MBA-HCM Theses and Dissertations (2023)
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- ItemA Descriptive study on nutrition knowledge and dietary practices among adults with Type 2 Diabetes Mellitus and Hypertension at Kitale County Referral Hospital(Strathmore University, 2023) Kiarie, R. W.Non-communicable diseases (NCDs) are the leading global cause of death, with most of these deaths occurring in low to middle- income countries (LMICs). Hypertension and diabetes are two of the four major NCDs, and they are often comorbidities, meaning that they occur at the same time. Morbidity and mortality is usually a result of long-term complications, and apart from medical therapy, these can be prevented by lifestyle interventions that include dietary modifications. This study sought to describe the nutrition knowledge and dietary practices of patients with type 2 diabetes and hypertension. The focus was on patients receiving care at the Kitale County Referral Hospital in Trans Nzoia County, and the study objectives were to (i) assess patients’ knowledge of dietary influence on diabetes and hypertension, (ii) assess sociocultural influences on patients’ dietary practices, (iii) assess patients’ willingness to change their dietary practices, and (iv) assess patient’s awareness of their dietary practices. The study was supported by the Social Cognitive Theory, which is premised upon the reciprocal interaction between individual, behavioural and environmental factors. These factors interact to formulate the control that an individual has over their illness, thereby influencing their motivation to perform self-care activities. This descriptive cross-sectional study utilized quantitative techniques by use of structured questionnaires as the main data collection instrument, in a target population of 973 and a sample size of 283 respondents. Data analysis was carried out using SPSS software, quantitative techniques were used to analyze the data, and descriptive techniques were applied to analyse the characteristics of the respondents. The following conclusions were made from the results: that majority of the participants understood the role of diet in the management of these two conditions; that some cultural practices posed a challenge to some participants, and that they had the family, spousal and social support they needed; that participants were willing to change their dietary practices and adhere to the recommended diet regimens; that most participants had received adequate nutrition education and counselling, however eating balanced diets was a challenge, they were not able to find all the foods they had been advised to eat, and they had to think about the cost of buying these foods. The study recommends sustained efforts in patient education, inclusion of experiential learning through the use of a hospital kitchen in order to contextualize use of locally available foods, and strategies to combat food insecurity especially among the ageing population in the county.
- ItemA Hospital-based study on the application of blockchain technology on data sharing in oncology treatment and value-based care in Nairobi County, Kenya(Strathmore University, 2023) Saini, B. V.This study deals with the Blockchain Technology (BcT) application for decentralizing Electronic Health Records (EHRs) data to store patient information, including medical reports, to ensure improved patient care. EHRs are entirely controlled by hospitals instead of patients, which makes it more difficult for patients to seek medical care from other providers using their historical data. Patients are the data subjects and the primary owners of the data; therefore, they should have more say and checks on balances on the providers in how their data is being shared and used. The existing system of storing patient details depends on the organization's servers, thus the need for Blockchain using multi-cloud integration to achieve data interoperability. This study will adopt a quantitative research design whereby Blockchain will design an experiment to establish the relationship between patient perspective, level of trust, and transparency in data sharing for oncology patients and value-based care through processing and analyzing the quantitative data from the private cancer center. This study will adopt a quantitative with various stakeholders in Oncology in Kenya. It will also undertake surveys through questionnaires with the chief oncologist, chief medical officer, nurse manager, lab technician, researchers, and IT personnel. The results showed that blockchain technology has the potential to transform the way health records and data are kept and used to treat and care for oncology patients. By combining and integrating data from various sources, healthcare organizations can enhance value-based care, prioritizing patient outcomes and using data to drive decision-making. Furthermore, evidence-based decision-making by extracting data insights is important for designing data-driven healthcare systems. This study provides valuable insights for healthcare policymakers, providers, and researchers in Kenya and beyond. By prioritizing patient outcomes, evidence-based decision-making, and data protection, healthcare organizations can improve the quality of care they provide and, ultimately, the health outcomes of their patients. Furthermore, by leveraging blockchain technology and other innovative solutions, healthcare providers can improve their services' efficiency, effectiveness, and sustainability.
- ItemAssessing quality of primary healthcare services for the elderly in Kiambu County, Kenya(Strathmore University, 2023) Mbiyu, J. W.Old age increases the risk of non-communicable diseases and other degenerative diseases. This trend is evident in many parts of the world including sub-Saharan African (SSA) countries such as Kenya. To adequately prepare and respond to the healthcare needs of the elderly in SSA, there is need for more research to generate information on health sys-tem challenges regarding provision of quality healthcare to the elderly in SSA. The objective of the study was to assess the quality of primary healthcare services for the el-derly in Kiambu County, Kenya. The County has the highest number of elderly persons (5% of the population) out of the 47 Counties in Kenya (KNBS 2019). The study popula-tion was the elderly people (defined as anyone aged 60 years and above) visiting the selected health facilities in Kiambu County. The study used a qualitative cross-sectional design, with purposeful sampling in which a semi-structured interview guide was used to capture information from the participants regarding the following aspects of quality of care: structure, process, and outcome. A total of seventy-two participants (24 males and 48 females, age range 60 – 86 years) were recruited from14 primary healthcare centres between the month of February and March 2023. Data analysis involved transcribing the data from the interviews held, followed by statistical analysis using the NVIVO. Results showed that lack of medication, referral for laboratory services, waiting time and short-age of healthcare workers (HCWs) were some of the challenges affecting the quality of healthcare for the elderly in Kiambu County. Additionally, interpersonal relationships with the healthcare providers which are all linked to quality of healthcare services for the elderly were found to be important for a positive experience for the elderly during the treatment process. The study also demonstrated that the access to care by the elderly de-pends on their satisfaction with the services provided by the healthcare facility and the health care provider. Key recommendations include: Kiambu County to address the is-sues of lack of drugs in the health facilities and especially those that relate to care for the elderly e.g. the non-communicable diseases medication, HCW training on social inclu-sion and re-designing of the health facilities to be disability friendly, HCW worker shortage to be addressed, In conclusion, the results of this study can be used to improve quality of healthcare for the elderly in other settings, depending on the context under which such services are being provided.
- ItemCo-payment fee and utilisation of healthcare services: the case of out-patient insured patients at Aga-Khan Hospital Mombasa(Strathmore University, 2023) Twahir, H.Third party payers of health such as health insurance companies whom for a long time have been reporting losses (despite an increase in the premium contributions), introduced gate keeping measures such as co-payments to try to control utilisation of health services by patients by reducing hospital visits, consultation, laboratory and pharmaceutical costs. Co-payments introduce out of pocket payments health, a key component in reducing universal health care. The effectiveness of these co-payments in reducing utilisation of health services/ health costs and resulting in savings for the health insurance companies is however still unclear, with some studies arguing that it has little or no effect and some actually having opposite effects of increasing health costs. This was a retrospective cross-sectional study carried out at the Aga-Khan Hospital, Mombasa Outpatient department (OPD) centers amongst different patients seeking healthcare services at the facility. Study patients included all insurance patients seeking health services at these different OPD centres. Those on co-payments were compared with those on no co-payments, seeking to determine if the presence of co-payments affected utilisation of various healthcare services and if so by what extent and at what difference in costs. Utilisation of health was determined through assessing patient numbers and cost. Data of more than 108,000 patients who visited the hospital over a 12-month period in the year 2021 was obtained from the Hospital Management Information System. Descriptive analysis was done presenting counts (percentages) and means (standard deviations) of the different variables. Bivariate analysis tests for differences in the hospital visits among the co-pay groups was done using Chi square tests for categorical variables and one-way analysis of variance (ANOVA) and median tests for the continuous variables, presenting the p values. Utilisation of health services was analysed by mainly comparing number of visits and costs of the different health services in the study population. The co-payment group was further divided into four tiers of co-payments (Kshs 1-500, 501-1000, 1001-1500 and 1501-2000). The findings showed that co-payments generally had the effect of increasing cost of utilisation of healthcare compared to when there was no co-payment and also affected the number of patients attempting to utilise health. Co-payment tier of Kshs 1-500 had the highest number of patients seen for those on co-payment and the number of patients generally decreased as co-payment increased. In conclusion, the study showed that, co-payments affected the overall costs of a patient visit to the hospital. There was also a significant difference in the consultation costs, laboratory costs and pharmaceutical costs per hospital visit of those on co-payment comparing those not on co-payment with those on co-payment paying more to see a doctor at the outpatient department compared to those not on co-payment. The overall utilisation costs per visit were also significantly higher in those who paid co-payment versus those that did not. Analysis of the different tiers of co-payments showed a significant difference in cost of utilisation in some aspects of healthcare in some tiers of co-payments. These results can thus be used by both the insurance companies and other stakeholders in the health industry to influence policy on health financing.
- ItemEffect of the rate of adoption of electronic data interchange on healthcare providers’ cashflow management in Kericho County(Strathmore University, 2023) Matolo, D. M.The purpose of this research was to assess the effect of the slow adoption of e-claims on private healthcare providers' cash flow management in Kericho County. Extensive review of existing literature is presented to understand the study area in context. Using the empirical information as well as theory of cash conversion, TAM and RBV theory, the researcher identified dependent (efficiency of e-claim in cash flow management) and independent variables (claim rejection, rate of adoption, reduced operational cost, faster claim settlement) that were tested in the study. The study used a mixed method approach (both qualitative and quantitative research approaches) to collect primary data through a combination of interviews and survey questionnaires in order to meet the set objectives. Thematic analysis, descriptive statistics, and regression analysis were the data analysis tools used. The findings of the study show that claims submitted electronically are processed more quickly, resulting in faster payment and improved cash flow management for private healthcare providers. It was also found that most private hospitals in Kericho county have adopted the use of EDI technology to process e-claims. The results show that although insurance providers may not easily identify fraud, using EDI to detect such occurrences is helpful. With reduced costs, rare inconsistencies, promptly submitted claims, and timely reimbursements, financial reporting becomes easier to process with each billable procedure accounted for. Overall, the study found that the strongest predictors of the efficiency of e-claims in cash flow management are reduced rejection (Mean 3.84), cost-effectiveness, timely payment (Mean 3.72), and reduced fraud (3.95). There was no significant relationship between the slow adoption of EDI and e-claims in cash flow management. Various recommendations are given to direct further studies in an effort to improve the current research. Key Words: EDI, e-claims, adoption, efficiency, cash flow management
- ItemFactors associated with the under-representation of women in medical leadership in Nairobi County Kenya: a mixed method study(Strathmore University, 2023) Obino, L. N.Effective healthcare systems in low- and middle-income countries require patient centered service delivery, and the role of gender in healthcare leadership in these countries is a significant concern. Despite the increasing number of women enrolling in professional degrees, their representation in higher-level medical leadership positions remains low. To address this issue, a mixed-method study was conducted in Nairobi County, Kenya, involving surveys and interviews with medical professionals in executive leadership and management positions. The study found that women met the one-third representation threshold in executive management committees of selected hospitals but faced several barriers in their career progression journey. After adjusting for significant covariates, women with higher levels of education were associated with less likelihood of ascending to leadership (β = -4.60; 95%CI: -9.15 - -0.051; p =0.048). On average, women were found to report higher barriers to career progression than men (Mean difference= 1.133; p value = 0.000; 95% CI: 0.539- 1.728). Women were also found to perceive a greater lack of executive sponsors compared to men (Mead difference=0.683; p-value =0.043; 95% CI :0.022- 1.345). The qualitative interviews revealed barriers such as challenges in work-life balance, limited opportunities for career development, poor communication and negotiation skills, organizational challenges such as limited succession planning, unconscious gender bias, politicization of roles within the organizations, dismissive attitude towards women leaders and lack of mentorship. Other barriers included lack of support from fellow women and patriarchal structures within the society. To promote gender equity in medical leadership, efforts should focus on challenging gender stereotypes, promoting diversity and inclusion, and creating more equitable career advancement opportunities. Future research should explore additional strategies to overcome these barriers and further enhance gender representation in healthcare leadership.
- ItemFactors influencing uptake of wellness programmes at AMREF Health Africa, Kenya(Strathmore University, 2023) Munyiri, N. E.Wellness programs have the ability of helping employees to change and maintain health behaviors. Unfortunately, most organizations that have adopted these programs do not register complete uptake. This study was aimed at determining the factors influencing the uptake of employee wellness programs offered at AMREF Health Africa in Kenya. The specific objectives of this study were to determine the uptake of the employee wellness program, to determine the effects of staff knowledge on wellness programs, to assess the effects of staff attitude towards wellness programs and to identify strategies to improve the wellness program at AMREF Health Africa. This study adopted a mixed methods research design. The target population of this study comprised staff in AMREF Health Africa. This study adopted a stratified random sampling approach to arrive at a sample of 140 employees. In addition, 5 people working in the human resource department were purposefully involved in the study to act as key informants. Therefore, the study had a total sample of 145 respondents. The study used a structured questionnaire and key informant guide to collect data. A pilot study was conducted to establish reliability and validity of instruments. Quantitative data was analyzed using descriptive statistics, correlation and regression. Quantitative analysis was conducted using the Statistical Package for the Social Sciences. Results of quantitative analysis were presented using tables. Qualitative data collected in this study was analyzed using content analysis. To carry out content analysis the researcher used NVIVO 12 software. The study results were explained using the wellness motivation theory, and the social learning theory. The results of qualitative analysis were presented in a narrative format. The study found that the uptake of the employee wellness program initiatives was low (35%). employee knowledge was found to have a significant effect on uptake of wellness programs. In regression analysis the employee's attitude was negative and significant. The qualitative study identified the following themes- Based on the findings of the study, the researcher recommends that AMREF Health Africa should focus on increasing staff knowledge and perception of the wellness program. Personalized wellness programs can also be developed to cater to the specific needs of the staff. Keywords; Wellness programs, AMREF Health Africa, Employees, Uptake.
- ItemHealth workers’ perceptions towards implementation of Universal Health Coverage pilot at Machakos Level 5 Hospital in Kenya(Strathmore University, 2023) Abuto, W. A.This study explores the perceptions of frontline healthcare workers on the implementation of Universal Health Coverage (UHC) pilot in Machakos County, Kenya. UHC is an initiative that aims to provide quality healthcare services to individuals and communities without financial hardship. The pilot was launched in December 2018 in four counties as part of President Kenyatta’s Big Four Agenda for socio-economic development and was intended to run for one year. The study employed a qualitative design using in-depth interviews with frontline healthcare workers in Machakos Level 5 Hospital. The findings revealed that the participants had a positive attitude towards UHC, but also faced various challenges such as inadequate funding, human resources and misuse of services by patients. The participants also suggested subsidized payments from users instead of complete removal of fee and supported the role of NHIF as a driver of the program. The study recommends a sustainable healthcare financing approach, provision of adequate human resources for health and stakeholder involvement and sensitization in decision making for successful scaling up of UHC.
- ItemImplementation of the WHO surgical safety checklist in Kenya - a case of Mater Misericordiae hospital(Strathmore University, 2023) Gebre, T. S.Surgical checklists have been used by hospitals around the world to improve process efficiency, and team coordination, reduce the adverse outcomes of surgery, and further decrease the overall cost of care. However, studies have shown that despite the use of surgical checklists, the adverse effects of surgical operations, including the rate of mortality and reoperations, remain high, especially in sub-Saharan Africa. To improve the safety of surgery worldwide, in 2008, the World Health Organization’s (WHO) Patient Safety Program published the WHO Surgical Safety Checklist, a nineteen- item checklist that acts as a visual aid designed to foster adherence to recommended standards of care and team communication. The checklist has had significant improvements in surgical processes and surgical outcomes in different hospitals, though most of the evidences are reported from high-income countries. The implementation of the checklist, the information on its use, and its impact in low-income countries remain poorly understood. This study sought to examine the implementation experiences of using the WHO surgical checklist and its influence on the delivery of surgical services in a private hospital in Kenya. The study was anchored on Causal Analysis based on Systems Theory. The study was limited to Mater Misericordiae Hospital since it’s the leading institution in the country providing a surgical training program and is aacreditaed as a center of excellence for cardiac surgeries. A mixed-methods research design was adopted. The population comprised surgeons, anesthetists, theatre nurses, and medical officers working in the surgical department. Data was collected using semi-structured questionnaires and an interview guide. Quantitative data was cleaned, coded, entered, and analyzed through descriptive statistics using SPSS Version 22.0, while qualitative data were manually coded and thematically analyzed through content analysis. The study found that majority of the health care workers at the Mater Misericordiae hospital were aware of the WHO SSC, and majority used the checklist in the surgical processes in the hospital, but not always. The health care workers acknowledged that the WHO SSC was easy to use; helped reduce human errors; and enhanced the patient’s safety in the operating room. The study concludes that aspects such as communication among team members facilitated effective implementation of SSC while barriers such as the high bulk of surgical cases, the turnaround time between cases, lack of resources, understaffing, and lack of adequate training hindered the effective use and implementation of the checklist in the hospital. The study recommends that periodic training for surgical staff to enhance their knowledge and use of the SSC and allocating more resources to ensure adequate and well-trained staff is recommended. This would lead to practical use and implementation of WHO SSC as well as frequent monitoring to ensure compliance with the checklist at all levels in the hospital.
- ItemMedical doctor's resignation from public sector employment in kenya: what are the underlined factors?(Strathmore University, 2023) Njuguna, J. N.The global shortage of healthcare workers has been cited as one of the impediments towards the achievement of Sustainable Development Goal 3 on good health and well-being for all. The devolution of healthcare services in Kenya has made significant progress towards the achievement this goal amidst numerous challenges. One of these challenges has been the high attrition rate of medical doctors from public healthcare employment through resignation. For policy makers at the national and county levels to instigate strategic recruitment and retention policy measures, it will be paramount to have a good understanding of the reasons why the doctors are resigning. The purpose of this study was to establish why medical doctors resign from public sector employment in Kenya. The study specifically determined the individual, job-related, organizational and environmental factors in the resignation of medical doctors from public sector employment. It is anchored on the Herzberg’s two-factor theory. This study adopted a cross sectional descriptive research design and targeted medical doctors who have resigned from public sector employment in Kenya since the devolution of medicals services in 2013. 113 doctors were sampled through convenient sampling and primary data obtained from them using a self-administered semi-structured questionnaire. From the results, it was evident that job-related factors (B=1.252, p=0.046) added significantly to the model prediction but environmental factors (B=0.776, p= 0.107) and organizational factors (B = 0.303, p = 0.702) did not add significantly to the model. For individual factors that were examined, only age and education level were found to have a significant association with resignation of the medical doctors from the public service. Other individual factors such as gender, tenure and marital status were found not to have a significant association with resignation of medical doctors from the public service. This implies that only the job-related factors, and some individual factors lead to the resignation of medical doctors from the public service. There is a need for public healthcare management to initiate further programs to understand why doctors and other healthcare workers are quitting public service as well as identify issues that may attract and retain healthcare workers. The study has provided recommendations future research and improving practice.
- ItemRelationship between task shifting and service delivery in informal settlements: a case of community health volunteers in Kibra(Strathmore University, 2023) Kiranka, K. N.Human Resource for Health is an essential pillar in provision of quality and responsive health care services for the population. However due to the shortage of health care workers in sub-Sahara Africa and worse in Kenya, the WHO has recommended the need for other strategies like task shifting as a way of managing these challenges. This study therefore sought to evaluate the strategy of task shifting and its implications on service delivery of non-Communicable diseases by the community health volunteers in the informal sector of Kibera in Nairobi County. The objectives of the study were to establish service delivery of community health volunteers on noncommunicable diseases, assess the effect of community health volunteers' skills on service delivery, evaluate the effect of training of community health volunteers on service delivery and determine the effect of motivation of community health volunteers on service delivery. The ability, motivation and opportunity theory and expectation theory were used to guide this study. The current study adopted a positivist approach. A descriptive cross-sectional design was used. The study targeted community health volunteers in Kibra. Slovin’s formula was used to calculate the sample size of 144 respondents. A semi-structured questionnaire was used to collect data from the respondents. Descriptive and regression analysis were used to analyse data using SPSS. Results were presented in form of tables and graphs. This study's findings exhibit that skill, motivation, training attributes, gender, age, and education level explained 58.2% of the total variation in service delivery (R2 = .582, F (17, 108) = 8.85, p < .001). This model had the greatest R square (R2) showing that skill has a significant positive effect on service delivery (β = .413, p < .01). On average, every unit increase in skill rating is associated with a .413 unit increase in service delivery rating, all else fixed. The study recommended that skilling of CHVs with regard to NCDs be given more weight as the other soft skills are, harmonize training calendar and creatively always find more sustainable ways of incentivizing the CHVs.