Masters Theses and Dissertations

Factors Influencing the Implementation of Performance Contracting Among Public Health Officers in Nyeri County Kenya

2025-10-01T00:00:00Z

Factors Influencing the Implementation of Performance Contracting Among Public Health Officers in Nyeri County Kenya MWANIKI, DENIS MURIITHI Performance contracting (PC) has been institutionalized within Kenya’s public health sector as a reform strategy to strengthen accountability, improve efficiency, and link rewards and sanctions to objectively verifiable results. However, despite its adoption, declining health indicators continue to be observed nationally and within Nyeri County, signaling persistent gaps between policy formulation and practical implementation. This study, therefore, examined the factors influencing the implementation of performance contracting among Public Health Officers (PHOs) and Public Health Technicians (PHTs) in Nyeri County. Specifically, it explored how government policies, stakeholder involvement, human resource (HR) strategies, and institutional factors shape PC implementation. A descriptive cross-sectional research design was employed, targeting all 112 PHOs and PHTs, from which 89 respondents were selected through stratified random sampling. Data were collected using structured self-administered questionnaires validated through expert review and pre-tested. Analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 24.0, applying descriptive statistics, Spearman’s correlation, and multiple regression analysis at a 0.05 level of significance. Results showed that all four independent variables significantly influenced PC implementation (R² = 0.681, F = 45.217, p < 0.001). HR strategies (β = 0.312, p = 0.001) and institutional factors (β = 0.287, p = 0.003) were the strongest predictors, underscoring the role of motivation, training, leadership, and supportive work systems. Correlation coefficients ranged from r = 0.492–0.615 (p < 0.01), indicating moderate to strong positive relationships among the variables. The study concluded that the success of performance contracting depends on integrating clear policy direction, participatory stakeholder engagement, effective HR strategies, and institutional leadership. It recommends strengthening HR capacity-building programs, aligning county policies with devolved operational contexts, and institutionalizing feedback mechanisms. The study contributes to public health management by providing empirical evidence to guide policy and managerial decisions on optimizing performance contracting in devolved health systems.

Factors Influencing Evidence-Based Decision-Making Among Specialized Nurses Working in Selected Health Facilities in Nairobi, Kenya

2025-10-01T00:00:00Z

Factors Influencing Evidence-Based Decision-Making Among Specialized Nurses Working in Selected Health Facilities in Nairobi, Kenya Agure, Safari Evidence-based decision-making (EBDM) and practice among nurses in Kenya, is largely unexplored. The study was designed to determine the factors influencing the utilization of evidence by nurses for decision-making and practice. In 2024, a concurrent, triangulation mixed methods study was designed, targeting nurses working in maternal and child (Reproductive) wards in selected facilities in Nairobi County with the sites being all public facilities of levels 4 and 5. A 5-point Likert scale questionnaire was administered to all nurses found working on the day the researcher visited the facility. Key informant interviews were also conducted on the same day. Ethical approval was sought from Kenya Methodist University and individual respondents completed Informed consent forms prior to participation in the study. All other ethical considerations required were adhered to. Quantitative data analysis was carried out using SPSS version 22 statistical software. Exploratory data analysis (EDA) was employed at the initial stage of analysis. Bivariate level analysis was used to assess the association of independent variables with EBDM utilization using Chi-square test and/ or Fisher’s Exact Test. All variables with a P-value < 0.25 in the bivariate analysis were subjected to multivariate analysis. Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CIs), were used to evaluate the strength of statistical association between dependent and independent variables. Qualitative data was managed using thematic analysis. Results show intuition is the most applied thought paradigm among nurses for decision making alluding to the importance of tacit knowledge in nursing. Factors that emerged as significantly associated with EBDM among reproductive nurses were individual in nature. The findings of this study are expected to inform policy and management efforts to enhance nurses’ decision making. As without nurses’ engagement with evidence and learning, EBDM contributions will continue to be negligible, it is recommend that more research be done to enhance institutional factors and the use of intuition to support EBDM. As well, strategies for harvesting tacit knowledge should be enriched.

An Assessment of Factors Influencing Clinical Learning Among Diploma Nursing Students at Moi Teaching and Referral Hospital Eldoret, Kenya

2025-06-01T00:00:00Z

An Assessment of Factors Influencing Clinical Learning Among Diploma Nursing Students at Moi Teaching and Referral Hospital Eldoret, Kenya Robert, Salome Nkatha Clinical learning is a critical component of nursing education worldwide, enabling students to develop practical skills through supervised patient care. Globally and regionally, nursing students face challenges such as inadequate supervision, resource shortages, and a persistent theory-practice gap, particularly in low- and middle-income countries. In Kenya, despite nurses demonstrating strong overall competencies, diploma nursing students often underperform in clinical placements compared to theoretical assessments, highlighting a pressing need for context-specific investigation. This study assessed factors influencing clinical learning among 304 diploma nursing students at Moi Teaching and Referral Hospital (MTRH), Kenya. The objectives were to: (a) identify student-related factors; (b) evaluate training institution-related factors; (c) examine clinical setting-related influences; and (d) explore students’ experiences with the preceptorship model. Using an explanatory sequential mixed-methods design, the study samples 304 nursing students by census sampling to complete questionnaires as well as 24 students participating in a total of 4 Focus Group Discussions (FGD). Quantitative data were analyzed with SPSS version 27 using descriptive statistics, chi-square tests for associations, and multivariate regression to identify predictors of clinical performance (p ≤ 0.05). Qualitative data underwent thematic analysis to enrich understanding of preceptorship experiences. Among the 304 respondents, key quantitative findings included: 37.83% (n=115) strongly disagreed that clinical supervision was adequate (χ²=15.7, p=0.001); 36.51% (n=111) reported ineffective teaching methods (χ²=12.4, p=0.004); and 33.88% (n=103) experienced poor cooperation with clinical staff (χ²=10.8, p=0.013). Anxiety and financial constraints were notable student-related barriers (anxiety χ²=11.5, p=0.009). Regression analysis revealed that training institution-related (β=0.32, p=0.002) and clinical setting-related factors (β=0.28, p=0.005) significantly predicted clinical performance, explaining 12.5% of variance (R²=0.125, F=7.64, p=0.003). Qualitative themes included supportive preceptorship fostering confidence and skills, resource limitations such as PPE shortages, and the persistent theory-practice gap due to inconsistent clinical guidance. In conclusion, inadequate supervision, poor teaching methods, and resource scarcity are significant barriers to effective clinical learning at MTRH. Strengthening supervision, enhancing teaching strategies, and improving clinical resources are essential to bridge the theory-practice gap and improve nursing students’ clinical competence.

Prevalence and Patterns of Psychoactive Substance Use Among Somali Youth Living in Eastleigh, in Nairobi, Kenya

2023-09-01T00:00:00Z

Prevalence and Patterns of Psychoactive Substance Use Among Somali Youth Living in Eastleigh, in Nairobi, Kenya KORIO, ADEN ABDI The usage of psychoactive substances is on the rise in many communities, particularly among the youth, and is having detrimental effects on people's health, leading to millions of deaths annually. According to a report by National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA) in 2004, the use of substances like alcohol, tobacco, marijuana, khat, and inhalants such as glue was widespread among young people between the ages of 10 and 24 in Kenya. Although the use of psychoactive substances leads to significant social and public health problems, the extent of the issue in sub-Saharan Africa is yet to be determined. This study aims to establish the prevalence and patterns of psychoactive substance use, as well as the demographic characteristics associated with its use, among the Somali community residing in Eastleigh, Nairobi, Kenya. This study was a cross-sectional survey study among consenting youth living in Easleigh North. Data is presented both in descriptive and inferential statistics. The sampled three areas in Eastleigh, known for drug abuse concerns, among sampled 270 households, out of a total of 9,408 households, aiming to interview one person per household. Data collection involved trained interviewers using questionnaires to inquire about demographics and drug use, focusing on the past 12 months. The study also utilized focus group discussions with youth aged 18 to 25, visiting sampled households for this purpose. Data collected was analyzed using SPSS version 23 to provide descriptive statistics, presented in tables and graphs illustrating psychotropic drug use categories, and significant consumption patterns were identified through t-chi-square tests based on demographic and environmental factors.This study found that 75% of youth use at least one psychoactive substance, miraa was the highest used Illicit substance (47.9%), while cannabis was the highest illicit used substances (23.9%) and prescription medication was found to be 10.3% use. Onset of all psychoactive substances was below 18 years of age. Comorbid use varied between Illicit psychoactive, (32.0% to 73.5%); illicit psychoactive substances (9.8% to 100%), Illicit substances and prescription medication (11.8% to 22.7%) and illicit substances and prescription medication (26.7% to 100%). 66.% reported reason for use to be peer pressure. Contributing factors to psychoactive substance use were other family members use (p=0.000), living conditions (p=0.003), family income (p=0.014) and gender (p=0.044). This recommends that policy makers for advocacy, sensitization, provision of appropriate treatment programs, and review training for public health workers. Recommendations for public health workers include the establishment of programs for preventions, treatment and databank, networks and linkages for referrals that incorporate other partners in mental health that include psychoactive substances

Effect of Electronic Payment System On Revenue Collection Performance of County Government of Kajiado, Kenya

2025-10-01T00:00:00Z

Effect of Electronic Payment System On Revenue Collection Performance of County Government of Kajiado, Kenya Saigilu, Jonathan Rayiani The study examined the effect of electronic payment systems on revenue collection performance in the County Government of Kajiado, Kenya. Revenue collection is a crucial aspect of county governments, enabling them to finance development projects and meet their financial obligations. Despite the adoption of electronic payment systems, challenges such as inefficiencies, fraud, and delayed payments persist. This study aimed to determine the influence of key components of electronic payment systems; online billing, receipting, payment, and response on revenue collection performance. Guided by the Optimal Tax Theory, Resource-Based View Theory, Innovation Diffusion Theory and the Technology Acceptance Model, the study employed a descriptive research design to investigate the relationship between the independent variables and revenue collection performance. The study targeted 195 respondents, including Executive Committee Members, Finance Personnel, and Revenue Officers, using stratified sampling to ensure representation. Sample size was 131. Data was collected through structured questionnaires, validated through pilot testing, and analyzed using both descriptive and inferential statistical methods, including multiple regression analysis. The findings revealed that all components of the electronic payment system significantly impacted revenue collection performance. Online billing and online response had the most substantial influence, demonstrating their importance in ensuring accurate billing and effective taxpayer engagement. Online receipting and payment also positively contributed by enhancing accuracy, convenience, and trust in the payment process. Correlation analysis further supported these findings, with strong positive relationships between the components of the electronic payment system and revenue collection performance. The results indicate that improving electronic payment systems can significantly enhance revenue collection by reducing inefficiencies, increasing transparency, and fostering taxpayer compliance. The study concludes that adopting and optimizing electronic payment systems is critical for achieving better revenue collection performance in county governments. The study recommends strengthening the online billing and response processes through continuous technological upgrades and robust taxpayer engagement mechanisms. Additionally, enhancing the usability of online receipting and payment platforms is essential to encourage adoption. Policymakers are urged to standardize electronic payment systems across counties and promote digital inclusion to address barriers to adoption. Future research could explore the long-term impacts of electronic payment systems, their scalability, and inter-county comparisons to identify best practices. This study provides actionable insights for county governments aiming to improve revenue collection efficiency through digital transformation.

Primary Healthcare Facilities' Readiness for Access to Mental Health Services in Selected Counties in Kenya

2025-10-01T00:00:00Z

Primary Healthcare Facilities' Readiness for Access to Mental Health Services in Selected Counties in Kenya MUSYOKI, MILCAH NDINDA Kenya’s primary healthcare (PHC) system faces a substantial unmet need for mental-health care, with many clients first presenting at Levels 2–4 while services remain sparse, inconsistently financed, and weakly integrated, leading to delayed detection and low uptake. This mixed-methods study examined how financing, human resources, leadership and governance, and infrastructure influence access to mental-health services in public PHC facilities in Kiambu and Makueni Counties. The study population comprised PHC facilities (Levels 2–4) and frontline providers/managers; facilities were sampled proportionally by county and level to yield 179 facilities, and 355 respondents participated, while key informants were selected purposively. Quantitative analysis used logistic regression with standard diagnostics; qualitative data were analyzed thematically. Compared with out-of-pocket payment, insurance increased odds of access (OR=1.82, p=0.014), while lack of risk pooling (OR=0.24, p<0.001) and lack of resource mobilization (OR=0.45, p=0.014) reduced access. On human resources, no mental-health training (OR=0.084, p<0.001), no mental-health skills (OR=0.076, p=0.001), and poor staff distribution (OR=0.382, p=0.046) were associated with lower access. On leadership and governance, absence of capacity building (OR=0.065, p<0.001), policy implementation (OR=0.262, p<0.001), and monitoring and evaluation (OR=0.214, p<0.001) each predicted reduced access. On infrastructure, inadequate physical infrastructure (OR=0.109, p=0.001), health products/technologies (OR=0.360, p=0.001), and ICT (OR=0.277, p=0.002) lowered access. Model performance was acceptable (Nagelkerke R2=0.608; Cox & Snell R2=0.304; Hosmer–Lemeshow χ2=3.076, p=0.215). Qualitative findings triangulated these patterns, highlighting gaps in staff capacity, policy execution and supervision, medicines and supplies, and private counseling space. The study offers an immediately usable PHC screening protocol and a context-specific integration framework. It concludes that improving access will require targeted investments in workforce upskilling, reliable psychotropic supply chains, adequate infrastructure, and strengthened governance. County governments should train medical workers and establish mental-health infrastructure in PHC facilities to mainstream treatment. Future research should extend beyond Kiambu and Makueni to more of Kenya’s 47 counties and include private hospitals.

Influence Of Strategic Management Practices on Public Service Delivery in Meru County Government, Kenya

2025-09-01T00:00:00Z

Influence Of Strategic Management Practices on Public Service Delivery in Meru County Government, Kenya Mary Mukiri, Mwiki Strategic management practices refer to deliberate and systematic actions undertaken by organizations to set objectives, formulate strategies, allocate resources, and make informed decisions to achieve their goals. These practices involve analyzing both internal and external environments, identifying strategic priorities, and implementing structured plans that guide an organization toward improved performance. Within the Meru County Government, strategic management practices are essential in enhancing efficiency, accountability, and quality of service delivery. The purpose of this study was to examine the role of strategic management practices in influencing service delivery in the Meru County Government. The study was guided by four specific objectives: to explore the relationship between performance measurement and service delivery; to determine the effect of resource allocation on service delivery; to assess the role of employee training in improving service outcomes; and to evaluate the contribution of strategic planning to enhanced service delivery. The study adopted a descriptive research design and collected quantitative data from a target population of 150 staff members drawn from the Finance, Supply Chain, and Administration departments of the Meru County Government. A census approach was employed, thereby including all 150 staff members in the study. Primary data were collected using structured questionnaires after obtaining a research permit from Kenya Methodist University. Respondents were informed about the study’s purpose and gave consent prior to participation. Data collected were coded, analyzed, and presented using descriptive and inferential statistics. The findings revealed that strategic planning and employee training play a significant role in improving service delivery within the county government. Performance measurement systems were found to be well-utilized, while resource allocation had an indirect but important effect. The study concluded that integrating planning, performance evaluation, training, and resource management enhances service outcomes. It recommends strengthening performance measurement through digital tools, aligning resources with strategic priorities, institutionalizing continuous staff training, and engaging stakeholders in regular strategic reviews.

An Examination of Threats and Countermeasures Relating to Healthcare Cyber Risks. The Case of Kenyatta National Hospital (KNH)

2025-09-01T00:00:00Z

An Examination of Threats and Countermeasures Relating to Healthcare Cyber Risks. The Case of Kenyatta National Hospital (KNH) Stephen, Ario Okongo The increasing reliance on digital technologies in Kenya’s healthcare sector has heightened the need for robust cybersecurity measures to protect sensitive patient data and ensure operational continuity. This study examined cybersecurity threats and countermeasures at Kenyatta National Hospital (KNH), the country’s largest public referral hospital, to develop a contextually relevant framework for enhancing data protection and institutional resilience. Specifically, the research investigated perceived cyber risks, the influence of the Kenya Cybercrime Act, and ethical data protection practices on the effectiveness of the hospital’s cybersecurity framework. Guided by the Socio-Technical Systems (STS) Theory, the study adopted a descriptive cross-sectional research design, utilizing a quantitative approach. A stratified random sample of 370 KNH staff, including ICT personnel, clinicians, and health records and admins, were surveyed using structured questionnaires, achieving a 98.6% response rate (365 valid responses). Data analysis involved descriptive statistics, correlation, and multiple regression techniques, ensuring robust insights into the relationships among key variables. Findings on cybersecurity threats revealed high perceived risks, particularly from external attacks (M = 4.18, SD = 1.09, Var = 1.19), device vulnerabilities (M = 3.99), and insider threats (M = 3.92). Correlation analysis showed that threats were strongly associated with the Cybercrime Act (r = 0.602, p < 0.01) and moderately with ethical guidelines (r = 0.485, p < 0.01), but insignificantly with the cybersecurity framework itself (r = 0.055, p = 0.297). Regression confirmed a significant negative coefficient for threats (B = -0.182, p = 0.007), indicating that heightened threats weaken the framework’s effectiveness. Analysis of the Kenya Cybercrime Act demonstrated moderate correlations with ethical guidelines (r = 0.539, p < 0.01) and a weaker positive correlation with the cybersecurity framework (r = 0.191, p < 0.01). In regression, the Act had a positive but marginally insignificant coefficient (B = 0.136, p = 0.054; Beta = 0.129), suggesting that while legal provisions support cybersecurity, their influence is not yet robust. For ethical guidelines, results showed a moderate correlation with the cybersecurity framework (r = 0.294, p < 0.01). Regression identified ethical guidelines as the most influential predictor (B = 0.303, p < 0.001; Beta = 0.309), confirming their pivotal role in strengthening KNH’s cybersecurity posture. The overall regression model was statistically significant (F(3,361) = 14.267, p < 0.001) with R = 0.326, R² = 0.106, and Adjusted R² = 0.099, indicating that the three predictors jointly explained about 10.6% of the variance in the hospital’s cybersecurity framework. The study concludes that ethical data protection guidelines are the strongest determinant of a resilient cybersecurity framework, while rising threats undermine readiness and the Cybercrime Act contributes moderately. It recommends strengthening ethical enforcement, embedding role-based staff training, enhancing legal compliance, and allocating resources to mitigate threats. Future research should simulate incident scenarios and assess patient data literacy across hospitals. Keywords: Cyber Threats, Cybersecurity, Data Security Framework, Ethical Data Protection, Healthcare, Kenyatta National Hospital, Kenya Cybercrime Act, Socio-Technical Systems Theory

Effect Of Employee Engagement Programs on Organizational Performance of Meru County Government, Kenya

2025-09-01T00:00:00Z

Effect Of Employee Engagement Programs on Organizational Performance of Meru County Government, Kenya Ireen, Mung’athia Mukiri Low morale of the staff, which had negatively affected the organizational performance, caused by a lack of increment in budgetary allocations towards general staff capacity building and engagement programs. The general objective of the study was to examine the effect of employee engagement programs on organizational performance of the Meru County Government, Kenya. The specific objectives were to determine the effect of training programs, wellness programs, employee feedback mechanisms, and employee involvement in decision-making on the organizational performance of the Meru County Government, Kenya. Human capital, social exchange, and participative decision-making, were the three theories of the study. Through a descriptive research design, 11 CECs, 11 directors, 11 administrators and 251 middle-level employees were included. The middle-level employees answered the questionnaires, whereas the senior-level management were interviewed. A pilot study was conducted in the Tharaka Nithi County Government. Additionally, the Cronbach alpha method was used to measure reliability. The study assessed content and criterion validity. SPSS software version 24 was used to analyze descriptive statistics such as frequencies, percentages, and means. Additionally, inferential statistics such as model summary and ANOVA were developed. Thematic method was used in the analysis of interview responses. The correlation coefficient for training programs was r = 0.501 at α <0.002; wellness programs was r = 0.387 at α < 0.001; employee feedback mechanisms was r = 0.653 at α < 0.003; and employee involvement in decision-making was r = 0.476 at α < 0.001. It was found out that all the four, were vital towards enhancing the performance of the county government. On training, there is the need for the county government leadership to develop an adequacy policy framework that would increase the budget allocated to training and development programs. On wellness programs, the departmental managers need to be more supportive of current employee wellness programs. On employee feedback mechanisms, HR management should come up with clear patterns of offering feedback on the issues raised by the employees or at least acknowledge them. Future studies should expand the study to even private corporations to gain more insights on the employee engagement programs present within their contexts. Key Terms: Employee Engagement Programs, Organizational Performance, Meru County Government, Kenya

Effect Of Zai Pits, Mulch and Manure on the Growth and Yield of Green Grams in Maragua Sub County

2025-09-01T00:00:00Z

Effect Of Zai Pits, Mulch and Manure on the Growth and Yield of Green Grams in Maragua Sub County Wilson, Gitau Kamau Green grams are crucial for human nutrition and environmental sustainability. Abundant in protein, fiber, and other nutrients, they enhance global food security, especially in areas with restricted protein consumption. Their cultivation boosts soil health and fertility, diminishes reliance on synthetic fertilizers via nitrogen fixation, and bolsters agricultural sustainability. Green grams are essential for human health, environmental sustainability, and agricultural success. However, erratic rainfall and temperature patterns significantly affect agricultural productivity, especially in arid areas such as Maragua Subcounty, Kenya. The research was directed by the subsequent objectives: (i) Evaluation of the impact of zai pits, mulch, and manure on the growth parameters and yield of green gram production, (ii) Investigation of the impacts of mulch and manure on the yield of green gram production. The data gathered throughout the experimental phase encompassed growth metrics of green gram, including leaf count, girth, height, and yield. The field experiments employed a randomized complete block design (RCBD) to guarantee the reliability and robustness of the results. The study employed an experiment to assess the impact of various treatments on the growth and yield of green gram production. Two replicates, each with its corresponding experimental units. Each replication comprises eight primary plots. The total number of plots per experimental site will be 16, yielding 96 sub-plots as each plot is divided into two sub-plots to accommodate the 8 types; this configuration will constitute a split-plot design. Each plot spans 2 meters by 2 meters, and each sub-plot has treatments implemented within an area of 60 cm by 60 cm, with a spacing of 80 cm by 20 cm between treatments. The analysis and data management of the collected data were performed using SPSS. An ANOVA test was performed to statistically evaluate the significance of the observed variations in plant height among the various treatments. The results indicated that the treatments had a statistically significant impact on plant height (p < 0.001), but site and block effects were not significant, demonstrating uniformity in the treatment response across the experimental conditions. Yield statistics corroborated these findings, indicating incremental gains from traditional farming to the integrated zai pit, manure, and mulch treatments. The traditional treatment yielded the least, whereas zai pit-based treatments, particularly when supplemented with manure and mulch, yielded the most. Duncan’s multiple range test identified seven unique subsets, demonstrating incremental and statistically significant yield enhancements with each additional treatment component. The research concludes that the incorporation of zai pits with organic soil amendments such as manure and mulch markedly enhances green gram development and yield in semi-arid conditions. The integration of these strategies improves soil moisture retention, nutrient accessibility, and general plant health, leading to enhanced vegetative growth and optimal yields. Smallholder farmers in semi-arid regions should implement integrated zai pit technology alongside organic inputs, such as manure and mulch, to optimize green gram productivity and enhance resilience to moisture stress.