MBA-HCM Theses and Dissertations (2022)

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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.
Cost drivers for Medically Assisted Treatment in HIV control in Nairobi, Kenya
(Strathmore University, 2022) Wangusi, Rebeccah Namalea
An estimated 18% of people who inject drugs in Kenya are infected with HIV. Medically Assisted Treatment with methadone offers promise as a HIV prevention strategy among this population. The costs of Medically Assisted Treatment services in two Kenyan public facilities were studied from an economic health care provider perspective. The objectives included: to determine the startup costs of setting up a medically assisted treatment clinic; to determine the annual recurrent costs and; to determine the annual unit cost per patient. The study utilized the cost of production theory. Data was collected from Ngara MAT Clinic and Mathari Teaching & Referral Hospital. Data were collected at the facility level using a micro-costing approach utilizing a modified version of the Drug Abuse Treatment Cost Analysis Program tool. Results showed that the total start-up costs ranged between $213,471.64 and $533,412.99 across the two sites with the cost of setting up a subsequent clinic being 50% less. An additional $316,294.77 and $ 365,080.32 were determined as the total annual recurrent costs necessary to run the program within the existing infrastructure for the different clinics. The annual per-patient cost of providing Medically Assisted Treatment ranged from $ 532 to $590 across the 2 sites, with an average cost of $562. This was lower than costs reported in upper and middle-income countries. Consistent with other studies, the main cost driver for Medically Assisted Treatment was personnel costs accounting for 59% of the total costs. For policymakers, the results of this study offer an opportunity to revisit and strengthen policies on Drug abuse prevention and financing for HIV prevention programs and Medically Assisted Treatment in particular.
Delivery of home-based care in the context of Universal Healthcare Coverage in Kenya
(Strathmore University, 2022) Chesaro, Sarah Chebet
Communicable and non-communicable diseases are a leading cause of morbidity and mortality and are contributing to over 60% of global mortality, out of which 80% occur in middle and low-income countries. The objectives of this study were: to examine the influence of legal factors, socio-economic factors, and demographic factors on home-based care delivery in Kenya. The study highlights the gaps in policy and hopefully guides future policy development to identify and establish a systematic approach to dealing with the gaps that relate to home-based care delivery in Kenya. A descriptive research design was utilized to collect data from healthcare workers working in health facilities registered to offer home-based care. The study population was 68 healthcare workers drawn from the nine home care facilities operating within Nairobi County and applied purposive sampling to collect data from healthcare workers. The study employed a semi-structured questionnaire in the data collection process and extensively utilized Google forms and physical questionnaires in the data collection. Data analysis was done using descriptive and inferential analysis. Based on the findings, the study concluded that legal, socioeconomic, and demographic factors had a positive and significant relationship with home-based care delivery in Nairobi. It also indicated that the current ethical concerns, guiding policies, laws, workers’ rights, and privileges among healthcare workers do not contribute to home-based care delivery. The results also indicated that relying on the home environment, client affordability, occupants at home, hazards, and availability of home resources positively improved home-based care delivery. However, healthcare workers’ gender and practice experience did not influence home-based care delivery. The results showed that healthcare workers with a bachelor’s degree positively and significantly contributed to the delivery of home-based care. It was thus concluded that healthcare workers should develop cost-effective home-care management that can be utilized in the long-term by patients through practical guidelines
Determinants of quality of healthcare services at Kenya Defence Forces Memorial Hospital
(Strathmore University, 2022) Kinyanjui, Mercy Wambui
New trends show that patients are attaching more importance to quality of healthcare service than ever before. However, problems have arisen with relation to quality of healthcare services provided in a majority of health facilities probably because of incapacitated personnel, insufficient resources, and psychical facilities, availability of drugs, lack of proper leadership and recently devolution of health services in Kenya. While the Kenya Defence Forces Memorial Hospital is different since it is a military based hospital that offers services to the military personnel and the families. Therefore, this study sought to establish the determinants of quality of healthcare services at Kenya Defence Forces Memorial Hospital. Specific objectives were to determine the effects of staffing, diagnostic services, physical facilities and availability of drugs on quality of healthcare services at Kenya Defence Forces Memorial Hospital. The study adopted a descriptive survey research design. This study was conducted at the Kenya Defence Forces Memorial Hospital in Nairobi; this was the unit of analysis. The study target population was 2,760 patients; simple random sampling method was used to select a sample of 197 respondents and the questionnaire was the tool for data collection. The data was analyzed through descriptive and inferential statistics with the help of Statistical Package for Social Sciences (SPSS) version 22. The study found that staffing, diagnostic services, physical facilities and availability of drugs had a weak significant relationship with quality of healthcare services. The study recommends that the government should increase the funding of the KDF Memorial Hospital and also provided with more medical equipment to enhance healthcare quality.
Factors influencing adherence to hazardous waste management policy frameworks among health workers in private hospitals in Nairobi County - Kenya
(Strathmore University, 2022) Chepchirchir, Constantyne
The global generation of hazardous waste in hospitals has recorded a significant increase in the recent past, with up to 64% of these wastes inappropriately managed in Low- and Middle-income Countries. In Kenya as well as other Low- and Middle-income countries, such improper management of this waste can lead to severe human and environmental health problems. Although healthcare workers in Kenya, have guidelines on proper management of this waste, the adherence to these policies and attendant hazardous waste management practices among healthcare workers in Nairobi County hospitals is unknown. This study, therefore, sought to investigate the factors influencing the adherence to hazardous waste management guidelines among healthcare workers in private hospitals in Nairobi County. The specific objectives of the study included; determining the level of adherence to proper HCWM practices among health workers, identifying the individual related factors that influence adherence to proper HCWM practices among health workers, and identifying the health facility-related (institutional) factors that influence adherence to proper HCWM practices in 4 selected hospitals in Nairobi County Kenya. From the population of 900 healthcare workers from 4 levels 4 facilities, random sampling was applied to identify the 90 respondents. Data analysis and reporting was done using appropriate quantitative methods. Based on the study findings, we would recommend the improvement of hazardous waste management efficiency.
Succession planning practices among public healthcare facility managers: a case study of Kakamega County
(Strathmore University, 2022) Ochola, Felix Samuel Onyango
Succession planning and management have been identified as a solution through a continuous transfer of skills and competencies. Succession planning and management have been noted to enhance performance and safeguard organization continuity. This dissertation aimed to assess succession planning practices among public health facilities managers. Specific objectives included assessment of institutionalization succession planning policy, talent management, and career development strategies among the public health facilities managers. The study employed a qualitative case study design. The target population was 162 public health facility managers. The sample size of 32 (20 from Level 2, 8 from Level 3, 3 from Level 4 and 1 from Level 5 health facilities) was estimated from theoretical saturation limit and stratification done through proportional allocation. The purposive sampling technique was used to determine the facilities to be visited due to access challenges. The researcher collected data using semi-structured, in-depth interviews. An audio recording was the primary method of capturing the data. Analysis of the data was done through thematic analysis. On the first objective, the study results showed that the majority of the respondents were not aware of succession planning. The policy had not been institutionalized in the department of health. The managers did practice succession planning to various levels depending on the complexity of the facilities they managed. The practice of talent management also varied across facilities with different levels of complexity depending on the size of the facility and the needs. The managers reported that talent management had a positive impact on health facility performance. Lack of uniformity of practice was also noted. The majority of managers in the department of health were underprepared for managerial duties. There was congruence among facility managers that career development had a positive impact on management preparedness and that it could help solve several issues including the appointment of staff that are not interested in management to managerial positions. The study concluded that managers that were interviewed did not practice succession planning and management as per the government policy. The study observed that the lack of spearheading of succession planning and management by the county department of health resulted in disjointed, lack of coordinated succession planning practices among facility managers. The study recommended that the county department of health spearhead the implementation of succession planning and management, while facility managers look into the adoption of talent management and career development strategies. Future studies can look into succession planning and its effect on performance in more complex health organizations like referral hospitals. A possible area of study also includes the effect of succession planning practices on departmental performance. Perception of senior managers on the challenges of succession planning was also suggested for the future study area.

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