Abstract:
Background: Globally, good governance is increasingly recognised as an important factor in health systems.
Governance is a key determinant of performance, particularly towards achieving targets that ultimately affect economic
and social development. However, conceptually and practically, governance is poorly understood by decision makers at
various levels. Governance is also difficult to measure, but it is critical in assessing responsive, inclusive, effective, and
efficient services. We examined the extent to which governance attributes have been implemented within the Department
of Health in Uasin Gishu County, Kenya.
Methods: A cross-sectional research design was adopted, with 108 decision makers forming the target population. The
study period was between April and July 2016. Select documents relating to governance were reviewed; subsequently,
data were collected using a self-administered, semi-structured questionnaire, with 5-point Likert-type questions and open-
ended questions. We calculated proportions related to agreement levels to establish the decision makers’ perceptions on
the implementation of governance attributes. Cronbach’s
a for the items was between 0.72 and 0.84. Qualitative data
were coded and categorised using a framework approach.
Results: Of the 93 decision makers who responded, most (n=64, 68.8%) had been in their current position for less than
5 years. Regarding governance attributes, over half of the participants agreed on the implementation of good governance
in terms of strategic vision as well as regulation and oversight. Around half of the participants were undecided on the
implementation of good governance in terms of intelligence and information, transparency, participation, and consensus
orientation. Almost two-thirds believed that accountability and equity were poorly implemented. A minority rated the over-
all governance score as good, while two-thirds considered governance to be poor. Corruption, nepotism, lack of trans-
parency, political interference, and inadequate use of information were all reported to affect the implementation of good
governance.
Conclusion: Decision makers reported poor implementation of governance attributes at public health facilities, especially
in terms of accountability, equity, community participation, consensus orientation, strategic vision, and regulation and
oversight. It is feasible and critical to evaluate implementation of governance attributes to help improve governance; the
successful implementation of each attribute depends on the successful implementation of all others.