MBA-HCM Theses and Dissertations (2018)

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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.
An assessment of the state of public healthcare governance in Tana river County, Kenya
(Strathmore University, 2018) Mwikairi, Mwenda Nicholas
There are six (6) building blocks in the health systems, namely health service delivery, health information systems, healthcare financing, health workforce, medical technologies and products and health leadership and governance. Since devolution of healthcare services in Kenya in 2013, there has been an increased investment in the various building blocks of healthcare, with varied improvement in health outcomes. Health leadership and governance has not received much attention of the blocks of the healthcare system. To foster accountability, transparency, integrity, professionalism, customer focus and innovativeness, H.E Uhuru Kenyatta launched Mwongozo, the Code of Governance for State Corporations in 2015, as a firm foundation and guide for the management, governance and oversight to state corporations and public bodies as grounded in Kenya’s constitution’s values and principles as well as best global practices of governance. The code is to be implemented on a ‘Comply or explain’ basis, meaning that public bodies may adopt this code to suit their field, with the stakeholders’ being the goal. The general objective of this study was to assess the extent to which Tana River County has complied with the Mwongozo Code of governance for State Corporations. Data was collected from five health facilities’ governance bodies through use of structured and unstructured questionnaires and by use of a focus group discussion..‘R’, free software for descriptive statistical computing and graphics, was used for analysis. The study revealed that healthcare governance bodies in Tana River County are neither constituted nor operated in line with the Mwongozo code of governance for state corporations. The study also revealed that current health governance bodies have limited capacity to effectively offer strategic direction and oversight to the healthcare system in Tana River County. The study identified lack of legitimacy, financial weakness, low technical capacity and lack of a structured appointment of healthcare governance body members as some of the challenges facing healthcare governance. The study recommends creation of policies and structures to aid recruitment and empowerment of health governing bodies that are capable of effectively carrying out their roles according to the Mwongozo code and global best practices.
Determinants of enrollment and retention of organized members of the informal sector into National Hospital Insurance Fund Nairobi County
(Strathmore University, 2018) Ariga, Christine
The global agenda focus is on how countries can adopt context specific initiatives towards realizing Universal Health Coverage as emphasis by the post 2015 development agenda(United Nations, 2015). The Kenya health financing strategy (2017) emphasis on Universal Health Coverage and envisions the National Hospital Insurance Fund (NHIF) as the primary provider of health insurance as the vehicle for delivery of UHC. The study sought to assess the determinants of enrolment and retention of organized groups of the informal sector into the NHIF Kenya with the aim of contributing to the knowledge on how social health insurance schemes can achieve Universal Health Coverage. The study target population was the informal sector members of organized groups (Self-help groups) in Kibera constituency Nairobi County. The objectives of the study were; to assess the views of informal sector workers about the improved benefit package , to describe the knowledge of benefit entitlements among organized members of the informal sector in Kibera and to examine access to the entitlements in terms of availability, affordability and accessibility. A descriptive cross-sectional study design was adopted with mixed method approach and sample size of 88 respondents from the study population was interviewed using a semi structured interview guide. Qualitative data were analyzed using content analysis, Quantitative data were entered into the statistical, package for social sciences (SPSS) version 24 and organized for statistical data analysis using descriptive statistics. The findings were summarized and presented using tables, figures and percentages. The result findings were that the members of the informal sector in Kibera view NHIF membership as essential and would recommend it to potential members. Majority of respondents are aware of 59 % of the NHIF benefit entitlements whereas 41% are not aware. Access of entitlements as a determinant of enrollment was assessed and it was found out that the distance to the accredited facilities was within World Health Organization recommendations and the benefit package was affordable and acceptable however 54% of the respondents stated that the benefits were not available at the chosen health care providers and thus affected utilization of these benefits and their satisfaction with the benefit package . The unmet demand of the benefit package therefore influenced the perception of NHIF and enrollment and retention of the informal sector.
Effects of co-payments on utilization of healthcare services at a private out-patient facility: a case study of AAR healthcare Kisumu Out-patient Centre
(Strathmore University, 2018) Gone, Michael
Rising cost of healthcare is a concern worldwide. In Kenya, this has seen insurance companies report losses despite increase in premiums. In order to control the rising costs, insurance companies have introduced co-payments on healthcare services with an aim of controlling utilization by limiting visits, costs, drugs and diagnostics. However, the effectiveness of co-payments in reducing utilization is still unclear, with some studies arguing that it has little or no effect. A retrospective cross- sectional study was carried out at AAR Healthcare Kisumu Outpatient Centre amongst AAR insurance patients seeking healthcare services at the facility. The study sought to determine if presence of a co-payment affects utilization and cost of various healthcare services. Data of approximately 3238 AAR insurance patient visits over a period of 6 months was obtained from the facility CIMS and ERPS systems. Descriptive analysis was done presenting counts (percentages), means (standard deviations) and medians (interquartile ranges (IQR)). Bivariate analysis tests for differences in the demographic and clinic costs 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 analyzed in terms of average cost per visit, number of laboratory tests done and number of drugs issued to clients with no co- payments, those paying Ksh. 50, those paying Ksh. 200 and those paying Ksh. 500 as co-payment. The study revealed no significant effect of a co-payment on the utilisation of healthcare services. There was no significant difference in the cost of a visit based on the co-payments status. The number of medication prescribed did not depend on the co-payment status. There was no significant difference in the laboratory tests ordered between those who had co-payment and those who did not have a co-payment; however there was a significant difference in the utilisation of laboratory tests based on the amount of co-payment paid, with the patient visits with a co-payment of Ksh. 50 having significantly less laboratory tests done. The results from the study can be used to inform policy on healthcare financing.
The Influence of human resource practices on performance of faith based health facilities in Kajiado County
(Strathmore University, 2018) Kiplangat, Maria Cherotich
The role of the Human Resource Management function in many health care facilities in Kenya is in disarray. The shortage of health workers reveals challenges with recruitment, training and workforce planning. Rural areas in Kenya are mainly occupied by people from low income backgrounds. It is challenging for such people to access mainstream healthcare facilities due to their low income. Some rural areas are very remote making it difficult for people within the areas to access healthcare facilities. In order to address the staffing gaps and ongoing workforce shortages in the health sector and faith based hospitals, there is need to deliberately focus on sound human resource practices as health workers are a key human resource required to save lives. Kajiado County has the highest number of faith based health facilities which are located in the remote areas of the County and mostly experience human resource challenges. This study sought to establish the influence of human resource practices on performance of faith based health facilities in Kajiado County. This research problem was studied through the use of a descriptive survey design. The target population of the study was 86 health workers in Five (5) Faith Based Health facilities in Kajiado County. Using Fischer formula, the study sampled 70 respondents who were used in the study. The questionnaire was selected instrument or tool for data collection for the study. The researcher used trained research assistants to administer the questionnaires to all the respondents of the study. Quantitative data collected was analysed by the use of descriptive statistics such as percentages, means, standard deviations and frequencies. Qualitative data or aspect of the data collected from the open-ended questions was analysed using SPSS while Regression analysis was used to determine the relationship between the study variable. The study established that recruitment and selection, staff training, staff reward management and career development positively influences the performance of faith based health facilities in Kajiado County. The study recommends the management of faith based health facilities should consider organizing for training and seminars for the employees as this will help to increase employee skills, loyalty and competence making them more willing to work harder for the success of the institution. The study also recommends that the management of faith based health facilities should consider instituting orientation programs during induction as this will help the new employees to learn on organizational policies, how the organization works thus speeding up the time it takes for them to become productive members of the organization. The study further recommends the faith based health facilities management to remain focused on developing the career path of its employees. This will boost the morale and ultimately the productivity of staff.
Factors contributing to overcrowding at the emergency department of the St. Francis community Hospital in Nairobi Kenya
(Strathmore University, 2018) Njogu, Mary Wanjiru
Emergency department (ED) overcrowding is a major barrier to safe and efficient health services delivery across hospitals. This study sought to identify and assess factors contributing to overcrowding at the ED of the St. Francis Community Hospital in Nairobi. The objectives were to describe the patterns of association between patients’ characteristics and overcrowding at the emergency department of the hospital, examine the institutional factors that contribute to overcrowding and determine the extent to which the hospital is complying with its own throughput target of four hours per client. A quantitative cross-sectional study was subsequently done with patients and staff over a two-week period. Data was collected using a questionnaire. Descriptive statistics were used to describe the association between patients’ characteristics and overcrowding. Non-parametric tests (factor analysis) were used to describe institution factors that contribute to overcrowding, with Wilcoxon rank test being used to check whether patients took the four-hour ED timeframe specified in the hospital charter. The IBM-SPSS Statistics software was used for analysis. The study found that different patient characteristics contributed to overcrowding at the ED. Patient factors included age, mode of arrival, level of education and gender. Institutional factors contributing to overcrowding included nursing staff shortage, excessive time spent at the laboratory, poor coordination of workers, and an overall lack of inpatient beds, admissions rooms, and other resources. The hospital was found not to comply with the four-hour per-client throughput target specified on the charter. The study showed that overcrowding is a multifaceted challenge caused by a combination of patient, policy, and institutional factors. Study findings will inform policy and practitioners on areas to focus on in trying to reduce ED overcrowding and improving patient flow and experience through the health system.
Effects of working environment on job satisfaction among physicians in Public Health Sector of Nairobi County
(Strathmore University, 2018) Bosire, Stellah Wairimu
Job satisfaction is the feeling of pleasure and achievement that one experiences in his/her job when they know that their work is worth doing; or the degree to which work gives feeling of pleasure. WHO refers to human resource for health as the engine that propels health systems. The presence of a highly skilled and motivated workforce is key to optimal health service delivery. While employees exist to achieve the goals of the organization, a dissatisfied employee is likely to leave the organization. The purpose of the study is to assess the effect of working environment on job satisfaction among physicians of Nairobi. The research questions that guided this study include; finding out the relationship between job satisfaction and training among physicians in public sector of Nairobi, the relationship between engagement and job satisfaction among physicians in public sector of Nairobi, the relationship between job security and job satisfaction among physicians in public sector of Nairobi and the relationship between physical working environment and job satisfaction among physicians in public sector of Nairobi. A descriptive research design was adopted, with physicians in Nairobi being the focus. The population of interest was the physicians in Nairobi. Data was analyzed using statistical methods that is, descriptive statistics describing the correlation using Pearson correlation. By researching the relationship between the working environment and job satisfaction, it becomes evident that the county of Nairobi it becomes evident that despite the multiple unrest in the health sector, very little has been done to understand what ails the human resource for health in Nairobi county. These research findings indicate that training, engagement, job security and the physical working environment have a positive correlation with job satisfaction. Further, the research reflects that although some efforts have been made to improve the working environment, there is dissatisfaction among the physicians in public sector of Nairobi who particularly ranked training as the most crucial factor that influenced job satisfaction.
Factors contributing to medication errors at the Kenyatta National Hospital
(Strathmore University, 2018) Kyalo-Ikol, Rhoda
Medication errors are among the most prevalent medical errors worldwide. The Institute of Medicine estimates 1.5 million preventable medication errors occur in the united states every year. Health care in Kenya has been largely susceptible to occurrences of medical mistakes and grave errors, some of which may have led to permanent disability and loss of life for the patients. 65% of medication errors detected had meaningful effect on patient’s health. Medication related deaths are estimated to be about 7000 each year. Failure to identify errors leads to repetition of mistakes and deteriorating patient safety in healthcare organizations. Although the error reporting system is the most commonly used method for identifying medication errors, there is significant under-reporting. This study aims to explain why under-reporting of medication errors happens and give recommendations on how there can be a shift of this practice so as to improve patient safety. This study sought to examine factors contributing to medication error reporting at the Kenyatta National Hospital’s Accident and Emergency department. The study design was cross sectional survey design. The study population included medical officers and nurses. A total of 110 staff were sampled for a self-administered questionnaire survey with a response rate of 96.4%. Survey questionnaire responses was analyzed using Statistical Package for Social Science (SPSS) version 20.0. The study found that both organizational factors and individual factors contribute to under reporting of medication errors. Fear of punishment and being labelled as incompetent influenced individuals decision on not reporting a medication error when it happened. Lack of a clearly defined institutional system for medication error reporting and poor feedback mechanisms also contributed to poor reporting of medical errors in the hospital. Further research should be conducted to assess medication iv error rates and severity of the problem in KNH. Data on medical error reporting in various public and private institutions should be assessed in order to give a more generalizable report on medical errors and patient safety in Kenya.
An Assessment of the implementation of the Free Maternal Services in Murang’a County Referral Hospital
(2018) Gikera, Leonard
This study aimed to establish the trends of utilization of FMS services at Murang’a County Referral Hospital between 2013 and 2017, to assess the readiness of the hospital to offer FMS and to explore the contextual factors affecting the implementation of FMS. The study adopted a mixed method design. Quantitative data on trends of the use of FMS was obtained from the hospital records. A checklist was used to assess the services availability and readiness, while a qualitative inquiry was done using semi-structured one-on-one interviews with key staff involved in the provision of maternal care at the health facilities. Quantitative data was analysed using SPSS while the qualitative data was analysed using a thematic framework analysis. There was demonstrated initial increase in utilization of skilled care in 2013 after elimination of user fees followed by decreased utilization in 2016 and 2017 which was attributed to unavailability of the services especially during the periods of industrial unrest by health workers and quality concerns. The outcomes however did not show significant improvement. The main challenges identified were inadequate and de-motivated health care workers, shortages of inputs like drugs and other health commodities, lack of continuous quality improvements structures, overcrowding due to inadequate physical facilities and uncompensated loss of revenue. The study recommends development of a robust and well-funded HR system at the county and facility levels. This will address recruitment, motivation, training and retention of health workers; Ring fencing health funds at the county level to ensure uninterrupted service provision; Upgrading of the physical infrastructure, especially the decongestion of the post-natal ward and establishment of an ICU; Strengthening the hospital and county Human Resource (HR) department; and Motivation of the healthcare workers through enhanced remuneration, provision of training and improved working conditions.
Bedside rationing by frontline healthcare workers: a case study of St.Francis community Hospital
(Strathmore University, 2018) Wanjiru, Grace
Studies on bedside rationing in developing countries such as Kenya are scanty. Bedside rationing entails implicit or explicit withholding of essential healthcare services from clients. The existing literature on bedside rationing in developed countries cannot be generalized to middle-income countries because of contextual differences. This study examined bedside rationing among frontline healthcare workers in St. Francis Community Hospital, which is a faith-based hospital located in Nairobi County off the main Thika High way 2 kms to Kasarani Mwiki Road in Kenya. The study used an explorative case study methodology and collected data using in-depth qualitative interviews. A purposive sample of 10 nurses was selected. A thematic analysis approach was used for data analysis. The study found that four forms of bedside rationing are practiced at St. Francis Community Hospital. The rationing includes deflection, deterrence, delay, and termination. Medical, patient, and hospital-related considerations determine the criteria used for bedside rationing. Additionally, factors affecting bedside rationing include unavailability, resource optimization policies, and skill empowerment at the management and operations levels. Bedside rationing was reported to compromise the quality of care provided at the hospital. Hiring more specialized doctors and nurses, providing extra beds, construction of new wards, new sources of funding, collaboration with medical training institutions and more support from the government to deal with negative effects of bedside rationing were reported as possible ways to reduce the negative effects of bedside rationing on care delivered. The study recommends development of new resource optimization guidelines consultation nurses. The hospital should undertake ethical rationing training to maintain quality of the care services. Financial partnership and liaising with the government for resource allocation will be imperative St. Francis Community Hospital offers complimentary services during strike. Future studies should focus on bedside rationing decisions among frontline healthcare workers in public hospitals and other faith-based hospitals.
The effect of hospital accreditation on the job satisfaction of nurses: a case study of Aga Khan University Hospital-Nairobi
(Strathmore University, 2018) Adhiambo Owino, Evangeline
Accreditation is an externally administered instrument to promote continuous quality improvement. In July 2013, Aga Khan University Hospital (AKUH)-Nairobi was accredited by the Joint Commission International (JCI). It became the first hospital in East Africa to receive this accreditation. The JCI accreditation process is both time consuming and resource intensive. It brings about various organisational and job-related changes, which ultimately affect the workload and quality of work life of staff. This study sought to assess the effect that accreditation has had on the job satisfaction of nurses working at AKUH. This was a cross-sectional mixed methods study, combining quantitative and qualitative approaches. It was a case study of nurses working in the maternity department of AKUH. Quantitative data was collected through a questionnaire survey. Two focus group discussions were also conducted for the qualitative component. Thematic content analysis was used to analyse qualitative data, while descriptive statistics was used for quantitative data. This study established that hospital accreditation brings about both positive and negative changes to the work environment. 76% of participants agreed that the department became better equipped after accreditation. Teamwork was also seen to have improved since accreditation. However, staffing levels were seen to be inadequate which resulted in heavier workloads and overtime work as accreditation came with extra demands for staff including compulsory documentation. Another important aspect of accreditation was JCI surveys which are mandatory. These were seen to cause high levels of stress. The nurses also noted that they are not really involved in decisions affecting their work since accreditation. Accreditation resulted in feelings of pride and achievement. However nurses lacked recognition and advancement opportunities. Overall, most nurses were proud to work in an accredited hospital but job satisfaction was low with 74% of respondents saying that they were not satisfied with their jobs.
Assessing out of pocket costs and the incidence of catastrophic expenditures among chronic disease households in Kenya
(Strathmore University, 2018) Ngolo, Julian
Universal Health Coverage (UHC) is among the global goals pursued by the Kenyan government. Currently, the country faces the burden of communicable diseases, chronic diseases and non-communicable diseases. To develop policies that ensure access to needed healthcare services and financial protection for all, examining out of pocket costs and the incidence of catastrophic health expenditures among households with chronic disease in Kenya is an important research and policy question. Descriptive analysis was done on secondary data from Kenya Household Expenditure and Utilization Survey (KHHEUS), 2013 consisting of 33,675 households. Out of these households, 8284 households reported having at least one member with a chronic disease. Catastrophic health expenditures was examined by obtaining the proportion of households that incurred out of pocket expenditures that exceeded 40% of a households’ non-food expenditure. The incidence of catastrophic health expenditures among chronic disease households was 8.1% and this increased to 13.5% when transport costs were considered. In addition, payments for outpatient services was the greatest driver of total out of pocket costs among chronic disease households and payment for drugs took the largest share of these costs. Variations in out of pocket costs incurred were noted with the richest quintiles and urban households incurring highest direct healthcare costs while the poorest quintiles and rural households incurred highest costs on transport. These results are important in policy making and designing health financing schemes
Factors influencing employee retention at M.P. Shah hospital in Nairobi, Kenya
(Strathmore University, 2018) Apinde, Austin
A key challenge towards achieving the Sustainable Development Goals (SDGs) in healthcare in Kenya is the low number of a properly trained and motivated health workforce. The ratio of health worker to population served remains disappointingly low, while at the same time there remains a huge challenge of retaining the limited number of health workers at the hospitals. This is a challenge that afflicts both the public and private hospitals in Kenya as many health workers leave their organizations to seek work elsewhere. Private hospitals are an integral pillar of the Kenyan health system and so the stakeholders need to develop employee retention strategies that will enable them to hold on to their health workers in this dynamic healthcare industry. This research aimed to extensively examine the factors that influence employee retention at a large private hospital in Kenya, with a case for M.P. Shah Hospital. The study explored the extent to which the known factors of employee motivation, work environment and training and development influenced employee retention at M.P. Shah Hospital.
Using Health Management and Information Systems for decision making: an exploratory study in private sector level 3 & 4 health centres in Narok
(Strathmore University, 2018) Cheruiyot, Daniel
In the recent past there has been a rapid uptake in the deployment and use of HMIS by private facilities in Kenya. It is unclear how private sector managers have implemented these systems and whether they are using these systems to provide the information to make important strategic decisions vs. other sources of information and to what extent. Our objective is to explore the use of the information generated by these systems in the strategic decision making process to inform if managers of private sector facilities are reaping the expected benefits. Through an exploratory qualitative research design using semi-structured interviews, the perceptions of the facility managers on HMIS were explored. A total of 6 respondents were purposively sampled. Data was transcribed, themes explored, and analyzed in a thematic analysis approach. The results from this study indicate that most private level 3 and 4 facilities have in place HMIS systems that are comprehensive in their coverage of facility operations. The findings from this study also indicate that managers did not seem to consider HMIS as an essential tool in the decision making process in their organizations. The use of information in the decision making process was affected by the quality of the HMIS system, Low information quality due to insufficient training and lack of information policies, access and usability of their HMIS, user satisfaction and organizational processes.
Assessing factors influencing the uptake of the health insurance subsidy program: a case of Turkana Central Sub county in Kenya
(Strathmore University, 2018) Lolos, Nelson Lodiita
The attainment of universal health coverage is a top global priority as advanced by WHO and member countries, including Kenya. Social health insurance schemes, like the Health Insurance Subsidy for the Poor serve as one of the means to achieve the UHC challenges of access to care, equity and affordability of services.The purpose of this study was to assess effectiveness of such SHI programmes in improving satisfaction, access and utilization of healthcare among the beneficiaries in Turkana central sub-County. The target respondents were beneficiaries of this programme (household heads), managers of implementing programme (NHIF, County health department, social services and children’s departments). This was a descriptive, cross-sectional case study that used mixed (both qualitative and quantitative) methodology for data collection. The sample size was 140 respondents randomly selected from the sampling frame while the key informants were purposively selected. Semi-structured questionnaire, focus group discussion (FGD) and in-depth interview (IDI) guides were used to collect data. STATA (version 15) statistical software was used to analyse the quantitative data. Qualitative data from IDIs and FGDs were coded and categorized into profiles, themes, topics or incidents as appropriate. Content analysis was done using conceptual approaches including grounded theory approach and framework approach. The findings indicate that the utilization rate of health facilities was at 0.3 visits per capita per year. Only about 18% of household members reported illness in the preceding 4 weeks, and of those, 83% sought care from health facilities. The most accessed service was outpatient. About 54% of members of households reported being sick in the preceding 4 weeks but did not seek care. Reasons given for not seeking care included OOP hidden costs, self-medication, long distances to providers, etc. Majority of respondents rated the HISP as good (3.4 points out of 5) but had concerns about quality of care, availability of services and health workers’ attitudes.This study recommends continuous awareness creation, advocacy, communication and social mobilization of beneficiaries. It further recommends that health providers improve quality and availability of services. The study also recommends policy shift on health financing, increase in allocation of resources to health financing and social protection programmes as well as better coordination.
Role of career development on performance of medical officers in County Governments: a case study of Murang’a County
(Strathmore University, 2018) Nduati, Robbinson T.
The human resource crisis in the health sector in low and middle-income countries (LMICs) is receiving increased global attention. African public health care systems suffer from significant “brain drain” of its health care professionals and knowledge as health workers migrate to wealthier countries. The “push” factors include a lack of better working conditions including promotion opportunities and career advancement. Following devolution of Health and Human Resource Management (HRM) to the County Governments, as per the new 2010 Kenya Constitution, the human resource crisis has become more evident. Policymakers and planners are realizing that it is simply not possible to achieve health development goals if health workers’ availability and performance are not addressed more effectively. This study sought to determine the role of career development on performance of medical officers and to improve their performance through effective and practical HRM interventions. The study was conducted in the main Sub County Hospitals and the County Referral Hospital in Murang’a County. Data analysis was carried out using SPSS (version 23). Basic descriptive statistics was done. The data was then analyzed through percentages, frequencies, mean and standard deviation and the findings presented in tables, graphs and narratives.The various aspects of career development explored in this study (career planning, career coaching, career mentoring, and empowerment) were generally found to be important to the participants in relation to their work decisions and job stability with empowerment being moderately practiced. However, these career development aspects did not significantly influence the performance of the medical officers as per the 2016-2017 Performance Appraisal results in Murang’a County.
Reimbursement practices and budgetary implications in the implementation of waivers and maternity care exemption policy in a Sub-County referral Hospital
(Strathmore University, 2018) Kinyanjui, Joan Njeri
The waiver and free maternity policies play a major role in enhancing equity and access to health care services among the poor and the pregnant mothers respectively. However, for the policies to be successful, there is need for regular and sustainable reimbursement practices to cater for the loss of the user fees exempted or waived. Lack of reliable reimbursement practices have huge budgetary implications on hospital management and results to hospitals adopting to coping mechanisms that are dysfunctional to the public health system. A mixed methodology was carried out qualitatively amongst five key respondents directly involved in the implementation process of both waiver and free maternity policy and quantitatively to obtain data on reimbursement practices of both waivers (23) and maternity services exemptions (1,151) within the study period. The data was analyzed through content analysis for qualitative data and descriptive analysis for quantitative data. The study revealed that the implementation status of waivers and exemptions faces financial challenges at the hospital studied. The waiver policy was neither funded nor budgeted for resulting to the facility issuing waivers to approximately 10% of eligible patients. The exemption policy for maternal care received irregular reimbursements which caused inefficiencies in the facility including shortage of drugs and consumables, late payments of utility bills, huge debts with suppliers, budgetary deficits, and decreased available revenue for hiring more staff to cater for increased service utilization. The employees cited demotivation and dissatisfaction due to the increased workload and lack of a compensation mechanism. The annual costs of waivers and exemptions relative to the reimbursement rate was very high and if this is not reevaluated, it would cripple the financial status of the hospital. The hospital had no sustainable coping mechanism besides operating on huge debts and cutting costs while allocating resources. In conclusion, irregular reimbursement of exemptions or lack of them in waivers have huge budgetary implications that have contributed to a dysfunctional public health care facility.
Factors associated with delay in presentation of Cancer patients for treatment: a patients’ perspective
(Strathmore University, 2018) Kabura, Njambi Ann
The global burden and threat of non-communicable diseases constitute one of the major challenges for development in the twenty-first century which undermines social and economic development throughout the world. A huge proportion of deaths due to non-communicable diseases, including cancer, occur in the low and middle income countries. Cancer is among the top five causes of mortality in Kenya. Its estimated annual incidence is close to 37000 and unfortunately close to 80% of the patients is diagnosed at an advanced stage. The economic impact of cancer is felt at an individual and most importantly a population level. Shortening the interval between onset of symptoms and initiation of treatment would greatly improve patient outcomes and also reduce the cost of more aggressive treatment. Understanding the pathways to care is critical for interventions to be made in a timely manner. An assessment of patients‟ perspectives guides strategic decision making to meet expectations and effectively manage health care performance. The main aim of this study was to identify the factors associated with late cancer diagnosis among patients presenting for treatment at Kenyatta National Hospital. A descriptive cross-sectional design was used for this study. The study was undertaken at Kenyatta National Hospital‟s Cancer Treatment Center. Standardized questionnaires were administered to all eligible and consenting patients with either stage three or four of cancer presenting for treatment at the cancer treatment center. Patients‟ records were also reviewed to ascertain the diagnosis, stage and type of cancer. The data collected was summarized and analyzed using Microsoft Excel and MINITAB 14. Female respondents were more than the male respondents. The mean age of the respondents was 49 years; 87% of the respondents were below 65 years old. 71% had attained only primary education, 10% had attained tertiary education. Most of the respondents (74%) resided in rural areas and 84% of them were in the informal sector. 87% had no pre-existing illnesses and only 23% were smokers. 65% of them had no prior knowledge on cancer, 71% were unaware of measures to reduce the risk of cancer and only 19% had been previously screened for cancer. 78% of the participants had experienced their symptoms for more than 6 months before the diagnosis of cancer was made. 58% of the participants initially sought help for their symptoms in private hospitals and 45% had their diagnosis made in private hospitals. 55% had their diagnosis made in secondary and tertiary public hospitals. 61% waited for more than 6 months before iv getting their diagnosis of cancer and a similar proportion had to wait for more than 3 months before initiation of treatment. Long waiting time for specialized treatment was identified as the main reason for delay. The findings of this study corroborate those of other similar studies. The success of any cancer control programs will require well-coordinated demand-side and supply-side efforts to address the barriers to early detection and treatment of cancer.
Examining the effects of incentive structures on the work of community health volunteers in Kwale County
(Strathmore University, 2018) Zecha, Noreen Nadzuwa
The Community Health Strategy (CHS) is an approach that aims to improve the health status of communities through initiation and implementation of health actions at household and community levels. CHS is a highly effective way of changing healthcare practices and care-seeking behavior. However, implementation of the strategy remains patchy, mostly due to challenges of retaining community health Volunteers (CHVs). Kwale, like other Kenyan counties, continues to grapple with CHV challenges. This study sought to examine factors that CHVs consider most important in incentivizing them to do their work in Kwale County. The study used a mixed methods approach. The study population were 402 CHVs in Kwale. Random sampling was used to select 197 respondents, and a questionnaire administered to collect quantitative data, which was subsequently analyzed using SPSS (Version, 23). An interview topic guide was used to collect qualitative data, and content analysis done. The study found that socio-demographic characteristics and incentives the CHVs considered most important influenced their work. Key incentives that CHVs identified as important included wages and working conditions, performance-linked payments, career and professional development, workload management, flexible working arrangements and positive working environments, training and supervision positively affected the performance of CHVs, the community factors which influence Performance of CHV include norms traditions, beliefs and security, the community appreciated the CHVs and community factors which influence Performance included norms traditions, beliefs and security. The study recommends that the County explore sustainable financial and non-financial incentives for CHVs. These may include allowances, cost reimbursement (transport), exchange tours, badges, recommendations letters, and certificates of recognition. There is a need for production and dissemination of key health information regarding the Community health strategy and targeting high impact interventions. These should include effective communication mechanisms through radios, television.

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