The Influence of Community Engagement on Advancing Universal Health Coverage Initiatives: A Case of Kisumu County, Kenya

Abstract

Purpose: This study examined the influence of community engagement on advancing Universal Health Coverage (UHC) initiatives in Kisumu County, Kenya, focusing on socio-demographic factors, capacity building, leadership, and cultural influences as determinants of UHC participation. Methodology: Grounded in Systems Theory and guided by a pragmatic research philosophy, the study adopted an analytical cross-sectional mixed-methods design. Quantitative data was collected from 340 respondents selected through simple random sampling across the seven sub-counties of Kisumu County. Qualitative data was obtained from key informant interviews with community leaders and a representative from the County Director of Health Services. Data was analyzed using descriptive and inferential statistics, including multiple linear regression, One-Way ANOVA, Chi-Square tests, and multiple logistic regression, while qualitative data was analyzed thematically. Findings: Socio-demographic factors significantly influenced UHC participation, with education and income emerging as strong positive predictors, while gender and household size were associated with lower participation. Capacity building was a critical determinant, with training participation and forum attendance significantly enhancing engagement, though a notable gap between awareness and enrolment persisted. Leadership trust and local leader participation strongly predicted UHC enrolment. Cultural taboos and traditional gender roles negatively influenced participation, while language accessibility emerged as the strongest cultural facilitator. The combined logistic regression model explained 52% of variance in UHC participation. Unique Contribution to Theory, Practice and Policy: The study provides empirical evidence that UHC challenges in Kisumu County are not primarily financial but are largely driven by deficits in community engagement. It recommends strengthening capacity building, enhancing leadership accountability, promoting multilingual health communication, and adopting culturally responsive approaches. The findings offer practical guidance for county health officials, policymakers, and community leaders seeking to advance equitable UHC implementation in Kenya and similar sub-Saharan African contexts.