MBA-HCM Theses and Dissertations (2021)

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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 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.
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.
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.
Automated Clinical Decision Support in HIV management: a comparative study of Point-of-Care and Retrospective Data Entry outcomes
(Strathmore University, 2021) Masibo, Wundundi Sammy
Kenyan healthcare facilities are increasingly adopting electronic medical records (EMRs) and electronic health management information systems (HMIS). Many public hospitals have automated HIV/AIDS care services in pursuit of efficiency and better patient outcomes. This has triggered interest in clinical decision support (CDS) systems. The CDS systems are designed to provide patient-specific information that is intelligently filtered to healthcare providers at appropriate times to enhance clinical decision-making. Studies have shown that automating CDS has certain advantages over manual systems. What remains unclear is whether the way the automated CDS is deployed has an impact. Point-of-care deployment refers to the use of CDS systems at the actual time of service delivery (data collection and system delivery are concurrent). Data is entered in real-time. Retrospective data entry (RDE) refers to deployment of systems to be used after the actual service delivery. Data is captured in primary manual tools and later transferred to the electronic database after the fact. This study sought to establish whether deploying a CDS system at point-of-care (POC) is more beneficial than deploying it retrospectively given the incidental capital outlays for POC systems. The study entailed a cross-sectional analysis of data collected through the KenyaEMR system; an electronic medical records system developed to manage HIV/AIDS services in Kenya. The study found that deploying CDS systems at point-of-care results in a lower patient missed appointment rate (21.34%, SD 8.24) compared to CDS applied retrospectively (31.58%, SD 15.47). CDS systems deployed at POC also result in better viral load testing rates (42.06%, SD 10.49) compared to retrospective CDS (37.56%, SD 10.03). There was no significant variation in the viral load suppression rates between POC and RDE modes (81.88%, SD 7.47 and 79.67%, SD 7.63 respectively). The study also enumerated challenges faced by system end-users when KenyaEMR is deployed retrospectively. These included duplication of work (84%) and lack of quality and timely data (74%). The potential barriers that constrain facility transition from retrospective data entry to point-of-care deployment were also established and included inconsistent power supply (95%) and negative staff attitude (74%).
Availability and affordability of essential medicines for Non-Communicable Diseases across six Kenyan Counties
(Strathmore University, 2021) Mohamud, Ahmed Mire
The burden of Non-Communicable diseases (NCDs) is increasing in Kenya and other low-and middle-income countries. Evidence suggests that poorer groups are more affected as they have to incur lifelong costs of treatment associated with NCDs. Typically, out of pocket payment for NCD medicines consumes the largest share of treatment costs for NCDs, exposing households to the risk of catastrophic health spending. This study sought to assess the availability and affordability of three medicines used for management of diabetes, dyslipidemias (problems of poor cholesterol control) and hypertension in pregnancy at public and private hospitals in Kenya, and assess the risk of incurring catastrophic health expenditure due to out of pocket purchase of the medicines. This study used a quantitative approach, analyzing data using the WHO/HAI methodology to determine availability and affordability of Atovarstatin 20mg, Metformin 500mg, Methyldopa 250mg. The study found out that atorvastatin’s availability was 32% and 70% in public and private facilities respectively; Metformin (94% and 84% in public and private respectively) and Methyldopa 75 and 82% for public and private facilities respectively. The lowest paid government worker would require a day’s wages to purchase a monthly dose of Atorvastatin in public facilities, and three days’ wages to purchase at a private facility. However, price differences were minimal for the other two medicines. The medicine price ratio (MPR) for Atorvastatin was nearly four times that of the international reference price list, the ratio was higher in private facilities as compared to public facilities (4.75 vs 1.19). The MPR for Methyldopa was 1.18 times the international reference price for both public and private facilities. The MPR for Metformin was three times the international reference price with the ratio being higher in private facilities. Finally, the study found that the risk of incurring catastrophic health expenditure due to out of pocket purchase of medicines for households was 1.5%, 6.8%, 15.1% and 28.8% for Metformin, Atorvastatin, a combination of two medicines (Atovarstatin and Metformin) and Methyldopa respectively. The study concluded that NCD medicines had low availability, were unaffordable and had a considerable risk of catastrophic health expenditure, especially among the poor.
Determinants of health seeking behavior among health workers in Kenya: a case of AAR Healthcare Kenya
(Strathmore University, 2021) Njuguna, Eva Wangeci
Whereas several studies have described health seeking behavior within the context of various diseases, and some among different population sub groups, the dominant perspective taken of healthcare workers has been that of service providers and not as consumers. This study sought to identify and assess the factors that influence health seeking behavior of healthcare workers in Kenya hence addressesing this gap. The specific objectives were: to determine the predisposing, the enabling, and the ‘need’ factors that influence health seeking behavior of healthcare workers. To achieve these objectives the study focused on a particular sub-group, that is, health care workers at AAR Health care Kenya - a private for-profit health services provider with a national footprint. The study was anchored on the Andersen health behavior model and adopted a mixed methods research design. The study targeted 200 health workers with a focus on those working at the Nairobi Outpatient Centres. The study employed a stratified random sampling technique whereby a 30% sample was picked from each subgroup, resulting in a sample size of 75 subjects. Primary data was collected through a questionnaire and data obtained analyzed through descriptive and inferential statistics. To this end, the study found that predisposing factors such as age, gender, level of education, marital status, religion and ethnicity determined the health seeking behavior of HCWs. The study also established that quality of health services in the health facility, cost of health service, ability to pay for the health service, availability of drugs, medical health insurance coverage, and waiting time before getting treatment in a health facility influenced health-seeking behavior of HCWs. Need factors such as perceived health status, severity of their illness, the status of their illness, duration they have stayed with a disease/ illness, ability to self-medicate and having poor health perception influenced HCWs health seeking behavior. The regression indicated that there is a positive and statistically significant association between health seeking behavior of HCWs and need factors, enabling factors and while predisposing factors were found to be statistically insignificant with health seeking behavior of HCWs. The study recommends for up-scaling the coverage of the existing health insurance schemes including the National Health Insurance Scheme, for HCWs. There is need to increase the number of health facilities in under-served areas. The quality of care provided at health facilities also requires attention (improve quality of care) and ensure availability of drugs. It is expected that the findings of this study will be of benefit to the healthcare workers in terms of improving the health seeking behavior of HCWs. To policy makers and regulatory institutions, the findings may trigger policy formulation aimed at improving the health seeking behavior by HCW; and to scholars and researchers the study addzknowledge in the field of health seeking behavior of HCWs and also act as a basis forzfurther research.
Dual practice of public hospital medical doctors at county referral hospitals in Nairobi, Kenya
(Strathmore University, 2021) Karugu, Lucy
This study assessed the dual practice of public hospital medical doctors at county referral hospitals in Nairobi, Kenya. The three-county referral hospitals under investigation were Pumwani hospital, Mbagathi hospital, and Mama Lucy hospital. Specifically, the study aimed to 1) establish the prevalence or extent of the dual practice of public hospital medical doctors; 2) determine forms and/or modes of dual practice of public hospital medical doctors; 3) identify factors that drive the dual practice of public hospital medical doctors; 4) find out reasons for commitment to public practice among public hospital medical doctors; and 5) examine consequences or impacts of dual practice of public hospital medical doctors. This study achieved these objectives through mixed methods of data collection and analysis. Moreover, the study adopted a descriptive online questionnaire survey with semi-structured and open-ended questions to collect data from 63 respondents (38 – medical doctors and 25 management teams) across the three hospitals under investigation. The Census sampling technique was adopted. The findings reported that the prevalence or extent of the dual practice of public hospital medical doctors is at 54%. Most public hospital medical doctors who engage in dual practice do so because of the low/negative perception they have on their current public practice income. The findings also indicate that the motivating factor or reason why most public hospital medical doctors engage in dual practice is to enhance their current income. That is to say, private practice income supplements public practice income. Though there exist dual practices among some public hospital medical doctors, the study established that some public hospital medical doctors, however, are committed to public practice. Results indicate that the responsibility to uphold public health for all and building reputation are some of the reasons some public hospital medical doctors are committed to public practice. Also, the study found out that faster promotion, increased salary, and provision of housing benefits are some of the conditions that would make the majority of the public hospital medical doctors who engage in dual practice give up their private practice for public practice. Consequently, the study findings report that consequences of the dual practice of public hospitals medical doctors varies and can either be positive or negative to the health system, patients, and public health institution. This study concludes that healthcare remains a development priority across nations. As the demand for health services increases so will the dual practice of public hospital medical doctors due to the growing disparity in the doctor-patient ratio. The study recommends the need for more policy frameworks on dual practice to work for the benefits of public hospitals. Also, the study recommends further research to focus on all county referral hospitals in Kenya with large sample size.
The Effect of psychological safety on quality of healthcare services by health workers in Kitale County Referral Hospital
(Strathmore University, 2021) Ouma, Edward Ochieng
Healthcare organizations operate in a dynamic, complex industry full of high demands and accountability with an aim to deliver services to the patient and the stakeholders at large. It hence needs a collaborative approach in carrying out its mandate, meaning individual, team dynamics and its organizational climate comes into play. When quality is critical and effective safe patient care is warranted, then performance comes to play. As a result, health organizations that tend to enhance an environment that facilitates faster learning, creativity, and innovation tend to have a better chance of success. Where an individual can air their opinion without fear of repercussion, take interpersonal risk without fear of retribution as long as it intends to meet or even further the organizational goals. These, as a result, lead to increased patient safety due to no fear of reporting medical errors, enhanced team cohesion, innovative solutions to emerging challenges. However, information concerning, the role of psychological safety on quality of health in Kenya is scanty. The objective of the study was to determine the effects of psychological safety of healthcare workers on the provision of quality healthcare in Kitale County referral hospital. The research was underpinned by the theories of conservation of resources, trait activation, and social exchange. The study applied quota and convenience sampling techniques as well as a cross-sectional descriptive design. Primary data was collected through structured questionnaires. Data collected was analyzed by both correlation analysis and multiple regression via SPSS. Results showed that team psychological safety had non-significant relationship with quality of healthcare(p-value>0.05) while both the individual (p-value=0.044) and organization (p-value<0.001) psychological safety have significant relationship with quality of healthcare. These results conclude that individual and organizational psychological safety contributes to improvement in healthcare quality in Kitale county referral hospital. The study recommends that county governments and management of public hospitals should improve individual, team and organizational psychological safety as a way of driving creativity and innovation in enhancing healthcare quality.
Effects of total quality management principles on employee performance: a case of Aga Khan University Hospital, Nairobi
(Strathmore University, 2021) Kasyoki, Nicholas Nyamai
Private healthcare institutions continually seek to provide a harmonious working environment where employees can ex-press their best attributes. Healthcare institutions are always trying to maximize employee output to maximize profits and compete in a competitive market. One way of n1axi1nising ei1lp1oy·ee Olttpnt is tlrroust tlt-e application of Total Quality Management (TQM). The main objective of this study was to assess the effect of Total Quality Management principles on healtl1eare personnel's performance and output at AKUHN. The specific objectives of this research were to determine the extent to which employee involvement affects the performance of healthcare staff at AKHUN and establish the extent to which teamwork affects the performance of healthcare staff at AKUHN. The study utilized a descriptive design and a positivism paradigm linked to a quantitative techniq11c to address the research objectives. A implosive sample of 132 participants was recruited to participate in this study. Structured online questionnaires were utilized in data collection. The collected data were analyzed using SPSS and Microsoft Excel software. Descriptive statistics were used to summarize the variable, while regression analysis assessed the relationship between the dependent and independent variables. The analysis findings indicated a significant positive relationship between teamwork .and employee performances. Employee involvement had a positive but significant relationship with employee performance. This study was limited to only one institution, and only two TQM principles among the eight studied elsewhere. The study findings add to the pool of knowledge about the effects of TQM principles on employee performance for quality healthcare service. Future research could consider expanding the study scope to get an accurate representation of the subject matter.
Examining level of awareness and compliance with the World Health Organization safety checklist among Kenyan anesthesiologists
(Strathmore University, 2021) Ntonjira, Muthoni
Patient safety is a fundamental right and is of great value among patients undergoing medical procedures that involve the administration of anesthesia due to the risks and high potential for complications. Statistics show that the global rate of adverse patient outcomes (mortality and complications) remain high, particularly in low- and middle-income countries. While factors such as low numbers of medical specialists contribute, there is growing evidence linking adverse outcomes to poor compliance to safety checklists and guidelines in surgery, including the World Health Organization Safe Surgery Checklist. This study assessed and explored compliance to safety checklists by medical specialists in order to inform policy and practice on how compliance can be improved for better outcomes. The study employed a mixed method approach to assess factors that influence compliance to the components of WHO surgical safety checklist among anesthesiologists and explore underlying reasons. Both quantitative and qualitative data were collected using questionnaires and interviews. Findings showed an understanding and good knowledge about all the components of the WHO safety checklist among the practitioners. Many agreed that the safety checklist is central to improving the safety in the operating room and in the surgical procedures. In terms of compliance, not all aspects of the checklist were adhered to by the practitioners. Participants only agreed to adhere to some of the aspects of the WHO safety checklist. The level of compliance with the WHO checklist strongly dependent on the level of knowledge among the respondents regarding the presence of these WHO safety checklist (p=0.000, B=0.821); high levels of knowledge correlated to high levels of compliance. There are significant discordances between knowledge and compliance of the WHO surgical safety checklist. Recommendations for improving compliance to the WHO safety checklist have been provided.
Examining private sector engagement in provision of public health services towards universal health coverage: a case study of Kisii County
(Strathmore University, 2021) Mounde, Mokaya Isaiah
For Kenya to achieve universal health coverage (UHC) by year 2022, the national and county governments must strengthen engagement with the private sector. Yet there is lack of clarity on private sector engagement across counties. This study sought to describe engagement and impact in Kisii County. Specifically, the study sought to describe the private sector engagement models in Kisii, examine achievements and challenges of engaging the sector in meeting public healthcare goals, and explore management views on the perceived impact of private sector engagement. A multiple methods approach was taken, with data collected from 62 employees of the Kisii county health department and the private sector. The quantitative component entailed collecting survey data from 52 participants (21 public, 31 private). The qualitative component entailed 10 in-depth interviews (five each for public and private). Findings indicated that whereas a myriad of private sector engagement models were employed, the public-private partnership model was most preferred. Engagement achievements included public sector getting human resources from the private sector; technical and capacity building support; and technological and financing support from the private sector. Engagement challenges included difficulty in regulating and holding the private actors accountable under the partnership arrangements; difficulty in engaging the private sector in non-profit initiatives; and county government inability to sustain programmes initiated by the private sector. Overall, private sector engagement was perceived to have had a positive impact on progress towards UHC in Kisii across all six-health system building blocks, namely, governance, health work force, financing, service delivery, healthcare technology and access to medicines. Among others, the study recommends that county governments should have a central role to play in targeting and identifying households for National Hospital Insurance Fund (NHIF) enrolment and that national governments ought to avail financial resources to facilitate increased population coverage through the NHIF in keeping with universal health coverage. The study also recommends that the Kenyan government should increase public financing of the health sector at the county level. By dedicating 15% of the national budget towards healthcare for instance, there will be an uplift in the healthcare system enough to realize the Universal Healthcare Coverage as per the Abuja declaration of 2001 to which Kenya is a signatory.
Examining the effect of result based financing on health worker motivation in Makueni County, Kenya
(Strathmore University, 2021) Makau, Leonard Cedric
Calls for universal health coverage (UHC) have triggered renewed focus on strengthening primary health care (PHC) and improving health worker performance. In Kenya, health service delivery is impeded by the poor quality of service, inefficient use of resources and low health worker motivation among other factors. Result-based financing (RBF) has the potential to strengthen service delivery by improving motivation, quality and resource use. The RBF concept typically entails deploying some form of financial reward towards staff who achieve a certain level of performance or outcomes. Studies on RBF in low and middle-income countries have given mixed results. This study looked at the effect of RBF on the motivation of PHC staff in Makueni County. Specifically, it sought to determine the effect of RBF, operational funds and service improvement funds on staff motivation. The study was conducted in the six sub-counties in Makueni County using a descriptive research design. Data was collected using a questionnaire, and descriptive and inferential statistical analyses were done. The study found a strong positive correlation between performance-based incentives and healthcare workers’ motivation. Also, the study revealed that performance-based payments and motivation of healthcare workers had a strong positive relationship. The study found that operational funds and motivation of healthcare workers have a strong positive relationship. The study established that service improvements funds had a strong positive correlation with the motivation of healthcare workers. The study recommended that health facility management consider performance-linked incentives for staff, and that effort is made to ensure availability of operations and service improvement funds for smooth running of the facilities. This would contribute to the UHC goal of ensuring access to safe and high-quality healthcare services.
Examining the sustainability and impact of an innovative community pharmacy model in expanding access to Non - Communicable Disease medicines in Nairobi, Kenya
(Strathmore University, 2021) Musyoki, Rebecca
As the burden of non-communicable diseases (NCDs) continues to rise globally, low- and middle income countries are increasingly appreciating the role of primary health care (PHC) facilities in early screening, detection and disease management However, PHC is poorly funded in most countries, resulting in capacity and operational challenges. In response, innovative models have begun emerging, including community-linked initiatives. This study sought to examine an innovative revolving fund community pharmacy model established to support the fight against NCDs in Nairobi. The study employed a qualitative approach to examine the role the community pharmacy played in expanding access to NCD medicines and explore its sustainability and perceived impact. Data was collected from patients, management committee and providers through in-depth interviews, and analysis conducted using a thematic framework approach. The study revealed that actor ecosystem (management, PHC facility staff and community members) generally understood the key model features, including its operations and financing. There was general agreement that the community pharmacy had promoted access to NCD medicines across key groups. Analysis of sustainability factors (outcome-based advocacy, systems orientation, community linkages, vision focus balance and infrastructure development) suggested that the model was relatively sustainable. The study recommends that for better sustainability, a policy framework for operation of this community pharmacy may be required, and should include· a regulation and oversight framework, monitoring, evaluation mechanisms, and community and stakeholder's engagement protocols. In addition, the study recommends community pharmacies run as partnerships to have shared vision and goals with realistic strategic plans detailing how to achieve them.
Exploring factors influencing the implementation of clinical risk management programs by nurses in public hospitals: a case study of the Mbagathi Hospital in Nairobi Kenya
(Strathmore University, 2021) Ogolla, Christine
As patient safety becomes a priority issue in health systems, clinical risk management (CRM) continues to gain prominence. CRM refers to strategies aimed at identifying, analyzing, and managing potential risks in healthcare organizations. Evidence shows that implementing CRM among nurses can be difficult in low-resource settings. This study explored the perspectives and experiences of nurses in implementing CRM in the context of a Kenyan public hospital, the Mbagathi Hospital in Nairobi Kenya. The study specifically explored how organizational culture and leadership, and resource availability affect the ability of nurses to implement clinical risk management activities at the Hospital. A qualitative approach was taken. This entailed interviewing up to 20 purposively selected nurses, ensuring that their experiences were captured at different levels of the hospital system. Data was collected using an open-ended interview guide, developed building on the objectives of the study. Data were transcribed and transferred into NVIVO for thematic analysis. The study findings revealed that the main resource factors that affect the implementation of CRM programs were the limitations of human, financial, and physical, and IT resources. This study also identified leadership factors like poor safety culture, poor leadership support and commitment, and poor collaboration and communication to affect CRM programs. This study concluded that although nurses are expected provide high quality and safe care, these challenges have created an unconducive environment to effectively integrate CRM programs into their professional practice. This study suggests that hospitals should provide a favorable working environment, foster leadership commitment, and support, and avail the necessary resources for the successful implementation of CRM programs. The findings of this study were disseminated by giving written feedback to study participants and the hospital management in form of emails. Dissemination will also be done by publishing the study in a peer-review journal to inform management of other public hospitals on strengthening the implementation of clinical risk management activities, and also to inform research on related topics.
Exploring the facilitators and challenges of Emergency Medical Services: a case of Kisii County Government
(Strathmore University, 2021) Manoti, Lyndah Kemunto
Emergency medical services (EMS) are urgent interventions and procedures offered to patients to prevent disability and preserve life after the occurrence of injury or acute illness. The services usually offered in out-of-hospital setups or during transit to a definitive health facility, contribute to the overall health outcomes. Globally, the need for EMS remains critical, as over half of the global mortalities are as a result of emergency medical diseases. This study aimed to explore facilitators and challenges of implementing EMS in Kisii County using the health system building block framework. The research was a cross-sectional qualitative study that utilized interviews for data collection. The target population was 14 the personnel in the EMS department; health managers and EMS frontline workers of the Kisii County. The study findings were subjected to qualitative data analysis and finding presented. The study followed all ethical considerations.The study established that the EMS implementation has improved health services by increasing the scope of services to include referrals, medical evacuation, and health education. The main facilitators for the EMS service delivery were a dedicated, diverse and team spirited work force, good communication and coordination during the dispatch process, availability of infrastructure, medical products, and technologies, and publicly financed system. The study also revealed that the main challenges in the EMS implementation are inadequately trained workforce, staff shortages, some faulty equipment, lack of financial transparency and delays in allocation, lack of a lead agency and national policies on EMS. Based on the findings, the study recommends that EMS implementers ensure that they have well trained and adequate EMS workforce, availability of functional communication, medical and transportation infrastructure. Additionally, develop national EMS policies and publicly financed EMS systems.
Factors affecting compliance to infection prevention and control measures among frontline health workers: a case study of the Kitale County Referral Hospital
(Strathmore University, 2021) Kisaka, Yvette Nafula
The quality of services provided at a healthcare facility is greatly influenced by compliance to infection prevention and control (IPC) standards. Low adherence increases the risk of transmitting pathogens like Covid-19 and exposure to occupational hazards. This study sought to assess factors that affect compliance to the IPC standards by frontline healthcare workers at the Kitale County Referral Hospital in Trans-Nzoia County. For purpose of the study, frontline healthcare workers include nurses and doctors only. The study objectives were to (i) examine the implementation of infection prevention and control (IPC) measures relating to hand hygiene, personal protective equipment (PPE) usage, and safe injection practices at the Kitale County Referral Hospital (ii) describe the patterns of association between selected health worker socio-demographic characteristics and compliance to the IPC standards and (iii) examine health facility factors that affect compliance to the IPC standards. A mixed-methods study design was employed. Actual data was collected from healthcare workers, who were stratified into two groups: nurses and doctors. For quantitative data, participants were selected using the stratified random sampling method, and data collected using a semi-structured questionnaire, followed by analysis using the Statistical Package for Social Sciences (SPSS). For the qualitative component, purposive sampling was employed to select participants, data collected through in-depth interviews guided by a topic guide and analyzed using the by NVivo Pro software. A total of 111 participants were involved in the survey, with eight being included in the in-depth interviews. Of the 111, 81% were nurses, and 65% female. Nearly two-thirds said they had had IPC training. The survey found the level of full compliance to be 53.2% for hand hygiene, 52.3% for PPE use, and 59.5% for injection safety which was lower than expected considering the global efforts towards improving IPC practices in the covid-19 era. Additionally, it showed a significant correlation between health worker cadre and compliance to hand hygiene. Existence of an IPC committee, provision of adequate PPE and injection safety boxes, management support, availability of policies and guidelines, and their ease of accessibility were also linked to level of compliance to hand hygiene, PPE use and injection safety. The findings add to ongoing research aimed at understanding how IPC policy and practice can be improved to eliminate transmission of nosocomial infections, especially in the Covid-19 pandemic.
Factors influencing access to finance by small and medium healthcare entrepreneurs in Kisii County
(Strathmore University, 2021) Omari, Dennis Nyabera
Access to finance is a major constraint for many healthcare entrepreneurs across the sector. Improving direct access to credit for small and medium healthcare entrepreneurs will not only have a strong impact on a count1y's health system, but it will also have long term positive implications on the country's economy at large. There is a great need for healthcare entrepreneurs to get access to credit facilities and financial institutions should understand and address this issue. This study investigated the factors that limit the accessibility to financing by small and medium healthcare entrepreneurs in Kisii County, Kenya. The study targeted 81 entrepreneurs operating licensed small and medium medical facilities in Kisii County. Data was collected using questionnaires composed of open-ended and closed-ended questions and gathered information in line with the study objectives, after a research permit was obtained from NACOSTI. A descriptive survey design was used for the study and the collected data was organized and analyzed with a statistical package used for social sciences. The study established that Kisii County health SME's is predominantly sole proprietorships, most of which have been in operations for less than ten years. These SME's have less than ten employees and the management of the SME's is mainly carried out by non-professional managers and the owners double up as the managers. Majority of the firms have a monthly turnover of between Kenya shillings thirty thousand and fifty thousand. The study also established that there is a statistically significant relationship between financial inclusion and intermediation efficiency and access in Kisii County while depth is statistically insignificant. In addition, the study established that there is a positive correlation between all the variables which is statistically significant which means that any increases in the variables depth, access and intermediation efficiency will lead to an increase in financial inclusion in SME's in Kisii County.
Factors influencing motivation and job satisfaction among healthcare workers at Garissa County Referral Hospital
(Strathmore University, 2021) Aden, Bulle Rukia
Motivation of healthcare workers is as important as is in other organizations, to be able to provide quality care to patients and ensuring better productivity of staff especially in public sector institutions. Low motivation has led to migration of health workers from low income countries to developed countries, being particularly grave in conflict zones among LMICs. An example in Kenya is the counties bordering Somalia such as Garissa and Mandera. The major challenges in providing health care services in Garissa County are the vastness of the county, poor road networks, insecurity including terrorist threats and frequent diseases outbreaks. Moreover, severe shortage of health personnel coupled with high level of staff quitting is a major hindrance to service delivery. The aim of this study was to identify factors which contribute to job satisfaction and job dissatisfaction among healthcare workers at Garissa County Referral Hospital. It determined which of Herzberg's motivation-hygiene factors are given greater value by healthcare workers at Garissa County Referral Hospital. The study focused on two medical professions namely; medical doctors, and nurses. Herzberg dual-factor theory was used as the framework for this study. The design of the study was based on a quantitative analysis approach using a survey methodology to determine factors that workers see important to their job satisfaction. In this study out of 189 respondents who were targeted, 171 of them responded to the online questionnaire. This represented 90.5% of the target population. From the findings, 18(62.1 %) of the medical doctor employees were male while the 37.9%. female. On the other hand, 99(69.7%) of the nurse employees were male while 43(30.3%) were female. Majority of the respondents were satisfied with these motivators; responsibility, advancement, possibility for growth with a mean score of 4.15, 4.08 and 4.06 respectively. However, most of the respondents were highly dissatisfied with the motivator factor recognition. Concerning the hygiene factors, majority of the respondents were highly satisfied that their job is permanent and pensionable (Job security) - 4.74. They were neutral with on Interpersonal relations-peers (3.73), status (3.69), working conditions (3.54) and company policies and administration (3.51). From the analysis of coefficient of determination (R2); it was concluded that job satisfaction explained 83% of the intention to leave the organization among healthcare workers at Garissa County Referral Hospital.
Factors influencing voluntary national hospital insurance fund enrolment and retention: a case of Busia County
(Strathmore University, 2021) Akute, Frankie Gweya
Health insurance is an important aspect of health financing. Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. The low uptake of NHIF in Kenya demonstrates the need for measures and strategies that would motivate and spur change at conceptual and theoretical levels in terms of universal healthcare provision. Kenya currently lacks evidence on whether income in the informal sector which contributes to the voluntary contribution members is sustainable and predictable making it able to support the financing of universal health coverage. The study used a cross-sectional survey design to determine factors influencing voluntary National Hospital insurance Fund enrolment and retention, a case of Busia County. Its specific objectives included: to examine the influence of economic status on voluntary enrolment of individuals to the National Hospital Insurance Fund in Busia County; to establish the influence of individual awareness on voluntary enrolment of individuals to the National Hospital Insurance Fund in Busia County; to determine the influence of cultural practices on retention of individuals voluntary enrolled with the NHIF in Busia County; and to explore the influence of quality of service on retention of individuals voluntary enrolled with the NHIF in Busia County. The theoretical foundation featured the conventional health insurance theory and the expected utility theory. The study population was drawn from Busia County and was concentrated in four sub counties; Bunyala, Butula, Teso North and Matayos. The accessible population for the study was 63,458. The sample size for this study was 397 participants. The study used structured questionnaires to collect data. The collected data was analysed quantitatively using SPSS version 20 and Minitab version 20. The results of the age distribution indicated that the majority of the respondents were above the age of 51. As far as the level of education was concerned, the majority of the NHIF members had only primary level of education. An assessment of the results relating to the employment status showed that most of the NHIF members were self-employed. Finally, the vast majority of the members had 4-6 children. Neither economic status factors nor cultural practices have negatively affected individuals’ voluntary enrolment to the NHIF. However, most individuals are neither aware about the enrolment process nor the associated health benefits. The study recommended that the policy makers of the NHIF should do more in coming up with incentives to lure younger individuals to enrol with the scheme. Further, subsidies should be offered to the informal sector so as to boost the voluntary enrolment to the scheme. The NHIF should engage in more awareness campaigns to raise the level of awareness about the method of registration and the associated benefits that accrue to someone upon registration.

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