MBA-HCM Theses and Dissertations (2018)

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    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.
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    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
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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.
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    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.
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    Effects of co-payments on utilization of healthcare services at a private out-patient facility: a case study of AAR healthcare Kisumu Out-patient Centre
    (Strathmore University, 2018) Gone, Michael
    Rising cost of healthcare is a concern worldwide. In Kenya, this has seen insurance companies report losses despite increase in premiums. In order to control the rising costs, insurance companies have introduced co-payments on healthcare services with an aim of controlling utilization by limiting visits, costs, drugs and diagnostics. However, the effectiveness of co-payments in reducing utilization is still unclear, with some studies arguing that it has little or no effect. A retrospective cross- sectional study was carried out at AAR Healthcare Kisumu Outpatient Centre amongst AAR insurance patients seeking healthcare services at the facility. The study sought to determine if presence of a co-payment affects utilization and cost of various healthcare services. Data of approximately 3238 AAR insurance patient visits over a period of 6 months was obtained from the facility CIMS and ERPS systems. Descriptive analysis was done presenting counts (percentages), means (standard deviations) and medians (interquartile ranges (IQR)). Bivariate analysis tests for differences in the demographic and clinic costs 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 analyzed in terms of average cost per visit, number of laboratory tests done and number of drugs issued to clients with no co- payments, those paying Ksh. 50, those paying Ksh. 200 and those paying Ksh. 500 as co-payment. The study revealed no significant effect of a co-payment on the utilisation of healthcare services. There was no significant difference in the cost of a visit based on the co-payments status. The number of medication prescribed did not depend on the co-payment status. There was no significant difference in the laboratory tests ordered between those who had co-payment and those who did not have a co-payment; however there was a significant difference in the utilisation of laboratory tests based on the amount of co-payment paid, with the patient visits with a co-payment of Ksh. 50 having significantly less laboratory tests done. The results from the study can be used to inform policy on healthcare financing.