Financial Accountability Practices on Service Delivery in Level 5 County Referral Hospitals in Kenya: The Moderating Role of Leadership Styles
DOI:
https://doi.org/10.70619/vol6iss3pp56-72-794Keywords:
Financial Accountability practices, Service Delivery, Leadership styles, County Referral HospitalsAbstract
Service delivery in Kenya’s county referral hospitals remains uneven despite ongoing reforms aimed at strengthening fiscal discipline and governance. Financial accountability practices, particularly transparency, compliance with financial regulations, and adherence to reporting standards, play a critical role in enhancing institutional performance. These practices are primarily underpinned by Agency Theory, which explains the need for oversight mechanisms to align the actions of hospital management (agents) with public and government expectations (principals), thereby preventing the misuse of resources and enhancing accountability. This perspective is reinforced by Institutional Theory, which emphasizes adherence to regulatory frameworks and norms, and Total Quality Management Theory, which links accountability processes to continuous improvement and service quality. This study examined the influence of financial accountability practices on service delivery in Level 5 county referral hospitals in Kenya, while also evaluating the moderating influence of leadership styles. A descriptive and quantitative research design was adopted. The target population comprised all 47 county referral hospitals, stratified across Kenya’s eight administrative regions. A sample of 148 respondents from hospital management teams was selected using stratified random sampling. Data were collected using structured questionnaires, and the questionnaires' validity and reliability were confirmed through pilot testing, expert review, and Cronbach’s alpha. Data analysis involved descriptive statistics, Pearson correlation, and multiple regression, complemented by diagnostic tests. Findings revealed that financial accountability practices significantly influence service delivery outcomes, with leadership styles strengthening this relationship. The study concluded that robust accountability frameworks, reinforced by effective leadership, are essential for enhancing service delivery quality in county referral hospitals.
References
Ali, M. (2024). Research philosophy and quantitative methods in social sciences. Journal of Research Methodology, 12(1), 15–28.
Alilyyani, B., Wong, C. A., & Cummings, G. (2022). Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review. International Journal of Nursing Studies, 83, 34–64.
Barasa, E., Kazungu, J., Orangi, S., & Kabia, E. (2021). Examining the level and inequality in health system responsiveness in Kenya: A mixed-methods analysis. International Journal for Equity in Health, 20(1), 1–14.
Barroy, H., Sparkes, S., & Dale, E. (2022). Assessing fiscal space for health in low- and middle-income countries. World Health Organization.
Bass, B. M., & Avolio, B. J. (2020). Multifactor Leadership Questionnaire Manual. Mind Garden.
Bass, B. M., & Riggio, R. E. (2021). Transformational leadership (3rd ed.). Routledge.
Berwick, D. M., Nolan, T. W., & Whittington, J. (2021). The triple aim: Care, health, and cost revisited. Health Affairs.
Cooper, D. R., & Schindler, P. S. (2014). Business research methods (12th ed.). McGraw-Hill.
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Sage Publications.
Field, A. (2020). Discovering statistics using IBM SPSS Statistics (5th ed.). Sage Publications.
Flynn, N., & Davis, P. (2023). Public sector accountability and governance: Emerging challenges and reforms. Public Administration Review, 83(2), 210–222.
Gathungu, E., & Irungu, D. (2022). Leadership styles and service delivery in public health institutions in Kenya. International Journal of Health Management, 15(2), 45–58.
Gitonga, J., & Kihoro, J. (2021). Financial accountability practices and performance of public hospitals in Kenya. International Journal of Public Sector Management, 34(4), 455–470.
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis (3rd ed.). Guilford Press.
Jensen, M. C., & Meckling, W. H. (1976). Theory of the firm: Managerial behavior, agency costs, and ownership structure. Journal of Financial Economics, 3(4), 305–360.
Kamau, P., & Mwangi, J. (2023). Financial management practices and performance of public hospitals in Kenya. Journal of Public Sector Finance, 15(2), 88–104.
Kariuki, M., & Gitonga, L. (2022). Workforce challenges and service delivery in Kenyan public health institutions. African Journal of Health Systems, 10(1), 55–70.
Kibet, R., Mwangi, J., & Mutua, F. (2023). Financial management practices and performance of county hospitals in Kenya. Journal of Public Health Finance, 12(3), 101–118.
Kim, S., & Lee, H. (2022). Participatory leadership and organizational performance. Public Management Review, 24(3), 345–360.
Kimani, J., & Mutua, P. (2022). Financial monitoring systems and healthcare service delivery in Kenya. Journal of Health Management, 24(3), 321–336.
Kimathi, L., Muriuki, J., & Wanjiru, P. (2021). Leadership approaches and healthcare service quality in Kenyan public hospitals. African Journal of Public Administration, 9(1), 23–37.
Lan, L., & Heracleous, L. (2021). Rethinking agency theory in public sector governance. Public Management Review, 23(5), 742–761.
Maina, J., Kariuki, P., & Gitau, S. (2023). Financial stewardship and healthcare delivery efficiency in Kenyan counties. Health Policy and Planning, 38(4), 567–579.
McIntyre, D., & Meheus, F. (2023). Fiscal policies and health system performance in developing countries. Health Policy and Planning, 38(2), 145–156.
McPake, B., Hanson, K., & Mills, A. (2023). Health economics: An international perspective (4th ed.). Routledge.
Ministry of Health. (2024). Kenya Health Sector Performance Report 2023/2024. Government of Kenya.
Mohiuddin, Z., Khan, S., & Ali, R. (2023). Leadership styles and organizational effectiveness. Journal of Organizational Behavior, 44(2), 213–229.
Mugenda, O. M., & Mugenda, A. G. (2019). Research methods: Quantitative and qualitative approaches. ACTS Press.
Muriithi, S., & Mwangi, D. (2023). Financial governance and organizational performance in public sector institutions. African Journal of Public Administration, 11(2), 45–60.
Ndiritu, A., Karanja, L., & Mwikali, R. (2021). Budget transparency and service delivery in Kenyan public hospitals. International Journal of Public Sector Management, 34(5), 621–635.
Odhiambo, R., & Onyango, D. (2024). Public financial accountability and service delivery in devolved health systems. International Journal of Public Administration, 47(3), 210–225.
Pillay, R., & Barron, P. (2021). Decentralized health systems and service delivery in South Africa. South African Medical Journal, 111(3), 234–239.
Skogstad, A., Hetland, J., & Einarsen, S. (2021). The impact of laissez-faire leadership. Work & Stress, 35(2), 1–19.
Sparkes, S., Barroy, H., & Kutzin, J. (2023). Public financial management for health: Key issues and reform strategies. Health Systems & Reform, 9(1), e210–e222.
Taherdoost, H. (2021). Sample size determination in research projects. International Journal of Economics and Management Systems, 6, 237–239.
Tavakol, M., & Dennick, R. (2021). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55.
Tsofa, B., Molyneux, S., Gilson, L., & Goodman, C. (2022). How does decentralization affect health sector planning and financial management? A case study of Kenya. Health Policy and Planning, 37(3), 312–321.
Wachira, S., Njoroge, P., & Mutiso, F. (2023). Industrial actions and healthcare service disruptions in Kenya. BMC Health Services Research, 23(1), 1–12.
World Health Organization (WHO). (2024). Health systems and service delivery framework.
Yukl, G. (2021). Leadership in organizations (9th ed.). Pearson Education.
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