (number of medical personnel and number of hospital beds per 10,000 people). The study also reveals the significant beneficial role of county gross domestic product in enhancing the availability of healthcare resources. Nevertheless, the paper demonstrates that county revenue impedes realizing adequate availability of healthcare resources in Kenyan counties. The study results point to the need to implement proactive decentralized fiscal policy interventions to realize an efficient healthcare system where human and technical healthcare resources are available. Specifically, enacting policy interventions that target effective financial allocation toward infrastructural development and building human resource capacity could enhance overall healthcare availability at the grassroots level. • Investigates effect of fiscal decentralization on healthcare availability outcomes. • Results indicate significant deleterious effect of fiscal decentralization on the healthcare availability. • The county gross domestic product enhances the availability of healthcare resources. • The county revenue impedes realizing adequate availability of healthcare resources in Kenyan counties. • There is need to implement proactive decentralized fiscal policies for efficient healthcare system