| dc.description.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. | en_US |
