Influence of Accountability on Health System Responsiveness: A Case of Pumwani Maternity Hospital Nairobi, Kenya

Abstract

Health and healthcare are essential to functioning of a society. While the government of Kenya is constitutionally mandated to ensure highest level of healthcare for all of its citizens, a number of hurdles remain on the way to realization of such priorities. To improve health system performance, accountability has been considered key to reducing abuse as well as assuring compliance with procedures and standards. The current study purposed to examine the influence of accountability mechanisms on health system responsiveness, focused on Pumwani Maternity Hospital, Kenya. The study was guided by the Principal-Agent and Complex Adaptive Systems theories. This study used correlation research design. The target populations were patients and employees at Pumwani Maternity Hospital. The hospital had a total of 206 employees at the time the study was conducted. Among the 206 employees 13 were departmental heads who were used as key informant. Yamane formula was used to get a sample of 130 hospital staff members. Primary data was collected using questionnaires, key informant guide and focused group discussions. Questionnaire was used to obtain information from hospital staff members. Key Informant Guide was used to collect data from 13 departmental heads. Focused Group Discussions (FGDs) was used to collect data from patients. Five FGDs of five patients were formed who took part in the discussions. Procedure for data collection comprised seeking permission from the National Commission for Science, Technology and Innovation through the Kenya Methodist University School of Post Graduates. A pretest was conducted at the Nakuru Level 5 Hospital. Data were analyzed both using descriptive and inferential statistics and thematic content analysis for quantitative and qualitative data respectively. The findings revealed that hospital staff involves patients in decision making. In addition majority of hospital staff agreed that they adhere to professional codes of conduct. The findings also revealed that the hospital has informal payment/user fees. From the findings the study concluded that there is a weak positive significant correlation between professional accountability and health systems responsiveness (r=.382**). In addition the study concluded that there is a moderate positive significant correlation between institutional accountability and health systems responsiveness (r=.547**).The study further concluded that there is a weak positive significant correlation between financial accountability and health systems responsiveness (r=.394**). Furthermore the study concluded that there is a moderate positive significant correlation between political accountability and health systems responsiveness (r=.572**). Finally the study concluded that there is a strong positive significant correlation between social accountability and health systems responsiveness (r=.643**). From the conclusion the study recommended that hospital should be able to collect such information on hospital practices and patient outcomes and for using those data to guide, educate, supervise, discipline, or recognize operations. It is also imperative to hold staff members accountable for tasks within their power to perform. To ensure that everyone has access to care irrespective of financial condition, the county government need to come up with policies to protect indigent patients from being detained for lack of money to pay for hospital services.