MBA-HCM Theses and Dissertations

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A Descriptive study on nutrition knowledge and dietary practices among adults with Type 2 Diabetes Mellitus and Hypertension at Kitale County Referral Hospital
(Strathmore University, 2023) Kiarie, R. W.
Non-communicable diseases (NCDs) are the leading global cause of death, with most of these deaths occurring in low to middle- income countries (LMICs). Hypertension and diabetes are two of the four major NCDs, and they are often comorbidities, meaning that they occur at the same time. Morbidity and mortality is usually a result of long-term complications, and apart from medical therapy, these can be prevented by lifestyle interventions that include dietary modifications. This study sought to describe the nutrition knowledge and dietary practices of patients with type 2 diabetes and hypertension. The focus was on patients receiving care at the Kitale County Referral Hospital in Trans Nzoia County, and the study objectives were to (i) assess patients’ knowledge of dietary influence on diabetes and hypertension, (ii) assess sociocultural influences on patients’ dietary practices, (iii) assess patients’ willingness to change their dietary practices, and (iv) assess patient’s awareness of their dietary practices. The study was supported by the Social Cognitive Theory, which is premised upon the reciprocal interaction between individual, behavioural and environmental factors. These factors interact to formulate the control that an individual has over their illness, thereby influencing their motivation to perform self-care activities. This descriptive cross-sectional study utilized quantitative techniques by use of structured questionnaires as the main data collection instrument, in a target population of 973 and a sample size of 283 respondents. Data analysis was carried out using SPSS software, quantitative techniques were used to analyze the data, and descriptive techniques were applied to analyse the characteristics of the respondents. The following conclusions were made from the results: that majority of the participants understood the role of diet in the management of these two conditions; that some cultural practices posed a challenge to some participants, and that they had the family, spousal and social support they needed; that participants were willing to change their dietary practices and adhere to the recommended diet regimens; that most participants had received adequate nutrition education and counselling, however eating balanced diets was a challenge, they were not able to find all the foods they had been advised to eat, and they had to think about the cost of buying these foods. The study recommends sustained efforts in patient education, inclusion of experiential learning through the use of a hospital kitchen in order to contextualize use of locally available foods, and strategies to combat food insecurity especially among the ageing population in the county.
A Hospital-based study on the application of blockchain technology on data sharing in oncology treatment and value-based care in Nairobi County, Kenya
(Strathmore University, 2023) Saini, B. V.
This study deals with the Blockchain Technology (BcT) application for decentralizing Electronic Health Records (EHRs) data to store patient information, including medical reports, to ensure improved patient care. EHRs are entirely controlled by hospitals instead of patients, which makes it more difficult for patients to seek medical care from other providers using their historical data. Patients are the data subjects and the primary owners of the data; therefore, they should have more say and checks on balances on the providers in how their data is being shared and used. The existing system of storing patient details depends on the organization's servers, thus the need for Blockchain using multi-cloud integration to achieve data interoperability. This study will adopt a quantitative research design whereby Blockchain will design an experiment to establish the relationship between patient perspective, level of trust, and transparency in data sharing for oncology patients and value-based care through processing and analyzing the quantitative data from the private cancer center. This study will adopt a quantitative with various stakeholders in Oncology in Kenya. It will also undertake surveys through questionnaires with the chief oncologist, chief medical officer, nurse manager, lab technician, researchers, and IT personnel. The results showed that blockchain technology has the potential to transform the way health records and data are kept and used to treat and care for oncology patients. By combining and integrating data from various sources, healthcare organizations can enhance value-based care, prioritizing patient outcomes and using data to drive decision-making. Furthermore, evidence-based decision-making by extracting data insights is important for designing data-driven healthcare systems. This study provides valuable insights for healthcare policymakers, providers, and researchers in Kenya and beyond. By prioritizing patient outcomes, evidence-based decision-making, and data protection, healthcare organizations can improve the quality of care they provide and, ultimately, the health outcomes of their patients. Furthermore, by leveraging blockchain technology and other innovative solutions, healthcare providers can improve their services' efficiency, effectiveness, and sustainability.
A Study of extrinsic and intrinsic factors influencing the job motivation of public sector health care workers in Nakuru County
(Strathmore University, 2021) Githatu, Grace Watiri
Diverse factors provide indicators of job motivation challenges amongst the healthcare workers. These factors include the high level of employee turnover. For example, in 2017, an estimated 700 doctors quit employment from government run hospitals Graham, 2018). Additionally, the Kenya Medical practitioners and Dentist Union (KMPDU) estimated that up to 2,300 doctors had left devolved sector employment between 2014 and 2016 for private sector engagement or further education abroad. Moreover, the various groups of the healthcare workers including doctors, nurses, and clinical officers have held numerous industrial strikes against their employer. Consequently, this study seeks to sh1dy the factors influencing the job motivation in the healthcare public sector. The study is based on Herzberg's 2-factor themy that splits factors affecting employee job motivation as extrinsic and motivating factors. The study used a descriptive research design and the target population was health workers in Nakuru County Public health facilities including doctors, clinical officers, laboratory technicians, pharmacists and nurses. The study population was 1756 respondents. The sample size of this study, using Taro Yamane's (1967) formula, was 326 respondents. The correlation between diverse factors and job motivation were examined. The study found a strong positive correlation between extrinsic factors and job motivation (r=0.633, p value =0.000). The study further found that there was a positive and statistically significant correlation between intrinsic factors and job motivation (r=0.795, p value =0.000). The regression analysis results revealed that a unit increase in extrinsic factors is associated with 0.318 increases in the job motivation levels with intrinsic factors kept constant. On the other hand, a unit increase in the intrinsic factors is associated with 0.596 increases in the job motivation levels with extrinsic factors kept constant. The study thus recommends that the intrinsic factors such be considered and factored within the instih1tions in order to improve on the job motivation levels. The intrinsic factors that had the lowest scores were salary paid being compensate with work done, dates of salary payments, salary increments levels, salary being competitive for tasks undertaken, supportive work environment for work station, and supervisor fairness levels.
An Assessment of the purchasing arrangements of an employer in-house managed scheme: a case study of AAR Healthcare
(Strathmore University, 2019) Mwaura, Njeri Lilian
Kenya has made a commitment to achieve Universal Health Coverage (UHC) by 2022. The country is undertaking health financing reforms that will set it on the path to achieving this goal. While health financing reforms have typically focused on the resource generation and pooling function of the health system, there is increasing recognition of the importance of the purchasing function of the health financing system. Purchasing refers to the transfer of pooled funds to healthcare providers in exchange for healthcare services provided to citizens. Purchasing could either be passive, which means merely paying bills, or strategic, which means structured to enhance the health system goals of equity, efficiency, and quality. Healthcare purchasing in Kenya is carried out by 5 main entities namely 1) the national hospital insurance fund (NHIF), 2) the county health systems 3) private health insurance 4) community-based health insurance schemes, and 5) employer in-house medical schemes. Previous studies done in Kenya has assessed the purchasing arrangements of the first 4. There is however not study that has examined the purchasing arrangements of employer in-house medical schemes. To fill this knowledge gap, this proposed study examined the purchasing arrangements of employer in house schemes in Kenya. Specifically, the study used a qualitative case study approach to examine the extent to which the purchasing arrangements of the AAR in-house medical scheme are strategic. This study employed the conceptual framework developed by the Resilient and Responsive Health Systems (RESYST) consortium to examine the purchasing actions of the AAR medical scheme across the three purchasing relationships, namely purchaser-government, purchasing-providers, and purchasing-citizens. Data was collected through a combination of in depth interviews and document reviews Respondents for the in-depth interviews were selected purposively to get individuals with in-depth knowledge of scheme. Relevant documents that contain information on the scheme were also obtained and analysed. Qualitative data was audio recorded, transcribed, importeded to NVIVO software, and analysed using a thematic approach. It was evidenced, by the findings put forward in this section that the purchasing mechanism in AAR Healthcare is passive as characterized by arbitrary fun allocation to the in-house scheme and nominal sourcing of providers. There was no evidence of strategic purchasing with regard to the acquisition or distribution of financing in the service provision process. The process was however deemed effective by all users. With regard to the second objective, it was evident that AAR Healthcare did not feature a specific purchasing entity as the purchasing functions were distributed between the HR, Procurement and Finance department. This therefore rendered the relationship between the purchaser and the other entities- citizens (employees), government and providers- as fragmented and uncharacterized; the system was essentially run as in-house health benefit scheme with the exception of contracted services given that the organization provided health services, such services were mainly sought in-house as opposed to through contracts with other providers. The main recommendation forthcoming from this study is that AAR Healthcare should consider a switch to strategic purchasing in effecting its healthcare provision function to employees. In achieving these, it will be necessary to first and foremost institute a designated purchaser for the fund; one that would be charged with orchestrating all functions involved with other actors in the purchasing function. Findings from this study can also be used to prescribe possible purchasing arrangements for employer managed schemes.
An Examination of the factors influencing the mode of child delivery in Nairobi County
(Strathmore University, 2021) Karori, Catherine
Kenya has a female population of approximately 25.8 million people according to the World Bank 2018 data (50.32% of the total population). Of these, 25.4% are of childbearing age between ages 15 to 49 (6.5 million). During childbirth, the women deliver at various healthcare facilities including at home, and undergo two main types of delivery: vaginal birth (normal delivery) or cesarean section (C-section) delivery. The recommended form of child delivery is a normal delivery. World Health Organization (WHO) recommends that C-section surgeries be carried out only when medically necessary. The international healthcare community recommends a C-section rate of I 0 - 15%. There continues to be growing global concern however about the increased rate of C-section deliveries. This research sought to study the growing trend of C-section rates using a study of Nairobi County in Kenya with a specific focus on examining the factors influencing the mode of child delivery. The study obtained data from several health facilities in Nairobi County. The data relates to the records of patients for the last thirty-six (36) months who have delivered by way of normal delivery or C-section and the classification of the patients by some of the key influencing factors for example the pre-payment mechanisms which include National Hospital Insurance Fund (NHIF), private health insurance and others. This was supported by questionnaires aimed at obtaining information on another key factor influencing the mode of child delivery being the characteristics of the women who opt for different modes of delivery namely normal delivery and C-section. The study aimed to provide recommendations on how best practices identified locally and globally can be implemented by the various stakeholders to achieve long-term sustainable models in healthcare while ensuring quality, accessible, and cost-effective healthcare services. In addition, the study sought to reinforce that sections be carried out only when medically necessary in the best interest of the maternal health practice and the various stakeholders. The findings indicated that there was a significantly positive correlation between key influencing factors like prepayment mechanisms and medical personnel on the mode of child delivery. The coefficient results pointed to a significant relation of medical personnel to the mode of child delivery. The independent T-test results indicated that there was a significant mean difference between the amount paid through cash and insurance. The study concluded that prepayment mechanisms and medical personnel have a statistically significant relationship with the mode of child delivery. However, when combined with other variables, prepayment mechanisms did not have a significant predictive ability to influence the mode of child delivery. In addition, the study concluded that in terms of financial implications, women who opted for prepayment mechanisms such as NHIF, corporate insurance, or private personal insurance were likely to pay more compared to those who opted for cash payment. The study recommended that the prepayment mechanisms, as a key influencing factor, enforce policies and guidelines including strategic purchasing models with healthcare service providers including medical doctors, and define acceptable levels of C-section deliveries.
An Investigation of factors influencing retention of doctors in Machakos County: a case of Machakos level 5 hospital
(Strathmore University, 2018) Kipkore, Sheila Jepkoech
Human resources in the health sector comprise a fundamental element in the delivery of health services and the achievement of Sustainable Development Goals (SDGs) globally. The escalating shortage of health personnel in Kenya has become critical concern that needs to be addressed as an integral strategy of improving the health systems (Miseda, Were, Mmianki, Mutuku, & Mutwiwa, 2017). The aim of this study is to investigate the factors such as job satisfaction; career progression and leadership style and how they affect retention of doctors in Machakos County. The study employed a survey research design and data was collected using structured questionnaires. The Quantitative data was assessed using descriptive statistics like frequency and percentages. The target population of the study was 54 doctors and 78% of them participated in the survey. The findings from the survey shows that doctors job satisfaction is affected by different factors that include high workload, poor stock of drugs and lack of recognition by management. On career progression the survey revealed that training did not follow the policy criteria, it was irregular and not supported financially by the management. Promotions were opportunities were unequal, irregular and not based on merit. The leadership style been practiced was the task-oriented leadership. From the findings of the study, it can be concluded that, retention is very important among the medical professionals therefore the hospital management and MOH should formulate retention strategies.
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.
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.
Assessing employee retention strategies at AAR Healthcare Limited Kenya
(Strathmore University, 2020) Khalibwa, Irene
Organizations are facing the hurdles of retaining their most valued employees with the current cutting competition among companies to have team of high performing workers. Studies have shown that the healthcare industry has very high staff turn-over with doctors who are key drivers of the healthcare industry having an average of 3 years’ length of stay in one particular employer. Some health facilities such as AAR however buck this trend. AAR Healthcare is one of the Tier 1 leading private healthcare services provider in Kenya with comparably high employee retention rate. This study assesses various employee retention strategies applied by AAR Healthcare Kenya. The study specifically investigates how work environment, training and development, recognition and compensation and leadership and management of employee strategies have been applied at AAR Healthcare Kenya and their effectiveness. The research applied a quantitative cross-sectional design approach. A multi-stage convenient sampling technique was adopted to select research respondents from the 21 branches and the headquarters with a total population of 343 employees. The findings of study showed that there was a relationship between employee retention and work environment safety, organization culture, leadership management style and reward recognition, all at 10% significance level. Conversely, the number of trainings did not have a statistically significant relationship with employee retention. Additionally, the study found that the employees were happy with the strategies employed to provide a good working environment and also with the organization culture. However, when it came to the reward and recognition and the leadership and management styles, there was room for improvement based on the responses. The study recommends that healthcare practitioners look into their strategies on these key areas the study focused on and especially, in reward and recognition and leadership and management style as this will further increase their chances of retaining their work force. Additionally, this study serves as a benchmark for policy makers on what can be done to help formulate strategies based on retention and offer guidance on what to do to increase employee retention for organizations .
Assessing factors influencing interprofessional collaboration amongst clinicians in outpatient care level four hospitals in Nairobi County: a qualitative study
(Strathmore University, 2022) Nta, Brigid
Effective interprofessional collaboration in healthcare is crucial for delivering high-quality care in the context of the increasing burden on outpatient healthcare services. However, there is inadequate understanding of the existing interprofessional collaboration and the factors that influence its effectiveness amongst clinicians – physicians, clinical officers, nurses, pharmacists and laboratory personnel in the provision of outpatient healthcare services. This study aimed to identify the factors that affect interprofessional collaboration amongst clinicians in public, private and faith-based level 4 outpatient care. The study was guided by the following objectives: a) To explore the clinicians’ perceived role of leadership and management on interprofessional collaboration in the provision of outpatient care services in level 4 hospitals in Nairobi Kenya. b) To explore the effects of communication in interprofessional collaboration amongst clinicians in the provision of outpatient care services in level 4 hospital in Nairobi Kenya. c) To explore the effect of availability of resources on interprofessional collaboration amongst clinicians in the provision of outpatient care services in level 4 hospitals in Nairobi Kenya. d) To explore the extent to which healthcare workers’ skills, training, and development affect interprofessional collaboration of clinicians in the provision of outpatient care services in level 4 hospitals in Nairobi Kenya. This study focused on one private hospital, one public hospital, and one faith-based hospital. A qualitative approach and open-ended interview were used to collect data from the clinicians. Purposive sampling technique was used to sample the public, private and faith-based outpatient healthcare facilities and the clinicians. Data was analysed using thematic analysis. The study showed that the clinicians had knowledge about interprofessional collaboration. It also revealed that private and faith-based hospitals had leadership which supported and encouraged interprofessional collaboration unlike the public that respondents thought management needed to improve. All the participants in the facilities suggested interprofessional education on collaboration should be encouraged as this will foster better collaboration among clinicians, better relationships, enhanced team work and encourage shared knowledge. The study recommends utilisation of a functional ICT system to help in facilitating communication amongst clinicians, security and follow up for patient’s information and continuity of care. The study also recommends interprofessional education for clinicians as part of their training.
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.
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
Assessing patients’ satisfaction with universal health coverage reforms using servqual model: a case of Matuu Sub County Hospital, Machakos County
(Strathmore University, 2021) Nzomo, Benjamin Masila
Kenya’s quest to be among nations worldwide providing Universal Health Coverage (UHC) to their populations took off in earnest in December 2018 with the roll out of a pilot study in four Counties namely Isiolo, Kisumu, Nyeri and Machakos. Quality health care services offered in a health facility as postulated by patient satisfaction is one of the cornerstones of UHC. Some studies have shown that as financial barrier to access of health care is lifted and service coverage increases, service quality often plummets in terms of safety, timeliness, efficiency, effectiveness and patient-centeredness due to overutilization and deficient governance structures among others. Empirical evidence of this in Sub Saharan Africa is however rather thin especially the shift in patient’s expectations and perceptions of service quality in the early phase (first five years) of UHC implementation. This study addressed this gap by evaluating patient’s satisfaction of services offered at a public sub-national level 4 health facility in Kenya three years after UHC roll out. Using a descriptive cross sectional study design, a sample of 311 patients was randomly selected to fill a SERVQUAL questionnaire to record their pre-service expectations and post service consumption perceptions of the services given since UHC commencement. Perception-expectation (P-E) gap scores were then analyzed using Statistical Package for Social Science (SPSS Version 25) to determine the statistical significance of the mean differences between patients’ expectations and perception of the five dimensions surveyed. The study findings showed a statistically significant overall patients’ satisfaction with UHC reforms in Matuu Sub County hospital. Patients were most satisfied with assurance; followed by empathy, reliability, tangibles and finally responsiveness. However, notable areas of dissatisfaction included the long turn-around time, staff’s inability to effectively communicate on when services will be offered and the uncaring attitude of the healthcare workers.
Assessing pharmaceutical commodity supply chain management challenges in Busia County
(Strathmore University, 2018) Apinde, Suco Sharon
Pharmaceuticals together with salaries consume 60-80% of the health budgets of most counties in Kenya, therefore improving performance of the pharmaceutical commodity supply chain is one of the key activities aimed at improving health systems in Kenya. An efficient supply chain system reduces wastage and ensures availability of and accessibility to essential medicines, namely the right product in the right quality, in the right condition, at the right place, at the right time and at the right cost (the six rights of logistics). The purpose of this study was to evaluate the pharmaceutical commodities supply chain management challenges that health care workers of Busia County encounter while delivering services to the population and use the information to suggest improvements on the pharmaceutical supply chain performance. The study objectives were a) to determine how effective the Logistics Management Information System in Busia county is in serving her population needs b) to determine if funds allocated for procurement of medicines are efficiently utilized and c) to determine whether the staff using the pharmaceutical Logistics Management Information System and others in the supply management system are well trained on supply chain management and are of the right number. The study sites for this research were five facilities in each of the seven sub-counties in Busia County, whereby a sub-county hospital, a high volume health centre, a high volume and a low volume dispensary as well as one faith-based dispensary were targeted for this study. Main areas of research were the health facility pharmacy department, the comprehensive care clinic pharmacy, the pharmacy and county stores respectively. Cross-sectional descriptive study design was used. Instruments used were structured questionnaires, always, better and control analysis and also vital, essential and non-essential analysis respectively. The main findings were that most of the facilities experienced long lead time and delays in delivery of essential supplies, funds for procurement of medicines were well utilized but facility staffing levels were inadequate. The recommendations from this study are that, a) the county government should employ and train more health workers to support pharmaceutical commodity supply chain management b) the County Government should adopt efficient and effective supply chain management system, the Logistics Management Information System, so as to minimize waste and inefficiencies of county procured pharmaceutical commodities.
Assessing quality of primary healthcare services for the elderly in Kiambu County, Kenya
(Strathmore University, 2023) Mbiyu, J. W.
Old age increases the risk of non-communicable diseases and other degenerative diseases. This trend is evident in many parts of the world including sub-Saharan African (SSA) countries such as Kenya. To adequately prepare and respond to the healthcare needs of the elderly in SSA, there is need for more research to generate information on health sys-tem challenges regarding provision of quality healthcare to the elderly in SSA. The objective of the study was to assess the quality of primary healthcare services for the el-derly in Kiambu County, Kenya. The County has the highest number of elderly persons (5% of the population) out of the 47 Counties in Kenya (KNBS 2019). The study popula-tion was the elderly people (defined as anyone aged 60 years and above) visiting the selected health facilities in Kiambu County. The study used a qualitative cross-sectional design, with purposeful sampling in which a semi-structured interview guide was used to capture information from the participants regarding the following aspects of quality of care: structure, process, and outcome. A total of seventy-two participants (24 males and 48 females, age range 60 – 86 years) were recruited from14 primary healthcare centres between the month of February and March 2023. Data analysis involved transcribing the data from the interviews held, followed by statistical analysis using the NVIVO. Results showed that lack of medication, referral for laboratory services, waiting time and short-age of healthcare workers (HCWs) were some of the challenges affecting the quality of healthcare for the elderly in Kiambu County. Additionally, interpersonal relationships with the healthcare providers which are all linked to quality of healthcare services for the elderly were found to be important for a positive experience for the elderly during the treatment process. The study also demonstrated that the access to care by the elderly de-pends on their satisfaction with the services provided by the healthcare facility and the health care provider. Key recommendations include: Kiambu County to address the is-sues of lack of drugs in the health facilities and especially those that relate to care for the elderly e.g. the non-communicable diseases medication, HCW training on social inclu-sion and re-designing of the health facilities to be disability friendly, HCW worker shortage to be addressed, In conclusion, the results of this study can be used to improve quality of healthcare for the elderly in other settings, depending on the context under which such services are being provided.
Assessing service availability before and after the introduction of free maternity services at the Pumwani maternity Hospital
(Strathmore University, 2018) Kavindu, Edna Mwende
Maternal health is the state of health of women during pregnancy, childbirth and the postpartum period. The Kenyan government introduced free maternal healthcare services in June 2013 to address the high maternal mortality rates that stood at 362 per 100000 live births in 2016. Maternal Mortality rate in Nairobi County was estimated to be at 57.1 per 100000 live births as of 2014. The study aimed at contributing towards strengthening maternity services by assessing the availability of maternity services before and after the introduction of the free maternity services policy at the Pumwani Maternity Hospital. This was a mixed method study; quantitative study (data from existing records) employing longitudinal study design and qualitative study where in depth interviews were conducted on six respondents using topic guides. This was simple and allowed evaluation of variables that change before and after interventions. The study was conducted in the month of February 2018 and was for the periods 2009 to 2017. The implementation of the free maternity services resulted to a 1974.75 mean increase in admissions, 1840.42 mean increase in total deliveries of which 1358.50 was increase in normal deliveries and 478.50 caesarian deliveries. These figures as seen in the analysis had not been recorded in the facility before and it is important also to note that these figures decline through the years. There was no much variation in the infrastructure, equipment and personnel and coping mechanisms largely relied on the Pumwani Maternity team. Similar studies are required both in the facility and the private entities to come up with recommendations on how to keep the numbers high and sustain the free maternity services policy. This study therefore contributes to knowledge that would inform policy in Kenya and other countries that seek to subsidize maternity services.
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.
Assessing the effect of devolution on the number of healthcare workers in hardship areas: a case study of doctors, clinical officers, nurses and specialists in Wajir County
(Strathmore University, 2018) Kala, Adankhalif Adan
Kenya has had shortage of healthcare workers since independence, but this picture is worse in the hardship areas as majority of these workers tend to concentrate in urban areas. The Constitution of Kenya 2010 devolved management of health workers to the 47 counties. The aim of this study was to find out the effect of devolution on number of healthcare workers in a typical hardship area, with major focus on doctors, nurses, clinical officers and specialists in Wajir County. The specific objectives were to find out the effect of devolution on the number of healthcare workers, and their distribution in the sub counties and how devolution influenced budgetary allocation to health. Secondary data analysis of the payroll and budget of health department for 5 years was done to find out the number of healthcare workers in terms of absolute numbers, specialization, and amount paid in salaries, number on study leave, and health budget allocation as at 2012 (before devolution and from 2014 to 2017 under county government). Descriptive statistics of graphs was used to present the data. The study established that Wajir County has had tremendous improvement in the number of health care workers in the past 5 years. The study further established that under the devolved governance, the number of healthcare workers who have improved their skills by undergoing further training and specializing in different fields of nursing, medicine and clinical medicine has significantly increased. The study found out that Wajir County allocated significant amount of funds in the annual budget for health, which has availed enough funds to recruit enough health workers. Wajir County recruited its first medical specialist, a surgeon in 2017. The County has also given a substantial number of staff paid study leave to improve number of specialists among doctors, nurses and clinical officers. The study concluded that there was a positive relationship between devolution and improvement in the number of healthcare workers.
Assessing the uptake and utilization of the National Hospital Insurance Fund's cancer benefit package at the MP Shah Hospital in Nairobi
(Strathmore University, 2018) Kamau, David Gachanja
Universal healthcare coverage (UHC) is a top priority for the Kenyan government, yet it presents a major challenge, with the increase in cancer incidences. This study sought to generate evidence on strengthening oncology services in Kenya by assessing the uptake and utilization of the recently launched National Hospital Insurance Fund (NHIF) Cancer Benefit Package among MP Shah Hospital clients, in Nairobi County. A mixed methods approach was used, combining a questionnaire survey among 71 cancer patients and in-depth interviews with 25 stakeholders/patients. Statistical and thematic content analyses were used for the survey and qualitative data respectively. Four-fifths of study participants were recently diagnosed with cancer (the last two years). The main barriers to access were low availability of cancer treatment facilities and limited access to specialized doctors and nurses. Two-thirds of respondents experienced catastrophic costs saying that the treatment was consuming more than 40% of their household income. It is evident from the study that uptake of health insurance among respondents was higher during treatment at 83% compared to only 66% at the time of diagnosis with only 63% of respondents aware of the Cancer Benefit Package. A resounding majority of respondents (70%) sought treatment at the facility because of the perceived high quality of services made affordable by the Cancer Benefit Package. The National Hospital Insurance Fund's Cancer Benefit Package provides a roadmap for accelerating the Universal Health Coverage agenda in Kenya by offering financial protection among cancer patients. This study recommends decision makers to expand the mandate of this scheme to include coverage among underserved populations especially in rural areas. This can be through the decentralization of cancer diagnostic and treatment centers as well as the training and development of adequate health personnel in oncology. Similar studies are required by both public and private entities to come up with recommendations on how to promote sustainable access to oncology services in Kenya.
An Assessment of activity completion time in a health care delivery program: a five year study of the kidney transplantation program at Kenyatta National Hospital, Nairobi-Kenya
(Strathmore University, 2021) Ngigi, John
The health and economic burdens due to non-communicable diseases (NCD‘s) in Kenya is on the rise and requires multi-sectorial engagements and collaborations to contain. Chronic kidney disease (CKD) is one of the NCD‘s with significant morbidity and mortality affecting about 10% of the Kenyan population. The healthcare system should be able to provide quality healthcare to the citizens in line with the sustainable development goals (SDG) where universal health coverage (UHC) is one of the deliverables. The Interlife kidney transplantation program at the Kenyatta National Hospital (KNH) is one of the initiatives set up within the healthcare system with the aim to provide specialized healthcare within the CKD care continuum. This study focused on the Interlife program as a case model on timeliness of healthcare delivery. This was a retrospective review of medical records of patients who were evaluated for suitability for kidney transplantation and eventually underwent kidney transplantation surgeries at KNH between 2010 and 2014. The study investigated the timeliness of various key processes involved in the pre-transplant and immediate post-transplant periods. The primary objective was to determine the throughput time within the transplant evaluation process. Specific objectives were:- To determine the turnaround time for some key routine diagnostic blood tests required for safety in kidney transplantation; (Human immunodeficiency virus (HIV), Hepatitis B virus surface antigen (HBsAg), hepatitis C virus antibodies (HCV) and cytomegalovirus antibodies (CMV)), to establish the timeliness of access to consultations with two key specialties (cardiology and anesthesiology) within the kidney transplant program, to determine adherence to the kidney transplant pathway for two key processes (kidney ultrasound and blood assay for calcineurin inhibitor (CNI) in blood), to determine average hospital length of stay among kidney transplanted patients and to establish the frequency and reasons for cancellations of planned kidney transplant surgeries. The deviations of the timings from the transplant protocol which ultimately contributed to the overall delay in the program were noted. Categorical data had counts and percentages calculated. For normally distributed continuous data, means and standard deviations were calculated. For skewed data, the median and interquartile ranges were calculated. Inferential statistics were reported at 95% confidence with the p value ˂ 0.05 considered statistically significant. Analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Ninety nine individual patients‘ medical records were traceable. Males were the majority at 73(73.7%). Twenty patients had their elective kidney transplant surgeries cancelled at least once for reasons which were medical, social, financial or logistical. In conclusion, the pre-transplant evaluations and the peri transplant processes in the program are not timely and it is recommended that measures be undertaken to address the preventable causes of delays and cancellations of elective transplant surgeries as part of the program quality improvement initiatives.