Devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. In this study, we examine health-care users’ and providers’ perceptions of the effect of devolved health services on referral maternal health-care access in Kisumu and Uasin Gishu counties in Western Kenya. Our findings suggest that while health workers are dissatisfied, there is considerable satisfaction among users of referral maternal health services. Users largely associate their satisfaction with devolution. However, closer analysis suggests that improved access is not only linked to devolved
health services but also to other developments both at the national level(health campaigns, increased mobile telephony) and county level (improved transportation, relocation of available funds).