SU+ Digital Repository

SU+ is an online repository for the preservation and promotion of assorted digital content at Strathmore University

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Conferences / Workshops / Seminars + 474
Documents and Proceedings of Conferences, Seminars, Workshops (and more) held at Strathmore University
Digital Archives 178
Assorted collections of resources covering various subject themes contributed by Faculty and Library Staff
Reports / Policies + 10
Public reports and policy documents
Research / Researchers / Publications 4661
Researcher Profiles / Conference presentations / Published research articles / Faculty and Corporate research outputs
Strathmore Heritage Collection 41
A digital chronicle of the History of the University presented through a mix of pictures, videos and digitized publications

Recent Submissions

Assessing awareness and attitudes towards National Health Insurance Scheme (NHIS) uptake among informal sector workers in Kampala, Uganda
(Strathmore University, 2026) Ninsiima, Sandra
Background: Uganda’s proposed National Health Insurance Scheme (NHIS) aims to reduce the high burden of out-of-pocket payments (41% of total health expenditure) and advance Universal Health Coverage. Success hinges on the enrolment of informal sector workers, who constitute 78–80% of the national labour force and over 80% of Kampala’s economy. However, urban-specific evidence on their awareness, attitudes, and barriers to uptake has been lacking. Objective: This study assessed awareness, attitudes, perceived barriers, preferred communication channels, and factors influencing potential uptake of the proposed NHIS among informal sector workers in Kampala. Methods: An explanatory sequential mixed-methods design was employed, whereby a structured cross-sectional quantitative survey was administered to 384 informal sector workers across Kampala's five divisions in the first phase, followed by in-depth qualitative interviews with a purposively selected subsample of 15 participants to contextualise and explain the quantitative findings. Quantitative data were analysed using descriptive statistics, chi-square tests, and multivariate logistic regression in STATA 17.0, while qualitative data were analysed thematically using NVivo 12. Results: Awareness of the proposed NHIS was low (14.1%), and among those aware, only 11.1% knew the proposed annual premium of UGX 100,000. Attitudes were generally positive (M = 3.58, SD = 0.65), but trust in government management was modest (M = 3.44, SD = 0.91). Key barriers included lack of information (M = 3.45, SD =0.84), poor health worker attitudes (mean = 3.38), and irregular income (M = 3.26, SD = 1.22). Social media (74.0%) and television (58.3%) were the most preferred channels, while religious leaders were the most trusted (M = 4.08, SD = 0.87). Multivariate logistic regression showed that enrolment intent was driven by perceived net benefit (OR = 2.85, p < .001), perceived cost reduction (OR = 2.29, p = .007), and institutional trust (OR = 1.57, p = .024), rather than demographic factors. Significant geographic and occupational variations in intent were observed. Conclusion: Informal sector workers in Kampala are willing to join the NHIS, but this willingness is conditional on closing the information gap, introducing flexible payment options, building institutional trust, and ensuring service quality. The findings underscore the need for equity-responsive design that addresses uniform premium challenges and geographic disparities to enhance uptake and advance Universal Health Coverage.
Insurer–provider contractual relationships and perceived healthcare service quality in Kenya
(Strathmore University, 2026) Muhadia, Scarlet
The private health insurance sector in Kenya plays a growing role in enhancing access to healthcare, yet its effectiveness depends largely on the quality of relationships between insurers and healthcare providers. Despite constitutional guarantees of the right to health, insured clients frequently encounter service delays, contractual disputes, and weak communication mechanisms that compromise service quality. This study investigated the impact of insurer-provider contractual relationships on clients’ perceptions of healthcare service quality in private health facilities across selected urban and peri-urban counties in Kenya. Anchored on the Gaps Model of Service Quality and the Donabedian Model of Healthcare Quality, the study will examine three sets of variables: terms and enforcement of insurer-provider contracts, the efficiency of communication and coordination mechanisms, and the timeliness of claims reimbursement and dispute resolution. Using a cross-sectional correlational design, data were collected from insured clients, private medical insurers, and facility administrators through structured questionnaires and key informant interviews. SPSS version 31 was used to compute descriptive and inferential statistics, while qualitative data were analyzed thematically. The findings revealed that insurer-provider contractual relationships have a positive and statistically significant influence on perceived healthcare service quality. Communication and coordination mechanisms had the strongest positive influence on healthcare quality (β = .578, p < 0.01), followed by insurer-provider contractual arrangements (β = .472, p < 0.01), and timeliness of claims reimbursement and dispute resolution (β = .157, p < 0.05). The three predictor variables jointly explained 57.7% of the variation in healthcare quality. The study further established that efficient digital communication systems, effective contractual enforcement, and timely reimbursement processes improve service responsiveness, reliability, and patient satisfaction, while reimbursement delays and contractual inefficiencies negatively affect continuity of care and operational efficiency within healthcare facilities. The study concludes that insurer-provider contractual relationships significantly influence healthcare service quality in Kenya, whereby communication and coordination mechanisms has the strongest effect, followed by contractual arrangements and reimbursement and dispute resolution processes. Based on the findings, the study recommends strengthening contractual enforcement frameworks, enhancing adoption of integrated digital communication and claims management systems, improving transparency in reimbursement processes, and institutionalizing efficient dispute resolution mechanisms in order to improve healthcare service quality and patient satisfaction within Kenya’s private healthcare sector.
Effect of cancer epidemiology on treatment efficiency in Kenyan
(Strathmore University, 2026) Nagaiahsamy, Vishnukumar
Globally and across Africa, the rising burden of cancer continues to place significant pressure on health systems, with increasing incidence, limited resources, and disparities in access undermining the delivery of timely and effective treatment. In Kenya, cancer cases and deaths are steadily increasing amid gaps in diagnostic capacity, radiotherapy access, and healthcare infrastructure, resulting in delays in diagnosis and treatment and reduced treatment efficiency. This study examines how cancer epidemiological patterns influence treatment efficiency at a facility level in Nairobi, providing context-specific evidence to inform oncology planning and service delivery. Guided by Epidemiologic Transition Theory and Health Services Utilization Theory, the study explains both the shift toward chronic diseases and how healthcare demand and system capacity shape service use and efficiency. Existing literature largely relies on aggregated or high-income country data, with limited longitudinal, facility-level evidence from urban African settings, creating a gap this study addresses. A pragmatic research philosophy and retrospective quantitative descriptive design were adopted using secondary data from 8,483 cancer patient records (2018–2025), collected through a validated structured extraction tool with a high retrieval rate of 94.3%. Findings revealed fluctuating annual trends influenced by COVID-19 disruptions, dominance of breast, cervical, and prostate cancers, and a patient population largely composed of older adults, females, and residents of Nairobi and nearby counties. Treatment efficiency was constrained by significant documentation gaps and limited recording of treatment and outcome indicators. The study concludes that strengthening data systems, improving capacity planning, and decentralizing oncology services are essential to enhance efficiency, equity, and overall cancer care delivery.
Determinants of successful strategy implementation in medium-sized hospitals in Nairobi, Kenya: a case of Bristol Park Hospital
(Strathmore University, 2026) Kathenge, Winfred Kavusi
The performance of organizations, including those in the healthcare sector, is determined not only by the quality of strategic plans but also by the effectiveness of their implementation. Despite developing well-crafted strategic plans, many medium-sized hospitals in Kenya face significant challenges in translating plans into action, resulting in implementation gaps that undermine organizational performance. This study sought to assess the determinants of successful strategy implementation in medium-sized private hospitals, with Bristol Park Hospital serving as a case study. Guided by the Dynamic Capability Theory (DCT), Resource-Based View (RBV), and McKinsey 7S Framework, the study pursued three objectives: to examine the impact of organizational alignment on strategy implementation, to investigate the role of internal resources in driving strategic execution, and to assess the influence of organizational structure and decision-making processes on implementation outcomes. A qualitative case study design was adopted, and purposive sampling was used to recruit 20 management personnel out of a total of 69 at Bristol Park Hospital. Data were collected through semi-structured key informant interviews, transcribed verbatim, coded, and analyzed thematically with the aid of NVivo software. Interviews revealed that the majority of respondents felt that successful strategy implementation requires aligning strategic objectives with the organization’s mission, vision, culture, and shared values, supported by effective communication channels. Respondents highlighted that internal resources, particularly human capital, financial allocations, and technological capacity, are critical enablers of execution, with targeted staff training and external partnerships helping to mitigate resource constraints. The hospital’s organizational structure was generally seen as facilitating communication and accountability, although respondents noted a need for greater decentralization in decision-making to enhance responsiveness. Additionally, while the Balanced Scorecard framework was widely used, respondents indicated that it requires customization to better suit the hospital’s operational realities. Overall, the study suggests that strategy implementation success in medium-sized private hospitals depends on a holistic approach that integrates organizational alignment, optimizes internal resource utilization, and adapts strategic frameworks to contextual realities. Respondents recommended strengthening communication systems, conducting regular strategy review meetings, investing in targeted capacity-building programs, and refining strategic frameworks such as the Balanced Scorecard to improve adaptability and comprehensiveness. Keywords: Strategy Implementation, Organisational Alignment, Internal Resources, Organisational Structure, Balanced Scorecard, McKinsey 7S, Resource-Based View, Dynamic Capability Theory, Medium-Sized Private Hospitals, Kenya
Factors influencing the retention of medical specialists working in public Level 4 and Level 5 rural health facilities in Kenya
(Strathmore University, 2026) Mose, Felister Moraa
The unequal distribution of healthcare workers, particularly medical specialists, remains a significant global challenge, especially in underdeveloped and rural regions. These areas often experience acute shortages across nearly all cadres of healthcare workers, with medical specialists being among the scarcest. Their scarcity contributes to elevated patient morbidity and mortality rates in rural settings. This study aimed to determine the factors influencing the retention of medical specialists in rural Kenya among Level 4 and 5 hospitals, to mitigate turnover and enhance access to specialized care. A descriptive cross-sectional study was conducted among 323 randomly selected medical specialists working in rural health facilities. Regression analysis was used to analyze the association between retention and various factors including working conditions, financial incentives, career development, and professional responsibilities. Findings revealed that only 32.5% of respondents were willing to remain at their current facilities. Key positive predictors of retention included the presence of quality equipment and infrastructure satisfaction with salary and availability of career development opportunities. However, limited availability of essential drugs and supplies significantly reduced retention. The study concluded that improving working conditions, providing professional development, and ensuring adequate resources are critical to enhancing specialist retention in rural Kenya, thereby improving healthcare service delivery in underserved regions. The study recommends that rural health facilities should strengthen working conditions, ensure consistent medical supplies, upgrade equipment, and maintain supportive infrastructure, while also improving salary competitiveness and expanding funding for professional development. Keywords: Medical specialists, Retention, Rural healthcare, Kenya, Healthcare workforce, Working conditions, Career development, Health equity.