What the study found
The study found a statistically significant but modest positive relationship between governance of hospital-generated revenue and health service delivery in Kenya's Level 5 public hospitals. It also found that leadership principles, meaning the leadership practices or principles used by hospital leaders, strongly affected that relationship.
Why the authors say this matters
The authors conclude that effective governance of hospital-generated revenue, together with strong leadership principles and equitable resource allocation, is important for strengthening healthcare infrastructure, sustaining services, and supporting efficient, high-quality care. They also recommend strengthening transparency, leadership development, equity-weighted budgeting, and revenue retention reforms.
What the researchers tested
The researchers used a descriptive cross-sectional design with quantitative data from 252 healthcare personnel in 13 Level 5 public hospitals across 10 counties in Kenya. They also collected qualitative data from patients and key informants to support the quantitative findings, and analyzed the data using descriptive statistics and regression analyses.
What worked and what didn't
Governance quality explained 25.3% of the variation in health service delivery outcomes when other factors were controlled. Leadership principles significantly moderated the relationship: strong leadership amplified the positive effect of governance on service delivery, while weak leadership made governance efforts counterproductive. At mean leadership levels, governance showed no significant effect.
What to keep in mind
The abstract reports ongoing challenges including operational inefficiencies, transparency deficits, and inequitable revenue allocation. It does not describe additional limitations beyond the study setting and design, so the findings should be understood within the 13-hospital, 10-county sample described in the abstract.
Key points
- Governance of hospital-generated revenue had a modest positive relationship with health service delivery.
- Leadership principles strongly influenced how governance affected service delivery.
- Governance quality explained 25.3% of the variation in service delivery outcomes.
- Strong leadership amplified governance effects, while weak leadership made them counterproductive.
- The study reported operational inefficiencies, transparency deficits, and inequitable revenue allocation.
Disclosure
- Research title:
- Governance of hospital revenue was linked to health service delivery
- Authors:
- Shem Odhiambo Ochola, Prof. Jack Busalile Mwimali, Susan Wekesa, Mary Omondi
- Institutions:
- Jomo Kenyatta University of Agriculture and Technology, Jomo Kenyatta University of Agriculture and Technology, Jomo Kenyatta University of Agriculture and Technology, Jomo Kenyatta University of Agriculture and Technology
- Publication date:
- 2026-02-25
- OpenAlex record:
- View
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