Factors influencing implementation of the safe motherhood, maternal and neonatal health component of the National Reproductive Health Policy (2007) in Nairobi County
Mbae, Jessica Karimi
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This study investigated factors influencing the implementation of the safe motherhood, maternal, and neonatal health component of the National Reproductive Health (NRHP) (2007) in Nairobi County using Mazmanian and Sabatier’s policy implementation framework. The investigation sought to determine the extent to which human resources, financial resources, hierarchical integration, and stakeholder involvement influenced the implementation of these components of the Policy. A mixed-methods approach consisting both qualitative and quantitative methods was applied. The 101 public health facilities in Nairobi County were the units of analysis and the unit of observation was senior health officials in the facility. The sample size was established as 80 respondents. A structured questionnaire was used to collect primary data, which was supplemented by literature review. The qualitative and quantitative data was analyzed using content and thematic analysis and statistical methods respectively. The quantitative findings are presented in figures and tables. These findings show positive and significant correlations for financial resources, hierarchical integration, and formal access by outsiders; and positive and nonsignificant correlations for human resources. The composite model (human resource, financial resources, hierarchical integration, and formal access by outsiders) had a 40.8 % effect on implementation of this component of the NRHP and the model was a good fit for the data given the positive F statistic (F = 12.291) at significance level p < 0.05. Linear regression analysis showed that formal access by outsiders (stakeholder participation) had the largest and only statistically significant effect on implementation of safe motherhood, maternal and neonatal health component of the NRHP (2007). The study thus recommends more concerted efforts toward stakeholder participation if implementation towards achieving the goals of the NHRP (2007) is to be realized. This calls for strategic stakeholder mapping and analysis, and for increased consultations with stakeholders including global health organizations such as WHO and UNICEF. The study was however limited to Nairobi County, and to this particular policy, and so the findings may not necessarily be generalizable.