Health System Influence On Functionality of Managers in Public Hospitals: A Case of Sub County Hospitals in Bungoma County


  • Tony Chahale Mugasia Kenya Methodist University
  • Lillian Muiruri Kenya Methodist University
  • Musa Oluoch Kenya Methodist University


Managers tasked with leading and managing the hospitals in the developing economies often have little formal preparation and face challenges in execution of their mandates. This study therefore interrogated the influence of management knowledge, organization capacity building systems, internal work environment and hospital finance on the functionality of managers in public Sub County hospitals in Kenya focusing on Bungoma County. A descriptive approach was adopted and 170 managers from the 10 Public Sub County hospitals in Bungoma County were targeted.  A structured questionnaire was used to collect quantitative data which was analysed through SPSS version 24 to give descriptive and inferential statistics. The results of the study indicated that management knowledge of a manager had a positive and significant influence on manager’s functionality to manage Sub-County Hospitals (? = 0.263; P-value <0.05); organization capacity building systems had a positive and significant influence on management of Public Hospitals (? = 0.327; P-value < 0.05); internal work environment had a positive and significant influence on management of Public Hospitals (? = 0.360; P-value < 0.05) and health finance equally had a positive and significant influence on management of Public Hospitals, this influence was not significant (? = 0.112; P-value < 0.05). This implies that a unit increase in these factors would lead to a significant increase in management of the Sub-County hospitals. Based on these, the study recommended the county government of Bungoma County to set aside a budget to recruit health workers to address HRH gaps. The county government to enhance their financial commitment towards the running of the public hospitals in the county. The County to increase proportion of their exchequer to the public hospital the current proportion is not adequate. County top leaders to revise the finance accountability frameworks for efficient funds utilization. Furthermore, the local political leaders should collectively rework their conflict resolution mechanisms with the management of the hospitals and look for alternatives problem solving mechanism to reduce interference with the normal operation of hospitals.

Keywords: Management Knowledge, Organization Capacity Building Systems, Internal Work Environment, Hospital Finance, Functionality of Managers, Public Sub County Hospitals, Kenya

Author Biographies

Tony Chahale Mugasia, Kenya Methodist University

Masters Student, Department of Health Systems Management, Kenya Methodist University, Kenya

Lillian Muiruri, Kenya Methodist University

Lecturer, Department of Health Systems Management, Kenya Methodist University, Kenya

Musa Oluoch, Kenya Methodist University

Lecturer, Department of Health Systems Management, Kenya Methodist University, Kenya


Addae, A. (2013). Challenges of financing healthcare in Ghana; The case of national health insurance scheme, International Journal of Asian Social Science, 3(2):511-522.

Barasa, W. Molyneux, S. English, M& Cleary, S. (2017). Hospitals as a complex adaptive systems, A case study of factor influencing priority setting practices at the hospital level in Kenya, Social science, and medicine 174 (2017) 104-12.

Gasto, F. Nyamhanga, T, Mwangu, M. Hurtig, A (2013). Challenges to the implementation of health sector decentralization in Tanzania: Experiences from kongwa district council. Global Health Action, 6(1).

Green, A.&Collins, C. (2003). Health systems in developing countries; public sector managers and the management of contradictions and change. International journal of health planning and management, S75-S76.

Griffith, J. R. (2000). Championship management of healthcare organizations. Journal of healthcare management,45. 17-31.

Kenya Health Act 2017, Kenya Gazette Supplement.

Kimathi, L. (2017). Challenges of the devolved health sector in Kenya; Teething problems or systemic contradictions? Africa development, Vol XLII, No 1 Pg. 55-77.

Lantz, P. (2008). Gender and leadership in healthcare administration; 21st century progress and challenges. Journal of healthcare management 53.291-301.

Lopes G, Kanida.N, Taweesak.S & Briggs.D (2009). An assessment of management competencies for primary health care managers in Timor Leste. Journal of health planning and management Vol 35, Issue 2, March 2020,

Mogere, D&Muga.R (2003). Assessment of Management and Leadership Skills, Competencies and ability among health care managers working in Level 3,4 And 5 Hospitals, Nyanza Province Kenya. Value in Health 17 2014, A1-A295.

Murkomen, O. K. (2012). Devolution and the Health System in Kenya. Devolution and Health Consultative Meeting.

Ministry of health Kenya Report (2015), Training needs assessment of Kenyans health workforce. Ministry of Health Afya House

Nyanator F, Awoonor W, Phillips. J, Tanya.J&Miller.R (2005) The Ghana Community Based Health Planning and Services Initiative for Scaling up delivery innovation,

Nyikuri, M. Tsofa B, Barasa E, Okoth P&Molyneux S (2015). Crises and Resilience at the Frontline Public Health Facility Managers under Devolution in a Sub-County on the Kenyan Coast. PLoS ONE 10(12): e0144768.

Rowe, L.A., Brillant, S.B., Cleveland, E (2010), Building capacity on health facility management; guiding principles for skills transfer in Liberia. Human resources for health Pg. 5,

Ross, A., Wenzel, F.J., and Mitlyng, J.W. (2002). Leadership for the future: Core competencies in health care. Chicago, IL: Health Administration Press/AUPHA Press.

Omondi.B.(2016). Factors influencing service delivery in public hospitals, A case of Nairobi County, Kenya {Master’s Thesis, University of Nairobi}.

O’Neil, Seims.R, Cheburet.S, Bragar.J & Sapati.B (2013), Leadership and Management to empower health workforce,

Omar, M., Gerein, N., Tarin, E (2009), Training evaluation: a case study of training Iranian health managers, Human resource health 7. 20

Pillay.R (2008). Managerial competencies of hospital managers in South Africa: a survey of managers in the public and private sectors. Hum Resour Health 6, 4 (2008).

Prashanth, N. S., Marchal, B., Kegels, G., & Criel, B. (2014). Evaluation of capacity-building program of district health managers in India: a contextualized theoretical framework. Frontiers in public health, 2, 89.

Van Vliet, V. (2011). Five Functions of Management (Fayol). Retrieved [22 January ,2020] from Tool’s hero:

World Health Organization. (2007). Strengthening management in low-income countries: lessons from Uganda: a case study on management of health services delivery. World health organization.

Zere, E., Walker, O., Kirigia, J. (2010) Health financing in Malawi; Evidence from national health accounts, BMC int human HUM Rights 10.




How to Cite

Mugasia, T. C., Muiruri, L., & Oluoch, M. (2021). Health System Influence On Functionality of Managers in Public Hospitals: A Case of Sub County Hospitals in Bungoma County. Journal of Public Policy & Governance, 5(2), 60–83. Retrieved from