EFFECT OF DELEGATION OF ROUTINE MEDICAL TASKS ON SPECIALISTCLINICAL OFFICERS IN QUALITY SERVICE DELIVERY IN MACHAKOSCOUNTY PUBLIC HEALTH FACILITIES
DOI:
https://doi.org/10.5281/zenodo.22823065Keywords:
Delegation, Routine medical tasks, Specialist Clinical Officers, Quality service deliveryAbstract
Purpose of Study: This study determined the effect of delegation of routine medical tasks on quality service delivery among Specialist Clinical Officers in public health facilities in Machakos County, Kenya. It specifically examined how delegation practices, including task matching, competence, supervision, and workload, influence efficiency and quality of healthcare service delivery.
Methodology: The study adopted a descriptive research design with a quantitative approach. The target population comprised 146 Specialist Clinical Officers, 232 General Healthcare Providers, and 30 Hospital Administrators from eight public health facilities. Stratified, proportionate, census, and purposive sampling techniques were used. Data were collected using structured questionnaires and key informant interviews and analysed using SPSS version 26, descriptive statistics, and multinomial logistic regression. A response rate of 93.6% was achieved.
Findings: The findings showed that 52.4% of respondents reported high efficiency in service delivery under task-shifting arrangements, while 32.2% reported medium efficiency and 15.4% low efficiency. Task matching to personnel skills significantly influenced both medium efficiency (p = .019, Exp(B) = 0.092) and high efficiency (p = .012, Exp(B) = 0.079). Inappropriate task matching substantially reduced the likelihood of efficient service delivery. Supportive supervision, competence of delegated personnel, and clear role boundaries were associated with improved efficiency, whereas increased workload negatively affected service delivery. Key informants reported improved access, shorter waiting times, quicker diagnosis and treatment, continuity of care, and greater patient satisfaction following delegation.
Conclusion: The study concludes that delegation of routine medical tasks significantly influences quality service delivery among Specialist Clinical Officers in Machakos County public health facilities. Effective task matching, appropriate supervision, competent personnel, continuous training, and manageable workloads are essential for achieving efficient and quality healthcare services. Strengthening these areas can optimise task-shifting outcomes.
Downloads
References
Becker, G. S. (1964). Human capital: A theoretical and empirical analysis, with special reference to education. University of Chicago Press. https://www.nber.org/system/files/chapters/c3730/c3730.pdf
Bhana, A., Petersen, I., Baillie, K. L., Flisher, A. J., & the MHaPP Research Programme Consortium. (2023). Implementing the World Health Report 2001 recommendations for integrating mental health into primary health care: A situation analysis of three African countries. International Review of Psychiatry, 22(6), 555–566. https://doi.org/10.3109/09540261.2010.536152
Callaghan, M., Ford, N., & Schneider, H. (2020). A systematics review of task-shifting for HIV treatment and care in Africa. Human Resources for Health, 8, 8. https://doi.org/10.1186/1478-4491-8-8
Das, J. K., Kumar, R., & Salam, R. A. (2020). Systematic review of performance of community health workers in low- and middle-income countries. Journal of Global Health, 10(2), 020413. https://doi.org/10.7189/jogh.10.020413
Donfouet, H. P. P., Daniel, T., Wilunda, C., & others. (2024). The impacts of task shifting on the management and treatment of malnourished children in Northern Kenya: A cluster-randomized controlled trial. Health Policy and Planning, 39(7), 710–721. https://doi.org/10.1093/heapol/czae036
El-Jardali, F., Fadlallah, R., & Morsi, R. Z. (2020). A review of national policies and strategies to improve quality of health care in the Eastern Mediterranean Region. Eastern Mediterranean Health Journal, 26(5), 515–525. https://doi.org/10.26719/emhj.20.006
English, M., Irimu, G., & Were, F. (2020). Improving paediatric care in Kenyan hospitals: A review of progress and challenges. Archives of Disease in Childhood, 105(6), 519–524. https://doi.org/10.1136/archdischild-2019-317542
Essendi, H., Scott, K., McAdam, L., Momanyi, H., Mutuku, R., Mwangome, P., & Rothschild, C. (2023). Task shifting and community engagement as the keys to increasing access to modern contraception: Findings from mixed methods operational research in coastal Kenya. Journal of Evaluation in Clinical Practice, 29(8), 1380–1392. https://doi.org/10.1111/jep.13889
Fulton, B. D., Scheffler, R. M., Sparkes, S. P., Auh, E. Y., Vujicic, M., & Soucat, A. (2019). Health workforce skill mix and task shifting in low-income countries: A review of recent evidence. Human Resources for Health, 9, 1. https://doi.org/10.1186/1478-4491-9-1
Gerber, F., Labhardt, N. D., & Ringwald, M. (2023). Community-based type 2 diabetes care by lay village health workers in rural Lesotho: Protocol for a cluster-randomized trial within the ComBaCaL cohort study. Trials, 24, 647. https://doi.org/10.1186/s13063-023-07729-8
Gyamfi, J., Iwelunmor, J., & Ogedegbe, G. (2020). Task shifting and health system efficiency in Ghana. Health Policy and Planning, 35(3), 298–308. https://doi.org/10.1093/heapol/czaa005
Heckman, J. J. (2000). Policies to foster human capital. Research in Economics, 54(1), 3–56. https://doi.org/10.1006/reec.1999.0225
Ismahan, S. M. (2023). Strategy evaluation and service delivery of universal health care at Machakos Level 5 Referral Hospital in Kenya [Master's thesis, University of Nairobi]. University of Nairobi Digital Repository. http://erepository.uonbi.ac.ke/handle/11295/163994
Kenya Law. (2022). Clinical Officers (Training, Registration and Licensing) Act. National Council for Law Reporting. http://new.kenyalaw.org
Koder, F. (2023). The role of task shifting in mitigating health workforce shortages: The ambitions and results of the TaSHI project. European Journal of Public Health, 33(Suppl 2), ckad160.618. https://doi.org/10.1093/eurpub/ckad160.618
Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2020). Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203–2212. https://doi.org/10.1016/S0140-6736(18)31668-4
Lee, J., Park, S., & Kim, H. (2021). Health system challenges in aging Asian societies: A review. Health Policy, 125(8), 1021–1030. https://doi.org/10.1016/j.healthpol.2021.05.008
Ministry of Health – Ghana. (2022). National health policy. Government of Ghana. https://moh.gov.gh/wp-content/uploads/2026/08/HSMTDP_Final-Draft_compiled_latest_signed-copy-EDITED-2.pdf
Ministry of Health – Kenya. (2022). Kenya health policy 2022–2030. Government Printer. http://guidelines.health.go.ke:8000/media/Kenya_Universal_Health_Coverage_Policy_2020__2030.pdf
Ministry of Health – Morocco. (2022). Health sector strategy. Government of Morocco. https://www.trade.gov/healthcare-resource-guide-morocco
Ministry of Health and Social Services – Namibia. (2023). Health sector review. Government of Namibia. https://www.parliament.na/wp-content/uploads/2023/03/Vote13-Ministry-of-Health-and-Social-Services-2023.pdf
Ministry of Health and Wellness – Botswana. (2023). National health policy. Government of Botswana. https://www.moh.gov.bw/guidelines.html
Mincer, J. (1974). Schooling, experience, and earnings. National Bureau of Economic Research. https://www.nber.org/system/files/chapters/c1765/c1765.pdf
Mugenda, O. M., & Mugenda, A. G. (2003). Research methods: Quantitative and qualitative approaches. African Centre for Technology Studies. https://ir-library.ku.ac.ke/items/0769481e-46cb-4710-b595-5806ae7db90e
National Department of Health – South Africa. (2023). Annual health sector report. Government of South Africa. https://www.gov.za/documents/annual-reports/department-health-annual-report-20232024-27-sep-2024
OECD. (2021). Health at a glance 2021: OECD indicators. OECD Publishing. https://doi.org/10.1787/ae3016b9-en
Okoroafor, S. C., & Christmals, C. D. (2024). Task shifting and sharing in sub-Saharan Africa: A review of evidence and implementation. Human Resources for Health, 22, 23. https://doi.org/10.3390/healthcare11081200.
Pallikkuth, R., Kumar, S., & Nair, S. (2024). Task-shifting in health systems: A review of effectiveness and implementation. Health Policy and Planning, 39(3), 345–358. https://doi.org/10.1093/heapol/czad089
Patel, A. (2023). Co-designing research with Aboriginal and Torres Strait Islander consumers of mental health services, mental health workers, elders and cultural healers. Australian Journal of Rural Health, 31(2), 234–247. https://doi.org/10.1111/ajr.12945
Pillay, R. (2021). Human capital theory and health workforce development. Human Resources for Health, 19, 56. https://doi.org/10.1186/s12960-021-00598-9
Rinaldi, G., Sanjaya, I. M., & Ahmad, R. (2021). Delegation scope and health service delivery in Indonesia. Health Policy and Planning, 36(5), 678–690. https://doi.org/10.1093/heapol/czab023
Schultz, T. W. (1961). Investment in human capital. The American Economic Review, 51(1), 1–17. https://www.scirp.org/reference/referencespapers?referenceid=4011401
Some, D., Edwards, J. K., Reid, T., Van den Bergh, R., Kosgei, R. J., Wilkinson, E., & others. (2023). Task shifting the management of non-communicable diseases to nurses in Kibera, Kenya: Does it work? PLOS Global Public Health, 3(4), e0001765. https://doi.org/10.1371/journal.pgph.0001765
Sweeney, J., & Sweeney, P. (2021). Competence of delegated personnel and health service delivery in the United States. Journal of Nursing Administration, 51(5), 267–275. https://doi.org/10.1097/NNA.0000000000001005
WHO. (2008). Task shifting: Rational redistribution of tasks among health workforce teams. World Health Organization. https://iris.who.int/items/b5c624db-537c-4e80-83f2-269f063fb8bb
WHO. (2020). Global health observatory data repository. World Health Organization. https://www.who.int/data/gho
WHO. (2021). Global strategy on human resources for health: Workforce 2030. World Health Organization. https://www.who.int/publications/i/item/9789241511131
Downloads
Published
Issue
Section
License
Copyright (c) 2026 International Journal of Biomedical Informatics, Health Systems and Integrated Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
