MBA-HCM Theses and Dissertations (2018)

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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.
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 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 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 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.
Assessment of data quality of an EMR system, and the effect of CD4 guideline change and patient escort on time to linkage to and retention in ART: a study at Kiambu County Referral Hospital
(Strathmore University, 2018) Muthee, Winnie G.
Kiambu County Referral Hospital adopted electronic medical records in the HIV clinic for longitudinal follow up of patients enrolled in care. The hospital also implemented CD4 guideline changes on antiretroviral therapy eligibility and a patient escort system to facilitate timely linkage of patients to treatment after HIV diagnosis. This study first evaluated data quality of the electronic medical records database, which was then utilized to assess the effect of CD4 guideline changes and patient escort on time to linkage to and retention in antiretroviral therapy. This study is a cross-sectional study that involved evaluation of medical records of eligible patient populations. For the data quality study, the sample size was based on random sampling on Microsoft Excel using a line list that was extracted from the electronic medical record database. This sample of electronic records was then compared against a similar sample of physical records. For the assessment of effect of CD4 guideline change and patient escort on time to linkage to and retention in antiretroviral therapy, a complete census of the eligible population was done using the electronic medical record database. There was over 70% completion rate for most clinical indicators evaluated in both electronic and physical records. Both ART start date (96 % vs 77%) and baseline CD4 (73% vs 56%) were significantly more complete in the physical records compared to electronic records. Almost all evaluated indicators had a mismatch rate of less than 10% between physical and electronic records, except for “date started ART” that had the highest mismatch rate of 20%. There was a significant decline in median time to linkage to ART from 51 days in the 350 CD4 cut-off group to 16 days in the “test and treat” group. There was a significantly higher retention in ART, and lower overall attrition and lost to follow up for the “test and treat” group. However, there was no significant difference in retention, overall attrition, lost to follow up and mortality between the pre and post patient escort groups. The study findings have important implications for the use and interpretation of data derived from EMR databases for ongoing patient follow up and retention in treatment programmes as well as operational research. The “test and treat” strategy showed improvements in both median time to linkage to and retention in ART. More research on patient escort as a behavioral intervention for linkage and retention in ART, as well as impact of “test and treat” strategy on mortality is needed.
An assessment of factors influencing patient safety incident reporting in the inpatient department at the Gertrude’s children Hospital in Nairobi,Kenya
(Strathmore University, 2018) Mugendi, Christine Muruga
The main purpose of the study was to establish the factors influencing the reporting Patient safety incidents at Gertrude’s Children hospital. The study employed a Descriptive mixed method with both quantitative and qualitative study design. Fifty Two nurses from the inpatient units participated in this study. A standard checklist Extracted from Q-pulse, a structured questionnaire and in-depth interviews guides were used for data collection. Statistical package of social sciences(SPSS)version 21.0 and the matic analysis was used to analyze the data. Eighty nine percent of the Nurses were aware of the hospital’s reporting system but about half of the nurses Rarely reported incidents. There was a significant low rate of reporting patient safety incidents among the nurses in the inpatient units of the hospital. The main challenges faced by staff on reporting patient safety incident were issues with accessibility of reporting platform, lack of time to report, fear of victimization, fear of unknown,lack of knowledge of what to report,and fear of intimidating colleagues.Some of the key recommendations includes; Provision of management support for patient safety culture,train all health care workers on the incident reporting process, ensure a non-punitive system when handling reported incidents and in all ways discourage victimization of staff reporting patient safety incidents and provision of appropriate timely feedback to staff on corrective measures.
Assessment of students’ perception of the MBA healthcare management program at Strathmore University
(Strathmore University, 2018) Mokua, James Soki
There is a need for healthcare workers to acquire managerial and leadership skills for their training to be relevant to the needs of the country and the community they serve. The main challenge is lack of leadership and managerial skills. With this gap in mind, Strathmore Business School (SBS) launched an MBA in Healthcare Management in 2013 to train health care workers and managers in leadership and managerial skills. The main objective of the study was to assess the experience of the present cohorts of students and past graduates of the MBA in Healthcare Management course at SBS. A mixed methodology provided a detailed analysis of the research problem. A questionnaire was administered to 177 students drawn from the present cohorts (2017, 2016, and 2015) and past graduates. Results indicated that Fifty six (56%) of the students responded. The overall scores were high for relevance, quality and employability. Productive sector linkages got mid-range scores. There was a downward linear trend noted for quality and an upward trend for security. 60% of the respondents were noted to be promoters. Students responded well to international faculty, modular program and case based learning. Points of improvement are in infrastructure (parking, library and cafeteria) and productive-sector linkages. In terms of promoting entrepreneurialism and practical skills, SBS has followed the majority of institutions by employing industry professionals as adjunct faculty and engaging guest speakers to provide business and entrepreneurial advice. New forms and levels of partnerships need to be considered in research, consultancy, staff exchanges and joint curriculum development with the productive sector.
An Assessment of the implementation of the East African pooled procurement mechanism among faith-based medicines supply organizations
(Strathmore University, 2018) Jaguga, Collins Davies Pambo
The East African region has a significant burden of communicable and noncommunicable diseases, yet patients have low access to essential medicines and medical supplies. Some of the barriers to accessing medicines are high prices and stock-outs. Pooled procurement of health products is an innovative approach to obtaining large volumes of products at competitive prices, thus promoting affordability and availability. A number of factors influence the success of pooled procurement mechanisms. These include sustainable financing, harmonization of processes and political support. The East African Pooled Procurement Mechanism had been in operation for over three years but significant benefits were not being realized. This study sought to understand how this pooled procurement intervention was implemented, challenges encountered and key strategies for the realization of intended outcomes. A census survey was conducted among members of the pooled procurement steering committee. Data was collected through questionnaires, a focus group discussion and individual interviews. Collected data was analyzed using content and thematic analysis approaches. The results revealed that implementation of the East African pooled procurement intervention involved, for the most part, elements of successful implementation of pooled procurement mechanisms. These were stakeholder engagement; situation analysis; consensus building and implementation planning; setting up of a central procurement agency and managing and organizing procurement. However, a myriad of challenges were faced in the implementation of this intervention. The major ones were conflicting legislations and regulations for health products across the East African countries and limited financial resources for procuring health products and meeting administrative costs. As a result, there were marginal cost savings and delays in delivering or non-delivery of health products to medicine supply organizations. In view of the major challenges, it is recommended that the initiative adopts the third or fourth model of pooled procurement, to navigate country legislations and regulations for health products; a revolving drug fund for sustainable financing is implemented for organizations that are not financially stable and a continuous quality improvement system through reporting, monitoring and evaluation system is established.
An Assessment of the implementation of the Free Maternal Services in Murang’a County Referral Hospital
(2018) Gikera, Leonard
This study aimed to establish the trends of utilization of FMS services at Murang’a County Referral Hospital between 2013 and 2017, to assess the readiness of the hospital to offer FMS and to explore the contextual factors affecting the implementation of FMS. The study adopted a mixed method design. Quantitative data on trends of the use of FMS was obtained from the hospital records. A checklist was used to assess the services availability and readiness, while a qualitative inquiry was done using semi-structured one-on-one interviews with key staff involved in the provision of maternal care at the health facilities. Quantitative data was analysed using SPSS while the qualitative data was analysed using a thematic framework analysis. There was demonstrated initial increase in utilization of skilled care in 2013 after elimination of user fees followed by decreased utilization in 2016 and 2017 which was attributed to unavailability of the services especially during the periods of industrial unrest by health workers and quality concerns. The outcomes however did not show significant improvement. The main challenges identified were inadequate and de-motivated health care workers, shortages of inputs like drugs and other health commodities, lack of continuous quality improvements structures, overcrowding due to inadequate physical facilities and uncompensated loss of revenue. The study recommends development of a robust and well-funded HR system at the county and facility levels. This will address recruitment, motivation, training and retention of health workers; Ring fencing health funds at the county level to ensure uninterrupted service provision; Upgrading of the physical infrastructure, especially the decongestion of the post-natal ward and establishment of an ICU; Strengthening the hospital and county Human Resource (HR) department; and Motivation of the healthcare workers through enhanced remuneration, provision of training and improved working conditions.
An assessment of the state of public healthcare governance in Tana river County, Kenya
(Strathmore University, 2018) Mwikairi, Mwenda Nicholas
There are six (6) building blocks in the health systems, namely health service delivery, health information systems, healthcare financing, health workforce, medical technologies and products and health leadership and governance. Since devolution of healthcare services in Kenya in 2013, there has been an increased investment in the various building blocks of healthcare, with varied improvement in health outcomes. Health leadership and governance has not received much attention of the blocks of the healthcare system. To foster accountability, transparency, integrity, professionalism, customer focus and innovativeness, H.E Uhuru Kenyatta launched Mwongozo, the Code of Governance for State Corporations in 2015, as a firm foundation and guide for the management, governance and oversight to state corporations and public bodies as grounded in Kenya’s constitution’s values and principles as well as best global practices of governance. The code is to be implemented on a ‘Comply or explain’ basis, meaning that public bodies may adopt this code to suit their field, with the stakeholders’ being the goal. The general objective of this study was to assess the extent to which Tana River County has complied with the Mwongozo Code of governance for State Corporations. Data was collected from five health facilities’ governance bodies through use of structured and unstructured questionnaires and by use of a focus group discussion..‘R’, free software for descriptive statistical computing and graphics, was used for analysis. The study revealed that healthcare governance bodies in Tana River County are neither constituted nor operated in line with the Mwongozo code of governance for state corporations. The study also revealed that current health governance bodies have limited capacity to effectively offer strategic direction and oversight to the healthcare system in Tana River County. The study identified lack of legitimacy, financial weakness, low technical capacity and lack of a structured appointment of healthcare governance body members as some of the challenges facing healthcare governance. The study recommends creation of policies and structures to aid recruitment and empowerment of health governing bodies that are capable of effectively carrying out their roles according to the Mwongozo code and global best practices.
Bedside rationing by frontline healthcare workers: a case study of St.Francis community Hospital
(Strathmore University, 2018) Wanjiru, Grace
Studies on bedside rationing in developing countries such as Kenya are scanty. Bedside rationing entails implicit or explicit withholding of essential healthcare services from clients. The existing literature on bedside rationing in developed countries cannot be generalized to middle-income countries because of contextual differences. This study examined bedside rationing among frontline healthcare workers in St. Francis Community Hospital, which is a faith-based hospital located in Nairobi County off the main Thika High way 2 kms to Kasarani Mwiki Road in Kenya. The study used an explorative case study methodology and collected data using in-depth qualitative interviews. A purposive sample of 10 nurses was selected. A thematic analysis approach was used for data analysis. The study found that four forms of bedside rationing are practiced at St. Francis Community Hospital. The rationing includes deflection, deterrence, delay, and termination. Medical, patient, and hospital-related considerations determine the criteria used for bedside rationing. Additionally, factors affecting bedside rationing include unavailability, resource optimization policies, and skill empowerment at the management and operations levels. Bedside rationing was reported to compromise the quality of care provided at the hospital. Hiring more specialized doctors and nurses, providing extra beds, construction of new wards, new sources of funding, collaboration with medical training institutions and more support from the government to deal with negative effects of bedside rationing were reported as possible ways to reduce the negative effects of bedside rationing on care delivered. The study recommends development of new resource optimization guidelines consultation nurses. The hospital should undertake ethical rationing training to maintain quality of the care services. Financial partnership and liaising with the government for resource allocation will be imperative St. Francis Community Hospital offers complimentary services during strike. Future studies should focus on bedside rationing decisions among frontline healthcare workers in public hospitals and other faith-based hospitals.
Determinants of client loyalty amongst outpatients at the Meridian Equator Hospital
(Strathmore University, 2018) Khosla, Gurpreet
The private health sector continues to grow exponentially across low- and middle-income countries such as Kenya, which has caused increased competition. This creates a strong need for understanding client preferences and drivers of loyalty. This study proposed to identify the determinants to outpatient client loyalty at a mid-sized private hospital in Kenya. The study measured loyalty among clients visiting the outpatient department of the Meridian Hospital and identified the factors that clients consider most important on where to seek services. The study further described the patterns of association between selected client and disease characteristics and factors identified by the clients as most important for loyalty. A mixed methods cross-sectional study design was used to collect primary data from eligible outpatients attending the Hospital over a two week study period. An average of 13 outpatients were sampled each day using a systematic sampling approach. Data was collected through a self-administered questionnaire. Analysis was done and descriptive statistics presented. Inferential statistics were used to measure the strength of the association between the patient characteristics and the factors identified by clients as most important for loyalty. The results showed that the physical factor, location of facility was most important, followed by service factors and cost factors. Behavioural and cultural factors weighted the least in client considerations for loyalty. Most patients perceived the quality of the health care services to be high, with tangibles as the highest rated service dimension and empathy having the lowest rating. It was found that there is a positive association between perceived service quality and both customer satisfaction and customer loyalty. It was also found that customer satisfaction has a very strong association with customer loyalty. The findings of this study will inform decision making by helping the management of Meridian Equator Hospital to prioritize for quality improvement the dimensions of quality with the greatest impact on customer attraction and retention. Study findings will also inform policy and practice on ways of attracting and retaining clients with different socio demographic and disease characteristics.
Determinants of enrollment and retention of organized members of the informal sector into National Hospital Insurance Fund Nairobi County
(Strathmore University, 2018) Ariga, Christine
The global agenda focus is on how countries can adopt context specific initiatives towards realizing Universal Health Coverage as emphasis by the post 2015 development agenda(United Nations, 2015). The Kenya health financing strategy (2017) emphasis on Universal Health Coverage and envisions the National Hospital Insurance Fund (NHIF) as the primary provider of health insurance as the vehicle for delivery of UHC. The study sought to assess the determinants of enrolment and retention of organized groups of the informal sector into the NHIF Kenya with the aim of contributing to the knowledge on how social health insurance schemes can achieve Universal Health Coverage. The study target population was the informal sector members of organized groups (Self-help groups) in Kibera constituency Nairobi County. The objectives of the study were; to assess the views of informal sector workers about the improved benefit package , to describe the knowledge of benefit entitlements among organized members of the informal sector in Kibera and to examine access to the entitlements in terms of availability, affordability and accessibility. A descriptive cross-sectional study design was adopted with mixed method approach and sample size of 88 respondents from the study population was interviewed using a semi structured interview guide. Qualitative data were analyzed using content analysis, Quantitative data were entered into the statistical, package for social sciences (SPSS) version 24 and organized for statistical data analysis using descriptive statistics. The findings were summarized and presented using tables, figures and percentages. The result findings were that the members of the informal sector in Kibera view NHIF membership as essential and would recommend it to potential members. Majority of respondents are aware of 59 % of the NHIF benefit entitlements whereas 41% are not aware. Access of entitlements as a determinant of enrollment was assessed and it was found out that the distance to the accredited facilities was within World Health Organization recommendations and the benefit package was affordable and acceptable however 54% of the respondents stated that the benefits were not available at the chosen health care providers and thus affected utilization of these benefits and their satisfaction with the benefit package . The unmet demand of the benefit package therefore influenced the perception of NHIF and enrollment and retention of the informal sector.
Determinants of retention strategies for health care practitioners in public health facilities in Kenya: a case of County Hospitals in Nairobi Kenya
(Strathmore University, 2018) Kamaara, Sheila Nduta
At the heart of each and every health care system, the workforce is central to advancing health. Healthcare is a labour- intensive industry and therefore retention and growth of is important. This study seeks to determine the retention strategies used by public health facilities where brain drain has become rampant in the facilities. The study sought to determine the retention strategies by looking at the following three aspects of the facilities. First the study looked at the relationship between the motivation strategies used and how they influenced staff retention in the public health facilities. Secondly, the study looked at the relationship between employee relations management strategies adopted to enhance the retention of healthcare practitioners in Kenya. Thirdly, the study focused on the professional growth strategies that are in place and how they influenced retention of healthcare practitioners in the public healthcare facilities. The study was based on various theories on employee behaviors such as the Expectancy theory and Maslow’s Theory. To achieve these objectives, the data was collected at the 3 County hospitals in Nairobi County (Mama Lucy Kibaki Hospital, Mbagathi County hospital and Pumwani Maternity Hospital) where a sample of 165 respondents was drawn using simple random sampling method. Primary data was collected using a semi structured questionnaire. Data was analyzed using SPSS (Version 20.0). Basic descriptive statistics were used as well. The data was then analyzed through percentages, frequencies, mean, standard deviation and inferential statistics. The findings were presented in tables, graphs and narratives for easy comparison. The study found out that all the variables had a positive and significant influence on employee retention. Motivation strategies had a significant influence on employee retention as shown by the coefficient (β = 0.365, t = 4.433, p> 0.000). Employee relations management strategies also showed a significant influence on employee retention with the coefficients (β = 0.168, t = 32.132, p> 0.005) indicating a positive effect employee retention. Professional growth strategies as well showed a significant influence with a coefficient of (β = 0.309, t = 3.781, p> 0.000) showing a positive and significant relationship. The study concluded that the hospital supervisors should usually discuss issues affecting employees with them and other employees and mentor and coach them. The study recommended that the hospitals should have a clear career development plan for their employees which improve their retention.
Determinants of uptake of National Hospital Insurance Fund (NHIF) membership among motorcycle riders in Kakamega County
(Strathmore University, 2018) Mose, Cliff A.
Health insurance is important in mitigating the financial 1isks associated with getting ill illness is associated with loss of productivity as one recuperates and loss of resources that are spent on paying for health care. Prolonged illness may also lead to loss of a means of livelihood if one is incapacitated for one reason or another. Health insurance thus plays a big role in offering financial risk protection and reduces risk of impoverishment due to catastrophic health expenditure arising from sickness or accidents. There is a great push towards prepayments for healthcare. Health insurance being a form of prepayment that needs a lot more support from government as a regulator and as a custodian of social welfare. Use of motorcycle for transport is a phenomenon that is quite prominent in rural and urban Kenya because of its convenience and affordability. Motorcycle industry employs a big number of youths and adults who earn a living by provide transport for both people and goods. The industry has been plagued by a great number of motorcycle accidents leading to a great strain in our health sector through long periods of treatment and congestion of the orthopedic wards in all major hospitals in the country. The many accidents on our roads are a pointer that motorcycle riding is a high-risk tmdertaking. This coupled with the blatant abuse of the Highway Code by motorists puts many riders in a precarious position everyday as the search for a living. The study sought to tmderstand the reasons behind the low enrolment into NHIF our most prominent insurer who provide an affordable and attractive enhance package that we believe would help mitigate the risks faced. The study setting is in Kakamega central sub county where a total of 140 boda boda riders were interviewed. A cross-sectional survey study setup was chosen and systematic sampling done. The data collection tool used was a semi structured questionnaire that data was cleaned and coded for analysis using STAT A version 15. In the findings there was 50 % enrolment in the scheme by the boda boda rider. The study recommends enhancing NHIF forums to improve information and awareness, review of penalties for missed premium contributions, quality improvement programs as well as overall health system strengthening through transformation of NHIF into a social insurance to help Kenya achieve UHC
The effect of hospital accreditation on the job satisfaction of nurses: a case study of Aga Khan University Hospital-Nairobi
(Strathmore University, 2018) Adhiambo Owino, Evangeline
Accreditation is an externally administered instrument to promote continuous quality improvement. In July 2013, Aga Khan University Hospital (AKUH)-Nairobi was accredited by the Joint Commission International (JCI). It became the first hospital in East Africa to receive this accreditation. The JCI accreditation process is both time consuming and resource intensive. It brings about various organisational and job-related changes, which ultimately affect the workload and quality of work life of staff. This study sought to assess the effect that accreditation has had on the job satisfaction of nurses working at AKUH. This was a cross-sectional mixed methods study, combining quantitative and qualitative approaches. It was a case study of nurses working in the maternity department of AKUH. Quantitative data was collected through a questionnaire survey. Two focus group discussions were also conducted for the qualitative component. Thematic content analysis was used to analyse qualitative data, while descriptive statistics was used for quantitative data. This study established that hospital accreditation brings about both positive and negative changes to the work environment. 76% of participants agreed that the department became better equipped after accreditation. Teamwork was also seen to have improved since accreditation. However, staffing levels were seen to be inadequate which resulted in heavier workloads and overtime work as accreditation came with extra demands for staff including compulsory documentation. Another important aspect of accreditation was JCI surveys which are mandatory. These were seen to cause high levels of stress. The nurses also noted that they are not really involved in decisions affecting their work since accreditation. Accreditation resulted in feelings of pride and achievement. However nurses lacked recognition and advancement opportunities. Overall, most nurses were proud to work in an accredited hospital but job satisfaction was low with 74% of respondents saying that they were not satisfied with their jobs.
The effect of market orientation on business performance: evidence from two private healthcare institutions in Kenya
(Strathmore University, 2018) Odhiambo, Omolo Ezra
The relationship between market orientation and business performance has been widely studied by scholars in marketing. Even though these studies have concluded that market orientation leads to better business performance, no studies of this nature have been done in the healthcare sector in Kenya. The purpose of this study was to test this relationship in the healthcare context in Kenya. The findings would be useful for healthcare managers in Kenya on whether to adopt it as a strategy in healthcare business or not.The study measured the effect of market orientation on three aspects of business performance in the private health sector in Kenya. These are employee performance, financial performance and customer satisfaction. Data was collected from a total of 37 respondents 11 being marketing executives and 26 being health center managers representing a total of 26 outpatient health facilities. Regression models were done and tests of correlation and significance carried out. The study found that market orientation positively influences customer satisfaction, employee performance and financial performance with the strongest association seen with customer satisfaction and the weakest with financial performance. This study therefore affirms the importance of market orientation as a strategy by healthcare managers in improving business performance. It is recommended to healthcare managers to seek to adopt practices and develop cultures that would lead their organizations to become more market oriented. More studies need to be conducted that are larger than this study to further test this relationship in the Kenyan Healthcare context.