Abstract
Public health facilities in Kenya face persistent resource constraints, staffing shortages, ageing infrastructure, and other risks that can undermine organisational performance. However, limited quantitative evidence exists on how integrated risk management practices influence performance in devolved public health facilities, particularly in the North Rift Region. This study examined the influence of risk identification, risk assessment, risk mitigation, and risk monitoring and evaluation on the organisational performance of public health facilities in the North Rift Region, Kenya. A positivist approach and explanatory cross-sectional survey design were adopted. The study targeted 42 Level 4 and 5 public health facilities in Uasin Gishu, Elgeyo Marakwet, Nandi, and Trans Nzoia counties. Data were collected from 300 management respondents selected through proportionate stratified random sampling and analysed using descriptive statistics, Pearson's correlation, and multiple linear regression. All four risk management practices had positive and statistically significant relationships with organisational performance. Risk identification was the strongest predictor (β = 0.311), followed by risk assessment (β = 0.273), risk mitigation (β = 0.249), and risk monitoring and evaluation (β = 0.223). The model explained 53.4% of the variance in organisational performance (R² = 0.534). The findings underscore the importance of strengthening integrated risk management systems within devolved public health facilities.