Master of Science in Health Systems Management

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

2026-06-16T13:11:11Z

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

2026-06-16T11:17:28Z

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.

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

2026-05-28T14:05:52Z

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 Access Factors On Uptake of Diagnostic Imaging by Oncology Patients in Nakuru, Bomet and Nandi Counties, Kenya

2026-02-25T07:17:19Z

Influence of Access Factors On Uptake of Diagnostic Imaging by Oncology Patients in Nakuru, Bomet and Nandi Counties, Kenya Muikamba, Lilian Cancer, a non-communicable disease, poses a significant global and national health threat, with high demands for diagnosis and treatment. Late diagnosis has been a key factor contributing to high cancer mortality rates in Kenya. This study aimed to examine how access factors influence oncology patients' uptake of diagnostic imaging in Nakuru, Bomet and Nandi Counties, Kenya. Specific objectives focused on the influence of demographic factors, equipment acceptability, healthcare accessibility, scanning costs, imaging adequacy, and the overall uptake of diagnostic imaging. The study was grounded in the Health Belief Model and the Theory of Planned Behavior. A cross-sectional research design was employed, collecting data from 3 public hospitals in Nakuru, Bomet and Nandi Counties, Kenya. The primary respondents were 326 patients and 41 health workers. Semi-structured questionnaires were used to interview patients and a key informant interview guide was used to collect data among the healthcare workers. A pre-test was conducted at Texas Cancer Center in Nairobi County. Data analysis was performed using SPSS version 25, which processed descriptive statistics and binary logistic regression and qualitative data was analysed using themes. Key findings revealed that 25% of the patients were aged 41-50, and 22% were aged 61-70. Most (89%) were married, and 61% were male. Breast and colon cancers were the most common diagnoses (63%). Regarding equipment awareness, 76% of patients were familiar with CT and MRI scanners, while only 5% knew about PET scanners. Insurance usage was inconsistent, with 41% of patients using it twice, but many had to rely on fundraising or family contributions for other expenses. Conclusions indicated that most patients seeking cancer diagnostic imaging were middle-aged or older, married individuals. Many patients 208(76%) had some prior knowledge of CT and MRI scanners, though awareness of PET scanners was low. Long wait times of 3-6 months were common due to overbooked sessions. Despite most patients having SHA or private insurance, many still paid out-of-pocket for services. Inadequate imaging services on operational days caused significant delays for patients. The study recommends that the hospitals should allocate more funding to raise awareness particularly among young, unmarried individuals, to encourage early diagnostic imaging, especially for females. Regarding equipment acceptability, hospitals should develop policies that include pre-imaging training for patients. To improve accessibility, hospitals should seek donor support and corporate partnerships to acquire more imaging equipment. On scanning costs, there is a need for the county governments to enhance public awareness of SHA's benefits. Lastly, hospitals should ensure that imaging services remain operational consistently to serve more patients efficiently. This study underscores the need for improved access, awareness, and resource allocation in cancer diagnostic imaging to reduce late diagnosis and enhance patient outcomes in Kenya.

Prevalence of Home Deliveries and Associated Factors Among Women of Reproductive Age in Rural Areas Of Marsabit County, Kenya

2026-02-25T07:09:00Z

Prevalence of Home Deliveries and Associated Factors Among Women of Reproductive Age in Rural Areas Of Marsabit County, Kenya Isako, Sori Sake This study examined the prevalence and factors influencing the preference for home deliveries in rural Marsabit County, focusing on cultural practices, healthcare facility-related factors, socioeconomic conditions, and awareness of government health initiatives. A descriptive cross-sectional mixed-methods design was employed, with 402 women participating in quantitative surveys and additional qualitative data gathered from 10 interviews and two focus group discussions. After data cleaning, 396 valid responses were analyzed. The analysis revealed that the point prevalence of home deliveries among women of reproductive age was 64.65% (n = 256). Furthermore, 291 (94.17%) of these home deliveries were attended by traditional birth attendants (TBAs), highlighting their significant role. Cultural beliefs and family influence substantially shaped delivery choices, with family cultural influence reducing the likelihood of a facility delivery (OR = 0.47, p = 0.009). Health-facility-related factors were also significant determinants. Long waiting times (OR = 1.58, p = 0.002) and respectful treatment by staff (OR = 1.86, p = 0.011) significantly influenced healthcare utilization. Socio-economic conditions, including higher education levels (OR = 1.854, p < 0.001) and stable employment (OR = 2.776, p = 0.007), were strongly associated with an increased likelihood of facility-based deliveries. Awareness of government initiatives, such as the Linda Mama program, was low, with 210 (53.03%) of respondents unaware of these programs, which contributed to the preference for home deliveries. Qualitative insights supported these findings, emphasizing deeply rooted cultural norms, mistrust in government healthcare services, and financial constraints as key barriers. Significant variables in the multivariate analysis included religion, number of home deliveries, family's cultural beliefs, cultural practices discouraging facility delivery, traditional ceremonies, unavailability of essential medications, sufficient health workers, long waiting times, and access to information. The study concluded that an integrated approach addressing cultural, socioeconomic, and healthcare access barriers is crucial for promoting safer delivery practices. Recommendations include improving healthcare infrastructure, integrating TBAs into the formal healthcare system, providing targeted financial support, and enhancing communication strategies to build trust in government health programs.

Influence of Psychological Contract On Job Satisfaction Among Medical Laboratory Professionals in Selected Public Health Sector Institutions at The National Government, Kenya

2026-02-25T07:03:18Z

Influence of Psychological Contract On Job Satisfaction Among Medical Laboratory Professionals in Selected Public Health Sector Institutions at The National Government, Kenya Nzoka, Peninna Mwongeli The psychological contract is an implicit agreement that shapes employee-employer expectations and significantly influences employee attitudes and behaviors in organizations. A positive psychological contract enhances job satisfaction by creating a supportive work environment. While research has explored psychological contracts among healthcare professionals in Kenya, there are limited specific studies on Medical Laboratory Professionals (MLPs) and how this contract affects their job satisfaction. This study aimed to assess the influence of the psychological contract on job satisfaction among MLPs in the public health sector, focusing on the Human Resources for Health pillar. The study aimed to determine the influence of employee and employer obligations, entitlements, and delegation on job satisfaction within National Government-selected health institutions. Utilizing the Psychological Contracts ‘Iceberg’ Model, a descriptive cross-sectional study design was applied, on 106 Medical Laboratory Professionals (MLPs) through Likert-scale questionnaires. Data collection included self-administered structured questionnaires and key informant interviews with human resource personnel and MLP managers. Qualitative analysis followed set themes, and quantitative data were processed using SPSS version 29 for both descriptive and inferential statistics. A response rate of 98 (92.7%) was attained. Male respondents were 48 (49%), female 50 (51%). Most of the respondents were >45 years, 58 (59.2%), 51% were undergraduate degree holders, 24.5% master’s degree holders, 19.4% diploma holders, with 2.0% having a Doctorate qualification. The results of Pearson’s correlation coefficient indicated that Employee obligations (p< 0.001), Employee entitlements (p< 0.001), Employer obligations (p< 0.001), and Delegation (p< 0.001) were significantly associated with Job satisfaction. Further, Multiple regression analysis revealed that Employee entitlements (p< 0.001), Employer obligations (p-value =0.003), and Delegation (p< 0.001) were significantly associated with Job satisfaction, while Employee obligations (p-value =0.578) insignificantly influenced Job satisfaction. The four independent variables combined account for 57.7% variation of the dependent variable (R2 =.577) with a model fit (F (4, 93) =31.70; p-value<0.001). Delegation had the strongest positive and significant association with job satisfaction (β = 0.362), indicating that it was the most important predictor in the model. Employee entitlements (β = 0.351) and employer obligations (β = 0.253) also showed significant positive relationships with job satisfaction. Conversely, employee obligations were found to have a negative association with job satisfaction. The study concludes that enhancing job satisfaction in the public health laboratory sector requires attention to the psychological aspects of employee relations, including obligations and entitlements, as well as structural elements like delegation. It suggests that organizations should build an environment that fosters motivation, value, and support for their workforce. Recommendations include focusing on purpose-driven expectations, implementing fair human resource policies, and defining roles clearly, balancing obligations with rewards to create a thriving workplace, and creating structures that encourage delegation practices by managers and human resource practitioners.

Determinants of Eight Contacts Antenatal Care Uptake Among Prenatal Mothers in Changamwe Sub-County Mombasa, Kenya

2026-02-25T06:54:49Z

Determinants of Eight Contacts Antenatal Care Uptake Among Prenatal Mothers in Changamwe Sub-County Mombasa, Kenya Bahati, Sophia Swalehe Optimal antenatal care (ANC) uptake is critical for improving maternal and neonatal health outcomes. Despite global efforts to promote ANC, maternal and neonatal mortality rates remain high. In Kenya, neonatal mortality stands at 21 deaths per 1,000 live births, emphasizing the need to enhance ANC uptake. In Changamwe Sub-County, data from the MOH 711 digital reporting tool revealed persistently low adherence to the recommended eight ANC contacts, alongside rising fresh and macerated stillbirths and fluctuating maternal deaths. This study assessed the determinants influencing ANC uptake among prenatal mothers in Changamwe, Mombasa, Kenya. Specifically, the study examined the role of community health promoters, the quality of ANC services, health need-related factors, and household status in determining the completion of eight ANC contacts. A mixed-method research design incorporating both qualitative and quantitative approaches was employed. The target population included postnatal mothers attending maternal child health clinics in public health facilities and maternal child healthcare clinic nurse managers as key informants. A total of 370 mothers and 4 nurse managers participated in the study, selected using purposive and simple random sampling techniques. Data collection involved structured questionnaires for mothers and key informant interviews with nurse managers. Descriptive statistics were used to summarize the findings, while correlation and multiple regression analyses assessed relationships between study variables. The results indicated that household status, health need-related factors, and the quality of ANC services significantly influenced ANC uptake. Specifically, household status was positively associated with ANC uptake (β = 0.45, p = .002), indicating that increased support within the household correlates with higher ANC attendance. Health need-related factors also showed a significant positive relationship (β = 0.38, p = .005), suggesting that mothers with greater health needs are more likely to attend ANC services. The quality of ANC services was another significant predictor (β = 0.42, p = .003), emphasizing the importance of service quality in encouraging ANC visits. However, community health promoters had no statistically significant impact on ANC uptake (β = 0.10, p = .08). Based on the findings, the study recommends strengthening household support systems by involving spouses in ANC education and empowering women in healthcare decision-making. Enhancing ANC service quality through respectful care, skilled provider training, and ensuring reliable supply chains for ANC commodities is also advised. Addressing health need-related barriers by promoting early screening for pregnancy complications and increasing maternal health literacy is crucial. Additionally, re-evaluating the role of community health promoters through targeted training, supervision, and structured home visit and referral frameworks is necessary. Implementing broad community sensitization campaigns to boost awareness and dispel myths surrounding ANC. Further research on community health promoters’ effectiveness in ANC promotion within varied contexts and explore the underlying factors contributing to the low rate of antenatal care (ANC) initiation before 12 weeks of gestation recommended. These recommendations underscore a need for multi-level interventions ranging from household empowerment to service delivery improvements to increase ANC uptake and ultimately reduce maternal and neonatal morbidity and mortality.

Factors Influencing Utilization of the Makueni Care Insurance Program Toward Universal Health Coverage in Makueni County, Kenya

2026-02-25T06:49:27Z

Factors Influencing Utilization of the Makueni Care Insurance Program Toward Universal Health Coverage in Makueni County, Kenya Kisilu, Mary Syontheke Health financing involves raising adequate funds for health services in ways that ensure people can access needed care without facing financial hardship or impoverishment. It also provides incentives for efficiency among both providers and users. Health insurance schemes play a central role in improving access to healthcare by pooling resources to reduce the financial burden on individuals and families. Such schemes are vital in advancing Universal Health Coverage (UHC) by ensuring equitable, affordable, and accessible health services. The Makueni Care Insurance Program (MCIP), implemented in Makueni County, Kenya, represents a key initiative toward achieving UHC. However, its success has been constrained by challenges related to funding, accessibility, affordability, and equity. This study focused on these factors to provide actionable insights for strengthening MCIP and similar health insurance schemes. Specifically, the study aimed to examine the influence of accessibility, affordability, equity, and funding on the utilization of MCIP in achieving UHC in Makueni County. The study targeted two primary groups: Hospital Administrators and Healthcare Providers, and Beneficiaries and Program Users. The Hospital Administrators and Healthcare Providers group comprised approximately 192 individuals, including 128 Hospital Administrators and 333 Healthcare Providers drawn from 16 public hospitals across Makueni County. The sample size was determined using Yamane’s formula at a 5% precision level, resulting in 45 hospital administrators and 99 healthcare providers. In addition, purposive sampling was used to select 40 program beneficiaries from each of the four facilities—Makueni County Referral Hospital, Emali Sub-County Hospital, Makindu Sub-County Hospital, and Kibwezi Sub-County Hospital—yielding a total of 160 beneficiaries. Stratified sampling was applied to ensure proportional representation across the facilities. A descriptive cross-sectional survey design was employed to gather quantitative data from program users, inpatients, and healthcare providers across the selected public health facilities. Data were collected using structured questionnaires tailored for program beneficiaries, administrators, and healthcare providers. The data were analyzed using SPSS (Version 26), applying Spearman rank correlation and multivariate regression analyses to evaluate relationships between the key factors and MCIP utilization. The findings revealed that funding, accessibility, affordability, and equity all played critical roles in improving the utilization of health insurance schemes such as MCIP. Specifically, affordability (β = 0.263, p < 0.001), accessibility (β = 0.167, p = 0.001), equity (β = 0.201, p < 0.001), and funding (β = 0.217, p < 0.001) had statistically significant positive effects on MCIP utilization. Among these, affordability had the strongest influence, underscoring the importance of financial considerations in beneficiary engagement. Based on these results, the study offered evidence-based recommendations for policymakers and stakeholders to enhance MCIP’s effectiveness. These included strategies to promote sustainable funding, improve service accessibility, ensure affordability through reduced premiums or subsidies, and strengthen equity in healthcare delivery. Implementing these interventions will foster greater enrollment and continued use of MCIP services, ultimately contributing to improved health outcomes and the realization of UHC in Makueni County and beyond.

Facilitators of Community Health Promoters Service Provision in Nandi County

2026-02-25T06:42:57Z

Facilitators of Community Health Promoters Service Provision in Nandi County Chebet, Risper Community Health Promoters (CHPs) play a vital role in expanding access to primary healthcare services in rural areas of Kenya. This study examined the key facilitators of service provision by CHPs in Nandi County, focusing on security of tenure, capacity building, financial incentives, and the availability of essential supplies and commodities. A descriptive research design was adopted. The target population comprised 1,567 CHPs serving across six sub-counties in Nandi County. Using Cochran’s formula, a sample of 306 respondents was determined through stratified sampling to ensure adequate representation. Data were collected using a structured Likert-scale questionnaire, which was pretested on 30 CHPs in Uasin Gishu County to ensure validity and reliability. A 93.8% response rate was achieved (n = 287). Descriptive analysis revealed moderate adequacy in working conditions across the four variables. Many CHPs cited unclear job contracts and a lack of employment assurance as demotivating factors. Capacity-building opportunities varied in frequency and quality, affecting service delivery. Irregular remuneration and delayed stipends were identified as major financial challenges. Additionally, the inconsistent availability of supplies and commodities disrupted service provision. Inferential analysis using Pearson correlation and multiple linear regression revealed significant positive associations between all four variables and service provision: security of tenure (r = 0.441, p < 0.01), capacity building (r = 0.518, p < 0.01), financial incentives (r = 0.486, p < 0.01), and supplies and commodities (r = 0.529, p < 0.01). Combined, these factors explained 47.3% of the variance in service provision (R² = 0.473, F = 52.763, p < 0.000). The findings indicate that CHPs with clear employment terms, continuous professional development opportunities, timely financial support, and adequate tools and materials provide higher levels of service. Strengthening these facilitators is essential for improving CHP performance and sustaining community health services in rural Kenya. The study recommends formalizing CHPs’ contracts, institutionalizing capacity-building programs, ensuring predictable financial incentives, and enhancing supply chain systems to support universal health coverage goals.

Influence of Performance Management System On Health Workers Performance at Public Hospitals in Nairobi County Kenya

2026-02-25T06:38:02Z

Influence of Performance Management System On Health Workers Performance at Public Hospitals in Nairobi County Kenya Anjichi, Jane Okaka Effective performance management is essential to the provision of health services. It is recognized as one of the key components of the healthy workforce pillar in health systems vital building blocks, effectively contributing to the greatest possible health care outcomes. By evaluating and improving employee performance, performance management systems assist healthcare organizations in maximizing the contribution of healthcare professionals towards anticipated health outcomes. There has been insufficient investigation into how integrating the entire process of the system affects health workers' performance in public hospitals particularly level three to five located in Nairobi County. Furthermore, empirical data regarding the efficacy of these systems was lacking. The study's objective was to investigate the influence of performance management system on the performance of health workers in public hospitals in Nairobi County, Kenya. Expectancy theory and goal-setting theory served as the study's specific objectives. A cross-sectional descriptive survey of the research design was adopted. Data was collected from 239 health care workers from three public hospitals using structured questionnaires. Data was analyzed using inferential statistics and descriptive approaches. A model of ordinal logistic regression was employed to investigate the relationship between the independent and dependent variables. Frequencies, means, standard deviations, and percentages were used to portray the results. The study found that efficient performance appraisal, feedback, and reward systems significantly enhance health workers’ performance. Considering a normal p-value of <0.01, there existed a substantial positive correlation between performance planning and reward systems (r = 0.496), health work's performance (r = 0.653), performance appraisal (r = 0.621), and performance feedback (r = 0.554). This suggested that performance evaluation, feedback, reward systems, and health workers' performance are often higher when there is greater performance planning. Binary logistic regression model suggested that Performance Appraisal, Feedback, and Reward Systems significantly influence health worker performance. The Nagelkerke R Square indicated that jointly Performance Appraisal, Performance Feedback, and Reward Systems accounted for 37.1% of the variation in health workers’ performance. Putting in place reliable performance management systems that offer consistent evaluations, helpful criticism, and fair compensation plans was highlighted by these findings. Cultivating a culture of accountability, acknowledgment, and motivation among healthcare workers is needed to improve performance.