MBA-HCM Theses and Dissertations (2023)

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Implementation of the WHO surgical safety checklist in Kenya - a case of Mater Misericordiae hospital
(Strathmore University, 2023) Gebre, T. S.
Surgical checklists have been used by hospitals around the world to improve process efficiency, and team coordination, reduce the adverse outcomes of surgery, and further decrease the overall cost of care. However, studies have shown that despite the use of surgical checklists, the adverse effects of surgical operations, including the rate of mortality and reoperations, remain high, especially in sub-Saharan Africa. To improve the safety of surgery worldwide, in 2008, the World Health Organization’s (WHO) Patient Safety Program published the WHO Surgical Safety Checklist, a nineteen- item checklist that acts as a visual aid designed to foster adherence to recommended standards of care and team communication. The checklist has had significant improvements in surgical processes and surgical outcomes in different hospitals, though most of the evidences are reported from high-income countries. The implementation of the checklist, the information on its use, and its impact in low-income countries remain poorly understood. This study sought to examine the implementation experiences of using the WHO surgical checklist and its influence on the delivery of surgical services in a private hospital in Kenya. The study was anchored on Causal Analysis based on Systems Theory. The study was limited to Mater Misericordiae Hospital since it’s the leading institution in the country providing a surgical training program and is aacreditaed as a center of excellence for cardiac surgeries. A mixed-methods research design was adopted. The population comprised surgeons, anesthetists, theatre nurses, and medical officers working in the surgical department. Data was collected using semi-structured questionnaires and an interview guide. Quantitative data was cleaned, coded, entered, and analyzed through descriptive statistics using SPSS Version 22.0, while qualitative data were manually coded and thematically analyzed through content analysis. The study found that majority of the health care workers at the Mater Misericordiae hospital were aware of the WHO SSC, and majority used the checklist in the surgical processes in the hospital, but not always. The health care workers acknowledged that the WHO SSC was easy to use; helped reduce human errors; and enhanced the patient’s safety in the operating room. The study concludes that aspects such as communication among team members facilitated effective implementation of SSC while barriers such as the high bulk of surgical cases, the turnaround time between cases, lack of resources, understaffing, and lack of adequate training hindered the effective use and implementation of the checklist in the hospital. The study recommends that periodic training for surgical staff to enhance their knowledge and use of the SSC and allocating more resources to ensure adequate and well-trained staff is recommended. This would lead to practical use and implementation of WHO SSC as well as frequent monitoring to ensure compliance with the checklist at all levels in the hospital.
Health workers’ perceptions towards implementation of Universal Health Coverage pilot at Machakos Level 5 Hospital in Kenya
(Strathmore University, 2023) Abuto, W. A.
This study explores the perceptions of frontline healthcare workers on the implementation of Universal Health Coverage (UHC) pilot in Machakos County, Kenya. UHC is an initiative that aims to provide quality healthcare services to individuals and communities without financial hardship. The pilot was launched in December 2018 in four counties as part of President Kenyatta’s Big Four Agenda for socio-economic development and was intended to run for one year. The study employed a qualitative design using in-depth interviews with frontline healthcare workers in Machakos Level 5 Hospital. The findings revealed that the participants had a positive attitude towards UHC, but also faced various challenges such as inadequate funding, human resources and misuse of services by patients. The participants also suggested subsidized payments from users instead of complete removal of fee and supported the role of NHIF as a driver of the program. The study recommends a sustainable healthcare financing approach, provision of adequate human resources for health and stakeholder involvement and sensitization in decision making for successful scaling up of UHC.
Relationship between task shifting and service delivery in informal settlements: a case of community health volunteers in Kibra
(Strathmore University, 2023) Kiranka, K. N.
Human Resource for Health is an essential pillar in provision of quality and responsive health care services for the population. However due to the shortage of health care workers in sub-Sahara Africa and worse in Kenya, the WHO has recommended the need for other strategies like task shifting as a way of managing these challenges. This study therefore sought to evaluate the strategy of task shifting and its implications on service delivery of non-Communicable diseases by the community health volunteers in the informal sector of Kibera in Nairobi County. The objectives of the study were to establish service delivery of community health volunteers on noncommunicable diseases, assess the effect of community health volunteers' skills on service delivery, evaluate the effect of training of community health volunteers on service delivery and determine the effect of motivation of community health volunteers on service delivery. The ability, motivation and opportunity theory and expectation theory were used to guide this study. The current study adopted a positivist approach. A descriptive cross-sectional design was used. The study targeted community health volunteers in Kibra. Slovin’s formula was used to calculate the sample size of 144 respondents. A semi-structured questionnaire was used to collect data from the respondents. Descriptive and regression analysis were used to analyse data using SPSS. Results were presented in form of tables and graphs. This study's findings exhibit that skill, motivation, training attributes, gender, age, and education level explained 58.2% of the total variation in service delivery (R2 = .582, F (17, 108) = 8.85, p < .001). This model had the greatest R square (R2) showing that skill has a significant positive effect on service delivery (β = .413, p < .01). On average, every unit increase in skill rating is associated with a .413 unit increase in service delivery rating, all else fixed. The study recommended that skilling of CHVs with regard to NCDs be given more weight as the other soft skills are, harmonize training calendar and creatively always find more sustainable ways of incentivizing the CHVs.
Co-payment fee and utilisation of healthcare services: the case of out-patient insured patients at Aga-Khan Hospital Mombasa
(Strathmore University, 2023) Twahir, H.
Third party payers of health such as health insurance companies whom for a long time have been reporting losses (despite an increase in the premium contributions), introduced gate keeping measures such as co-payments to try to control utilisation of health services by patients by reducing hospital visits, consultation, laboratory and pharmaceutical costs. Co-payments introduce out of pocket payments health, a key component in reducing universal health care. The effectiveness of these co-payments in reducing utilisation of health services/ health costs and resulting in savings for the health insurance companies is however still unclear, with some studies arguing that it has little or no effect and some actually having opposite effects of increasing health costs. This was a retrospective cross-sectional study carried out at the Aga-Khan Hospital, Mombasa Outpatient department (OPD) centers amongst different patients seeking healthcare services at the facility. Study patients included all insurance patients seeking health services at these different OPD centres. Those on co-payments were compared with those on no co-payments, seeking to determine if the presence of co-payments affected utilisation of various healthcare services and if so by what extent and at what difference in costs. Utilisation of health was determined through assessing patient numbers and cost. Data of more than 108,000 patients who visited the hospital over a 12-month period in the year 2021 was obtained from the Hospital Management Information System. Descriptive analysis was done presenting counts (percentages) and means (standard deviations) of the different variables. Bivariate analysis tests for differences in the hospital visits among the co-pay groups was done using Chi square tests for categorical variables and one-way analysis of variance (ANOVA) and median tests for the continuous variables, presenting the p values. Utilisation of health services was analysed by mainly comparing number of visits and costs of the different health services in the study population. The co-payment group was further divided into four tiers of co-payments (Kshs 1-500, 501-1000, 1001-1500 and 1501-2000). The findings showed that co-payments generally had the effect of increasing cost of utilisation of healthcare compared to when there was no co-payment and also affected the number of patients attempting to utilise health. Co-payment tier of Kshs 1-500 had the highest number of patients seen for those on co-payment and the number of patients generally decreased as co-payment increased. In conclusion, the study showed that, co-payments affected the overall costs of a patient visit to the hospital. There was also a significant difference in the consultation costs, laboratory costs and pharmaceutical costs per hospital visit of those on co-payment comparing those not on co-payment with those on co-payment paying more to see a doctor at the outpatient department compared to those not on co-payment. The overall utilisation costs per visit were also significantly higher in those who paid co-payment versus those that did not. Analysis of the different tiers of co-payments showed a significant difference in cost of utilisation in some aspects of healthcare in some tiers of co-payments. These results can thus be used by both the insurance companies and other stakeholders in the health industry to influence policy on health financing.
A Descriptive study on nutrition knowledge and dietary practices among adults with Type 2 Diabetes Mellitus and Hypertension at Kitale County Referral Hospital
(Strathmore University, 2023) Kiarie, R. W.
Non-communicable diseases (NCDs) are the leading global cause of death, with most of these deaths occurring in low to middle- income countries (LMICs). Hypertension and diabetes are two of the four major NCDs, and they are often comorbidities, meaning that they occur at the same time. Morbidity and mortality is usually a result of long-term complications, and apart from medical therapy, these can be prevented by lifestyle interventions that include dietary modifications. This study sought to describe the nutrition knowledge and dietary practices of patients with type 2 diabetes and hypertension. The focus was on patients receiving care at the Kitale County Referral Hospital in Trans Nzoia County, and the study objectives were to (i) assess patients’ knowledge of dietary influence on diabetes and hypertension, (ii) assess sociocultural influences on patients’ dietary practices, (iii) assess patients’ willingness to change their dietary practices, and (iv) assess patient’s awareness of their dietary practices. The study was supported by the Social Cognitive Theory, which is premised upon the reciprocal interaction between individual, behavioural and environmental factors. These factors interact to formulate the control that an individual has over their illness, thereby influencing their motivation to perform self-care activities. This descriptive cross-sectional study utilized quantitative techniques by use of structured questionnaires as the main data collection instrument, in a target population of 973 and a sample size of 283 respondents. Data analysis was carried out using SPSS software, quantitative techniques were used to analyze the data, and descriptive techniques were applied to analyse the characteristics of the respondents. The following conclusions were made from the results: that majority of the participants understood the role of diet in the management of these two conditions; that some cultural practices posed a challenge to some participants, and that they had the family, spousal and social support they needed; that participants were willing to change their dietary practices and adhere to the recommended diet regimens; that most participants had received adequate nutrition education and counselling, however eating balanced diets was a challenge, they were not able to find all the foods they had been advised to eat, and they had to think about the cost of buying these foods. The study recommends sustained efforts in patient education, inclusion of experiential learning through the use of a hospital kitchen in order to contextualize use of locally available foods, and strategies to combat food insecurity especially among the ageing population in the county.

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