MBA-HCM Theses and Dissertations

Permanent URI for this community

http://hdl.handle.net/11071/3958

Browse

Now showing 1 - 20 of 125

Exploring the perceptions of pediatric health care workers on audit and performance feedback in Kenyan County Hospitals
(Strathmore University, 2015) Waiganjo, Peter
Poor service delivery in the Kenyan public healthcare institutions can be attributed to non-compliance to evidence based practises and clinical guidelines by the health providers. This has resulted to drug dose errors, poor compliance with evidence‐based standards and high mortality rates from avoidable and treatable illnesses in children. It is through audit that intervention approaches and processes are developed and implemented in a healthcare system to improve service delivery. Health systems must be improved if continued and sustained gains in health outcomes are to be made particularly in low and middle income countries. Through an exploratory qualitative research design using semi-structured interviews and focus group discussions, the perceptions of the healthcare workers on audit and feedback were explored. A total of 53 paediatric healthcare workers from were purposively sampled through 10 focus group discussions and 10 semi structured interviews. Data were transcribed, themes explored, and revised in two rounds of coding and analysis in Microsoft Excel, subjected to a layered analysis, and reviewed. Eight major themes of the perceptions and behaviour of the healthcare workers to A&F were identified: commitment to improve care; opportunity to reflect on quality of care delivered; understand hospital morbidity and mortality; reinforced standards on care; used data for planning; enhanced teamwork, A&F as an incentive; and enhanced supportive supervision. The reporting and the data within the hospitals were accurate and reliable and used for decision making. The audit and performance feedback reports positively influenced the behavioural attributes and the leaderships and management skills of the health workers. The hospitals appreciated the feedback reports which elicited reactions they were never aware about their performance. There was general perception in the improvement of paediatric care and reduction in variation in practice and documentation process in the hospitals.
Costing of dental services in individually owned dental clinics in Nairobi County
(Strathmore University, 2016) Ochieng, Eric Odhiambo
Back ground: There is very limited relevant literature on costing of dental services globally and hardly any in the sub-Saharan Africa. In Kenya, there is no empirical data available to inform decision on appropriate pricing of dental services. This study thus aimed at generating information on costs and pricing determinants for dental services in order to inform policy on pricing of dental services in Kenya. Methodology This was mainly a costing study. Provider perspective was preferred. Two facilities were purposively sampled based on physical size. Facility A was the larger facility, and Facility B the smaller facility. A bottom-up approach to costing was adopted and cost components categorized into recurrent and capital costs. Results and conclusion The cost estimates for the dentals services for facility A and B respectively were: KSh.3,596 and KSh.4,095 for a root canal treatment, KSh.2,070 and KSh.1,874 for a dental filling, KShs.1,922 and KSh.1,888 for scaling, and KSh.1,625 and KSh.1,536 for a tooth extraction.. Comparisons between estimated costs of specific dental services and prices charged for the respective services at the facilities mostly revealed huge mark ups. This information on cost estimates is crucial if dental services are to be priced accurately to assure that dentists practice profitably and patients are charged fairly
Analysis of medicines expenditure for fiscal year 2014/2015 at Lodwar County Referral Hospital
(Strathmore University, 2016) Kokonya, Daniel Masiga
Major causes of stock outs in public hospital are inadequate fund to purchase the medicines and inefficiencies in the pharmaceutical supply chain. Good pharmaceutical management can result in efficient use of funds for purchasing medicines and improvement of the pharmaceutical supply chain. The objective of this study was to analyse pharmaceutical supply chain costs at Lodwar County Referral Hospital in order to get insight of how the funds were used and use this information to improve pharmaceutical management. This study was conducted using the retrospective case study methodology. A total cost analysis of pharmaceutical supply chain costs was done (pharmaceutical acquisition cost, Inventory holding cost, purchasing cost and shortage cost) for fiscal year 2014/2015 was conducted to identify key cost areas. Pharmaceutical acquisition costs were then subjected to ABC and VEN analysis to narrow down on groups requiring greater fiscal and managerial control The study showed that the total pharmaceutical supply chain cost of Lodwar County Referral Hospital for fiscal year 2014/2015 was KES 53,228,625. Pharmaceutical acquisition costs accounted for 92.3%; inventory holding cost 6.3%; purchasing cost 1% and shortage cost 0.4 % of the total costs. ABC– VEN analysis resulted in identification of three groups requiring different level of managerial control. Class I drugs comprising of 74 of the 200 products (37%) accounted for 82% of the total cost. This group was identified for stringent fiscal and managerial control. In conclusion the total cost analysis aided in identification of pharmaceutical supply chain costs that should be controlled. And the ABC – VEN analysis aided in identifying a comprehensive group of drugs among the essential medicines list that may require higher managerial control.
Investigating challenges to electronic medical record systems adoption : a case of Coast Province General Hospital
(Strathmore University, 2016) Sumbi, Everlyne M.
Background: The recent worldwide focus on healthcare quality improvement, cost containment and enhanced patient experience has led to increased need for adoption of Electronic Medical Record systems (EMR).This would significantly reduce clinician workload and medical errors while saving the institution major expenses. Kenya is globally acclaimed as a leader for its Information Communication Telecommunications (ICT) innovations such as M-PESA.Yet compared to developed nations, Kenya has a long way to go on EMR systems adoption. This paper thus examines the potential challenges as perceived by user groups, to EMR systems adoption in a public hospital and suggests possible interventions to the said challenges. Methodology: A descriptive survey research design was used. A sample size of 141 was used out of a population of 473 employees working at the Coast Province General Hospital (CPGH). Stratified random sampling technique was used based on categories of staff establishment .Data was collected using structured questionnaires and analyzed using SPSS version 20 and Microsoft Excel 2007. Results: The study findings indicate that financial, technical and time constraints are among the challenges to EMR adoption at CPGH with change process as a mediating factor. The respondents strongly agreed that lack of proper leadership, lack of stakeholder involvement, resistance to changing the traditional way of working and lack of motivating factors were among the impediments to adopting this change. EMR systems adoption requires extensive commitment to system administration, control, maintenance, and support in order to keep it working effectively and efficiently. High initial costs, ongoing maintenance costs and uncertain return on investment were highlighted as key financial barriers. Lack of the infrastructure and skills among the user groups, presumed complexity and lack of customizability were some of the technical barriers voiced. Time to learn the system; time to enter data and time to convert the records was perceived to have an effect on workflow and workload. Conclusions: The policy makers thus need to budget for EMR adoption expenses, put measures to train staff, communicate the shared vision through stakeholder involvement, and have monitoring and evaluation strategy in place. The process of EMR adoption should be treated as a change project, and led by implementers or change managers. The quality of change management plays an important role in the success of EMR adoption. The findings from this study will be shared with the hospital administration for consideration in policy formulation, decision making, research and development and in addressing the said challenges.
Relationship between effective drug inventory control management and stock-outs in Kenya’s public hospitals : a case study of Kenyatta National Hospital and Defence Forces Memorial Hospital
(Strathmore University, 2016) Awle, Ismail A.
The purpose of the study is to evaluate the relationship between effective drug inventory control management and Stock outs in two leading Kenya public hospitals: Kenyatta National Hospital and Defence Forces Memorial Hospital. The study objectives were: a) to determine how policies, systems, staff capacity affect drug inventory control management in Kenya’s public hospital; and b)to establish association between inventory management and stock outs in the two hospitals. Descriptive survey design involving a mix of qualitative and quantitative research methods was used. The instruments used were self - administered questionnaires, one on one in - depth interviews and observations. The main conclusion from the study was that the relationship between stock out and determinants of drug inventory management were non-significant in both hospitals. The main recommendation from this study is that more determinants other than the ones in this study need to be evaluated to establish the real causes of drug stock outs in public hospitals.
A comparative analysis of Kenyan pharmacists perception towards pharmaceuticals made in India and China
(Strathmore University, 2016) Tawakal, Ahmed Hassan
Imports from India and China constitute over 40% of the total value of pharmaceutical imports into Kenya. However products made in these countries are faced with the challenge of being perceived in the context of the country of their origin. This concept has identified that national stereotypes of products and services from a country exist and they affect the product evaluation and purchase intention of the market. The purpose of this study is to identify the perception of Kenyan pharmacists towards pharmaceutical products from India and China as well as their cognitive and affective image towards those countries. The study also seeks to analyse the impact of product image perception towards purchase intention of pharmaceuticals and to compare the results of the two countries. The study utilized a cross-sectional design with systematic sampling of the population. Descriptive analysis of the data was performed and is presented in table and charts form. Inferential and correlational analysis were also done to determine the correlation effect of the different parameters on the purchase intention. The results of the study suggest that there is variation in impact of product perception on purchase intention of pharmaceuticals for the two countries and that pharmacists generally had a favourable view towards pharmaceuticals made in India as compared to those made in China. The study will help pharmaceutical marketers from the study countries identify the most important determinants of purchase intention among pharmacists and to shape their promotion activities to target those aspects.
The influence of motivation and work environment on nurse retention: a case of Shalom Hospitals
(Strathmore University, 2016) Onyango, Hellen
Among the key pillars of a healthcare delivery system are health workers. Most of the attention and research has focused on the care givers in public health facilities. This study sought to determine the factors which affect the nurse retention rates in Shalom hospitals. According to the human resource department at the Shalom hospitals the nursing department has a high turnover of nurses which in turn affects quality and efficiency at the hospitals. The study specifically sought to investigate the relationship between nurse retention and work environment and internal motivating factors at Shalom hospitals. It also sought to investigate what current retention strategies are in place by the hospital management for the nurses. The study was based on Herzberg’s theory of motivation which states the causes of job satisfaction and job dissatisfaction as motivation and work environment factors respectively. The study aimed to establish the relationship between nurse retention rate at Shalom hospitals and Herzberg’s dual theory. To achieve these objectives, the study collected data from nurses currently working at the Shalom group of Hospitals in Machakos and Athi river towns. The study employed a quantitative research design in research methodological procedures. The data was collected through questionnaires and analyzed through descriptive statistics using SPSS. The study revealed that there was a positive relationship between work environment and nurse retention and motivating factors and nurse retention. A prediction model showed that a unit increase in internal motivating factors would increase staff retention rates more than a unit increase in work environment factors. The study concludes that provision and maintenance of quality work environment and provision of quality standard internal motivating factors helps to increase retention in Shalom hospitals. The study further concludes that most of the nurses were not contented with the quality of the current nurse retention strategies being employed at Shalom hospitals. The research recommends that the management of Shalom hospitals should develop an overall strategic plan which includes internal motivation such as praise and appreciation, competitive compensation package, improve on career growth and enhancement programs and job security.
An investigation of the influence of talent management practices on retention of healthcare professionals at Kijabe Mission Hospital, Kiambu
(Strathmore University, 2016) Mukweyi, Anne Shinaka
Retention involves all the processes that are geared towards making an employee want to stay within an organization. This process is dependent on how that organization attracts, selects, develops and retains its best employees (Talent Management). At the core of talent management is the assumption that the „talent‟ must be found, segmented, nurtured and placed in pivotal positions that are crucial for the competitive advantage of the Firm. Building on the Human Capital theory, this research investigated talent management practices and their influence on retention in one of the largest mission hospitals in Kenya, Kijabe hospital. The study applied both Qualitative (interviews with key informants and use of documented reviews) and Quantitative data collection methods (Questionnaires). Descriptive and causal research designs were used in the analysis of data. Convenience sampling technique was used to select the sample size for quantitative data and purposive sampling was used for qualitative data. The results showed that talent development had appositive impact on retention with 49.6 % of staff showing that there is a genuine interest by the organization to foster and develop employees. Talent acquisition had affair rating in that though only 11% of respondents in the general staff category had good knowledge on the HR recruitment and selection process 32% of staff agreed that the organization appoints high calibre employees. The reward systems had the most negative impact on retention with more than 86% of staff stating that the salary offered was not competitive to market rates and was the number one cause of turnover among staff.
An investigation of clinical knowledge management practices at the Aga Khan University Hospital, Nairobi
(Strathmore University, 2016) Hirani, Mumtaz Shaffique
Globalization has had a lot of impact on the management of various organizations, and the health care sector is not exempt. In the era of knowledge economy, management of knowledge has become a significant tool for enhancing the competitiveness of firms. The Aga Khan University Hospital, Nairobi is the tertiary, teaching and referral healthcare facility in Kenya. Their approach to care is guided by their core principles of Quality, Access, Impact and Relevance. Knowledge management at The AKUH is primarily facilitated by the University hospital library and The Continuous Medical Education (CME) department. The libraries provide the university community access to comprehensive and multi-disciplinary information resources in print and digital formats. This access is provided through innovative services and state-of-the-art systems. Despite all the above there still exist an empirical gap in the knowledge management practices of the healthcare institution. This study investigated the knowledge management practices implemented in the university hospital. Simple random sampling technique was applied to select a sample size of respondents picked from the university hospital setting. The research applied both quantitative and qualitative data analysis. Out of 201 questionnaires’ distributed, 188 responded giving a response rate of 93%. 8 of the respondents were section heads and 10 were program directors, 64 were consultants, 28 were registrars, 24 were senior house officers and 54 were residents. Data was collected from the respondents using structured questionnaires. For qualitative study, semi structured interviews were conducted on 13 senior managers out of which 8 were chairs of different clinical departments,1ICT officer, 1 regional librarian and 1 head librarian, 1 dean of the medical college and 1 CME coordinator to make a total of thirteen giving a response rate of 81%. Descriptive and causal research designs were used in analysis of the data. The design was ideal in describing the characteristics of the large targeted sample used in the study. The results of the study established that the use of Electronic medical records, Continuous medical education, Communities of Practice, Knowledge cafes, and Web based system are the key knowledge management practices that are in place in the university hospital. The leadership role played by top management emerged as being a key facilitator of knowledge management practices in the healthcare facility. The results from this study will inform the hospital management on the knowledge management practices in the hospital, suggest that knowledge management practices directly influence the performance of clinical staff. Key recommendations from the study were that an alignment of knowledge management policy to the organizational strategy would act as guideline on how knowledge should be disseminated within the organization, secondly the role of leadership in managing KM activities in terms of management support is key and finally, incentive programs which reward knowledge sharing are important so as to encourage employees to actively share knowledge both in the departments and across department knowledge sharing. Further research efforts can investigate the impact of social media in the improving implementation of knowledge management within organizations or between sector partners. The study was limited to the Aga Khan University Hospital which is a private health care facility, further studies can be carried out in public health care facilities.
An investigation of the factors associated with needlestick injuries in two county referral hospitals in Nairobi
(Strathmore University, 2016) Achungo, Florence Akinyi
The health care working environment carries with it a considerable risk of occupational hazards. These hazards include biological, physical, chemical, radiation and psychological hazards. Biological hazards is the most prevalent type of hazard within the health care work environment, with needle stick injury being the most prevalent type of biological hazard. The aim of this study was to investigate the factors causing needle stick injuries in county referral hospitals in Nairobi City County in order to recommend strategies for reducing the injuries. Based on the accident/incident theory, the study investigated the two main categories of causal factors, that is, system failures and human errors, and their association with occurrence of needle stick injuries among health workers in Nairobi. The study was carried out in the casualty, surgical and pediatric departments of two county referral hospitals in Nairobi. A sample of 140 health care workers was drawn from staff working in these departments. Structured questionnaires were used to collect data from the health care workers. Descriptive analysis of the data was performed using SPSS. Descriptive analysis revealed that a more than 50% of the health care workers associated the occurrence of needle stick injuries incurred through work pressure and fatigue, and which resulted to human errors. The study concluded that pressure of work and fatigue were the leading factors associated with needles stick injuries among health care workers in Nairobi County. The study recommends that hospital management should evaluate ways of relieving health worker pressure and stress in order to reduce occurrence of needle stick accidents. Further studies to establish the presence of system failures within the hospitals is also recommended. Since ordinal test of correlation was not performed on the results of this study, these findings may not be generalizable to other health facilities of similar status.
Determining the differences between patients’ and employees’ perceptions and expectations of quality of service in outpatient departments in Kiambu County Public Hospitals
(Strathmore University, 2016) Maina, Stephen Mwangi
The demand for effective healthcare within the Kenyan population has continued to rise making it hard for the government to provide sufficient health care services. Despite the on-going reform effort, the majority of the people in many counties still have limited access to quality health services. Living in the world of information and technology, patients are now more aware of their needs and rights. Health is a social good and needs public participation, including proper allocation of resources responding to public needs. In order for the health sector to meet the given public needs, it needs to change in line with the changing needs of the customers, this can only be met if these needs are determined by use of the surveys which ensure that the healthy sector offer quality services. The objective of this study was to determine the differences between patients’ and employees’ perceptions and expectations of quality of customer service in an outpatient department in 3 public Kiambu County hospitals, Kenya. The study was conducted in Kiambu County. SPSS (version 20) was used to analyze the study’s data. Basic descriptive statistics was done. The data was analyzed through percentages, frequencies, mean, standard deviation and Chi-Square test and the findings were presented in tables, graphs and narratives for easy comparisons and understanding to the readers. The study revealed that there is difference in patients and employees’ perception of quality of service at the hospitals. Patients don’t expect much from the treatment facilities though hospital staff perceives these facilities to affect the quality of service offered to a great extent. Both patients and employees’ opinion on the effect of customer care related factors on service quality are moderate. Patients in public hospitals don’t expect much of customer care services from the employees hence they perceive it as affecting service quality to moderate extent. Patients view the effect of medical care related factors on service quality as moderate while employees view it as very great. Patients appreciate medical care while employees view it as not enough. The study recommends that the county government of Kiambu should strive to improve quality of patient service in all hospitals under their management. This can be enhanced through provision of physical facilities in order enhance patient satisfaction. Periodic assessments should be consistently carried out to determine the physical state of each hospital and appropriate measures taken as per the report, the county government needs also to ensure consistent supply of basic hospital amenities in order to enhance the quality of health care provision. Patients should also be sensitized on the kind of customer service to expect from public hospitals.
A survey of dentists’ satisfaction with patient dental covers, provided by insurance companies based in Kenya.
(Strathmore University, 2016) Lodhi, Tariq Abbas
The financing for public oral health care delivery in Kenya is very limited. The option for Kenyans is therefore either to pay ‘out of pocket’ or utilize dental insurance covers after paying a premium. The purpose of this study is to explore the satisfaction of dentists with patient dental insurance covers in Kenya, and investigate its benefits to their patients; since dentists are the actual dental services providers and not the insurance companies who sell these covers. An exploratory web based survey was sent to 840 dentists registered with the Kenya Dental Association, with 77 completing the entire survey, and 55 dentists fulfilling the selection criteria of having past insurance experience. The results showed that 72.73% dentists were not satisfied with insurance companies and 87.27% felt dental covers in Kenya did not meet the needs of their patients. A few specific issues were further probed. 92.31% of dentists were dissatisfied with the period of time taken to pay them by insurance companies for dental services rendered. This time was found to be 3 months or more. 90.39% of respondents were dissatisfied with the annual dental cover limit offered to patients. The common limits for these covers was found to be between Kshs 10-20,000/-. 86.54% of dentists were dissatisfied with the exclusions of dental procedures, not covered by insurance. 80.77% were dissatisfied with the fees for dental procedures paid to the dentist by Insurance companies. 76.93% were dissatisfied with the process of pre-authorization prior to treatment. 67.31% were dissatisfied with the time taken for approval by insurance companies to commence dental treatment. It is recommended that dental insurance providers reconsider their exclusion criteria and annual patient dental cover limits. ICT can further be adopted to improve the pre-authorization process. A different remuneration model for dentists can be adopted to promote preventive dental care.
An exploration of strategies adopted by pharmaceutical companies in Kenya to achieve sustainable competitive advantage
(Strathmore University, 2016) Munene, Winnie (Dr.)
Competitive strategies are a broad range of strategies firms resort to in order to cope with competition, beat competition or keep ahead of competitors. In the pharmaceutical industry in Kenya, pharmaceuticals companies have developed competitive advantage that was only short lived due to quick imitation by fellow competitors especially companies manufacturing generic products. This study sought to determine strategies adopted by pharmaceutical companies in Kenya to develop sustainable competitive advantage, to describe the internal organizational capabilities contributing to pharmaceutical companies in Kenya competitive advantage, to analyze the external environmental factors influencing pharmaceutical companies in Kenya competitive advantage. The study adopted a descriptive survey design. The study population comprised of 25 Pharmaceutical companies in Kenya. Purposive Sampling was used to select two senior employees in each pharmaceutical company from the finance and operation department, thus a sample size of 50 respondents. Primary data was collected using pre-determined questionnaires. Quantitative data collected was analyzed by the use of descriptive statistics using SPSS and presented through percentages, means, standard deviations and frequencies. Multiple regression analysis was conducted. The study found that the strategies adopted by pharmaceutical companies in view of developing sustainable competitive advantage include cost leadership strategy, product differentiation strategy, market focus, as well as investment in research. Among the external organizational capabilities include strategic customer targeting, evaluating organizational strengths and exploring market niches. The internal organizational capabilities contributing sustainable competitive advantage pharmaceutical companies include, investment in staff development, resource allocative efficiency, maintenance of quality accounting standards. This study recommends that differentiation strategy should be highly adopted in order to promote organizational performance, that organizations should highly adopt cost leadership strategy and should periodically conduct SWOT analysis as this will be helpful in establishing business objectives and achieving the organization’s mission, vision and goals.
Analysis of the effectiveness of free maternity health policy on utilization and financing of health facilities in Mombasa County
(Strathmore University, 2016) Shikely, Khadija Sood Mohamed
Maternal mortality has been a concern for Kenya for a long time, and one of the reasons for poor uptake of maternal services is the financial barrier. The government was of the view that removing this barrier would dramatically improve uptake. The Government of Kenya decided to have free maternity health care services in order to reduce maternal deaths and to improve on the quality of delivery among pregnant women. Maternal mortality ratio in Mombasa County is 129 per 100.000 live births. Free maternity health policy was born on 1st June 2013, H.E Uhuru Kenyatta, President of the Republic of Kenya declared all women to deliver free in all public hospitals. The main aim of this study was to assess the effectiveness of Free Maternity Health Policy on utilization and financing at health facilities in Mombasa County with the following specific objectives: i) To describe the utilization rate before and after Free Maternity Health Policy. ii) To assess if the Free Maternity Health Policy (financing mechanism) contributed to improved utilization and iii) To assess financial implementation challenges, adequacy of financing the policy and the hospital coping mechanisms. This study employed a descriptive cross-sectional design where the respondents were asked to complete questionnaires, in depth interviews were carried out and in addition, existing health records of mothers who benefitted from the policy and the existing financial records at the facilities during the period of the study, were reviewed to assess the health care utilization and health care financing and its challenges. The study was conducted in Mombasa County at purposively selected sites. The target sites was two high volume health facilities, Likoni and Tudor sub county hospitals, both level four hospitals of similar scope of services and in two different sub counties. The target population included health service administrators, clinicians and nurses providing maternity services in their health care facilities. Data was collected through document reviews, key informant in depth interviews, and extraction from health facilities records. The data collected was coded, quantified and analyzed quantitatively and qualitatively. Quantitative data was analyzed with the use of Statistical Package for Social Sciences (SPSS, version 21.0). The information was displayed by use of bar charts, graphs and pie charts. This was done by tallying up responses, computing percentages of variations in response as well as describing and interpreting the data in line with the study objectives and assumptions through use of SPSS. Thematic analysis was used to test data that is qualitative nature or aspect of the data collected from the open ended questions. The study also conducted a correlation inferential analysis. The results of the study on the utilization levels of maternity services before and after FMHP indicated that there was a significant increase (207 deliveries or 95%) in the number of maternity patients in the health care facilities after FMHP. The greatest increase was seen among mothers aged <35 years (201 deliveries or 102%) - the average age of the delivering mothers being 25 years. The study also shows that the common parity for both before and after FMHP is the 2nd parity at 96 mothers and 177 mothers delivering in may 2012 and may 2014 respectively. The study also found that majority of the patients who delivered at the health facilities had no education and were unemployed. The results also indicates that there was increase in delivery levels by mothers across different levels of education with the highest rate of increase being for mothers with no education at 44 (400%) followed by those with tertiary education at 15 (107%) increase respectively. It is evident from the results that financing mechanisms after FMHP are much better compared to the one before FMHP. This is supported by a significant increase in the revenue, (through reimbursements from the national government) of the health facilities by Ksh 1,703,320 which is four times more (409%) than the revenue collected before FMHP. This can also be explained by the difference in the average fees per delivery charged before FMHP which was Ksh 2082.64 with what the government reimbursed per delivery after FMHP which was Ksh 5000. Majority (80%) of the respondents were of the view that FMHP is achieving its stated purpose and that the health workers (93%) are also complying with the the policy guidelines despite the barriers to compliance particularly at an operational level. Majority of the respondents (87%) affirmed that health workers were not involved in the drafting and implementation of the FMHP. Only 13% of the interviewees were of the view that the health workers were involved. However it is evident that majority (87%) of the respondents believe that the policy has had a greater impact on the quality of health care compared to its impact on financing of maternity health care whereby only 47% of them believed it had a positive impact.
Factors influencing membership uptake of National Hospital Insurance Fund among the poor : a pastoralist’ perspective
(Strathmore University, 2016) Kipaseyia, John Saitoti
It’s important to address disparities in access to health insurance among marginalized groups in order to accelerate the achievement of Sustainable Development Goals (SDGs) post-2015 and also to identify interventions that will mitigate this situation. The purpose of the study was to establish determinants of uptake of National Hospital Insurance Fund scheme by an informal pastoralist’s community in Kenya, which will be of significance to the government of Kenya in formulating and implementing health insurance policy as it gears towards universal health coverage. The target population was the informal sector participants at Olkeri Group Ranch, Kajiado West Constituency in Kajiado County. Descriptive study design was adopted while simple random sampling method was applied to select a representative sample of 246 households in the study population. The data collection tools were questionnaires with both closed and open ended questions which were reviewed, cleaned and coded to minimize errors and enable easy entry and analysis. Statistical Package for Social Sciences (SPSS) version 20 was used to organize the data and carry out statistical analysis. In the findings only 2.3% of respondents were enrolled in NHIF scheme. This study recommends decision makers modify NHIF policies in terms of reviewing payments of health insurance premiums to ensure those who are still excluded due to lack of cash to pay are brought on board by paying premium in kind using their biological assets. The scheme should also tailor its marketing strategies to cater for those with less or no education by conducting information, education and communication campaigns to promote awareness and knowledge of health insurance.
Assessing the acceptability and willingness to pay for HIV services among patients at LVCT health HIV clinics
(Strathmore University, 2016) Otiso, Lilian Dr.
There have been several calls for sustainability of the predominantly donor funded HIV programs globally due to reduction in HIV funding. User fees for HIV services were eliminated by the World Health Organization in 2006. This study sought to explore if it is acceptable (does not violate rights) to charge for HIV services and willingness to pay (WTP) for HIV care and treatment services among patients at LVCT Health clinics in Nairobi and Kisumu. It also sought to examine the factors that influence WTP health care payment methods for HIV services that patients in the clinics could use to pay for services. The study applied a cross-sectional survey design utilising quantitative data with some open ended questions. Three hundred and sixty (360) patients in LVCT Health clinics in Nairobi and Kisumu were issued with questionnaires and 337 responded. Quantitative data analysis techniques involving descriptive statistics, Chi square tests and logistic regression were carried out. Qualitative data was coded and presented in themes. Ethical approval was obtained from the Strathmore University Institutional Review Board. Findings revealed that only 16% of respondents found it acceptable to be charged for the services. Reasons given for not being acceptable were that patients are poor and would not afford treatment. 64.5% were willing to pay if donors withdrew funding support to the clinic, but majority (74.5%) were willing to pay less than Ksh 2000 per visit (estimated required amount Ksh 5000). There was significant association (p<0.05) between WTP and education level, income, presence of private medical insurance and having paid for HIV services before. 59.6% of respondents were enrolled in the National Hospital Insurance Fund (NHIF) and 61% were willing to use it to finance their treatment. Those who did not want to use it did not want their employer or insurance company to find out their HIV status. The findings demonstrate that though willing to pay, majority of HIV patients are poor and would not be able to afford user fees for HIV treatment making them vulnerable to its effects. NHIF and private medical insurance seem like viable options that should be explored to finance HIV treatment.
The effect of free maternal health care services on perceived quality of service delivery at Nakuru Provincial General Hospital
(Strathmore University, 2016) Murima, John Mwangi
The introduction of the free maternal healthcare services by the government of Kenya in all public facilities in June 2013 was geared towards addressing the high burden of maternal mortality currently estimated at 488 deaths per 100,000 live births. This is well above MDG target of 147 per 100,000 live births that was to be achieved by September 2015. The increased access to facility based child birth as a result of free maternity services may compromise the quality of maternal care due to inadequate preparations and investments to handle the large influx of expectant mothers. The study aimed at assessing the effect of the free maternal health care at Nakuru Provincial General Hospital which is a teaching and a regional referral hospital serving a catchment population of 1.6 million people. The study was undertaken between August and September 2015. This was a quantitative study employing descriptive research design. Questionnaires were administered after signed consent to the respective post-partum mothers upon discharge from the hospital. Administrative data on measures of quality were used against the National Norm and Standards of Maternal Services in Kenya. A total of 423 post natal mothers participated in the study. The implementation of the free maternal services resulted in a 53% increase in the number of deliveries at Nakuru PGH. Post natal mothers in the age group 20-24 years accounted for the majority 38.5%. Both physical and organizational resources were found to have largely remained the same despite the increased number of pregnant mothers seeking delivery services. However, the healthcare activities (process measures) involved in maternal services were found to be below the minimum National quality standards. In particular, 33.2% of post natal mothers had not signed the medical or surgical consent while 42% of the mothers in labour did not receive the prescribed pain relief medication. However, 97.3% of the post natal mothers had their labour management plotted on partograph. The majority 87% of the post natal mothers had a length of stay of upto two days with 13% of them leaving after one day of admission. The increased number of deliveries at Nakuru PGH as a result of the implementation of the free maternal services had not negatively affected the perceived quality of maternal care. However, more investment in the physical and organizational resources is needed to sustain or improve on the gains made in the quality of care offered. Similar studies are needed in other facilities to come up context-specific recommendations to sustain the free maternity services.
Investigation of healthcare marketing communication channels used for hypertension in low income setting in Nairobi County
(Strathmore University, 2016) Kitulu, Jacqueline W.
Hypertension is a chronic non communicable disease and its prevalence is on an alarming rise in Kenya, Africa and globally. It is noted to be the number one risk factor for global mortality, a position reiterated by numerous scholars. It is made worse by the fact that in most cases it is an illness without symptoms, so that it can persist for many years with resultant complications that are expensive to manage on an individual and national level. Management of this global time bomb will require an awareness/ information education communication aspect to address the silent nature of this condition. The aim of the study was to determine the most effective healthcare marketing communication channel that would lead to early detection of hypertension through awareness and behaviour change that would lead the largely unaware public to seek hypertension diagnosis and treatment at health facilities. Healthcare marketing techniques have been very effective in changing patient behaviour in the realm of communicable diseases such as HIV. This descriptive survey was carried out in low income setting of Nairobi County taking advantage of sites that were involved in the Healthy Heart Africa project. The study found that health promotion channels used for behaviour change communication for communicable diseases can also be utilized for non communicable diseases. Interpersonal communication was found to be the most significant health communication channel for creating public awareness on hypertension, mobilizing for screening and therefore diagnosis and treatment. Four other channels stood out as being potentially significant for increasing hypertension awareness and these were newspapers, internet, use of barazas and community health workers. The study population was also noted to have high levels of awareness of the risk factors for and the seriousness of hypertension as a medical condition.
Determinants of retention strategies for health care practitioners in public health facilities in Kenya: a case of County Hospitals in Nairobi Kenya
(Strathmore University, 2018) Kamaara, Sheila Nduta
At the heart of each and every health care system, the workforce is central to advancing health. Healthcare is a labour- intensive industry and therefore retention and growth of is important. This study seeks to determine the retention strategies used by public health facilities where brain drain has become rampant in the facilities. The study sought to determine the retention strategies by looking at the following three aspects of the facilities. First the study looked at the relationship between the motivation strategies used and how they influenced staff retention in the public health facilities. Secondly, the study looked at the relationship between employee relations management strategies adopted to enhance the retention of healthcare practitioners in Kenya. Thirdly, the study focused on the professional growth strategies that are in place and how they influenced retention of healthcare practitioners in the public healthcare facilities. The study was based on various theories on employee behaviors such as the Expectancy theory and Maslow’s Theory. To achieve these objectives, the data was collected at the 3 County hospitals in Nairobi County (Mama Lucy Kibaki Hospital, Mbagathi County hospital and Pumwani Maternity Hospital) where a sample of 165 respondents was drawn using simple random sampling method. Primary data was collected using a semi structured questionnaire. Data was analyzed using SPSS (Version 20.0). Basic descriptive statistics were used as well. The data was then analyzed through percentages, frequencies, mean, standard deviation and inferential statistics. The findings were presented in tables, graphs and narratives for easy comparison. The study found out that all the variables had a positive and significant influence on employee retention. Motivation strategies had a significant influence on employee retention as shown by the coefficient (β = 0.365, t = 4.433, p> 0.000). Employee relations management strategies also showed a significant influence on employee retention with the coefficients (β = 0.168, t = 32.132, p> 0.005) indicating a positive effect employee retention. Professional growth strategies as well showed a significant influence with a coefficient of (β = 0.309, t = 3.781, p> 0.000) showing a positive and significant relationship. The study concluded that the hospital supervisors should usually discuss issues affecting employees with them and other employees and mentor and coach them. The study recommended that the hospitals should have a clear career development plan for their employees which improve their retention.
Exploring hand hygiene practices among healthcare workers in Ruiru Sub-County Hospital
(Strathmore University, 2018) Kamau, Esther
The individual, household and economic impact of Hospital Acquired Infections (HAIs) globally cannot be overstated; therefore, how healthcare workers perform and comply to hand hygiene practices is essential for mitigating its effects. The aim of this study was to understand the hand hygiene practices at Ruiru Sub-County Hospital, a level 4 facility in Kiambu County, Kenya. A cross-sectional descriptive study was done using a modified WHO hand hygiene questionnaire to assess knowledge, structural and individual factors that affect hygiene practices, and recommend potential interventions to improve hand hygiene; and a structured, unobtrusive observation of hand hygiene performance and compliance. Overall compliance rate with hand hygiene practices was found to be 54.1% among health care workers at the facility. The survey revealed acceptable training and knowledge standards among the healthcare workers but a disproportionate behavior gap. The significance of the study is to contribute to the revention and elimination of hospital acquired infections, which are increasingly becoming among the top global burden of disease. The effects of HAIs goes beyond the infected patient, but also affects the family and the economy,because of loss of productive lives through disability and death.

Browse

Browsing MBA-HCM Theses and Dissertations by Issue Date

Results Per Page

Sort Options