MBA-HCM Theses and Dissertations (2021)

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    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.
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    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.
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    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.
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    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.
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    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.