Role of Health Care Provider Networks in Provision of Quality Health Services in Kenya

Abstract

The focus of this study is the health service delivery building block with an emphasis on organization of health service, through healthcare provider networks (HPNs). The service delivery building block functions to deliver safe, quality personal and nonpersonal health care. A HPN is a group of three or more autonomous organizations working together across structural, temporal and geographical boundaries to implement a particular population health strategy. The HPN an innovation in the private sector is one of the service delivery models that have improved access to health services albeit there being no known studies or empirical evidence to support the effectiveness of the networks in Kenya. Provider networks are the definitive solution to tackle complex healthcare challenges that single handed providers may not be able to tackle. This study aimed at determining the influence that legal support, provider capacity building, clinical support and health commodity security has on provision of quality health services in a HPN, in Kenya. There are several HPNs in Kenya that support provision of reproductive health services for example TUNZA, Reproductive Health Network Kenya (RHNK) and AMUA, however the target population for this study was 457 health care providers within RHNK and 5 RHNK board members. A sample of 252 health care providers was drawn using simple random sampling, while the 5 board members were sampled using purposive sampling. A structured questionnaire was used to collect data from the health care providers in the network, and key informant interview guide was used to collect data from the board members. Quantitative data was analyzed using SPSS version 23, for descriptive and inferential statistics. Thematic analysis of qualitative data was done using NVIVO version 12. A 100% (252) response rate was attained. Male respondents were 132(52%), 117(46%) of the respondents were between 41-50 years, majority 184(73%) were nurses and owned nursing homes 78(31%), 127(51%) of the respondents were diploma holders and nearly a third 70(28%) had 16-20 years‟ work experience. Bivariate analysis indicates that legal support (r =.235**, P < .001), capacity building (r = .213**, P < .001) and clinical support (r = .232**, P < .001) had a positive and significant influence on the provision of quality health services in the provider network. Multivariate analysis indicates that provider capacity (β2 = .068, P < .001), and clinical support (β2 = -.094, P < .001) significantly influenced provision of quality service provision. In conclusion, capacity building through training, mentorship and coaching greatly influences delivery of quality health services in a provider network. This study therefore recommends that: i) the national MOH as well as County Health Offices should adapt the use of HPNs to improve quality of primary care services in public facilities, ii) the HPN board members should put into place sustainability mechanisms to ensure access to legal services beyond external support project phase, iii) the board members of HPN should continue to provide capacity building to its members, and iv) the board members of HPN should educate the members on the usefulness of the support supervision in order to demystify the notion of “policing” and cultivate a supportive collaboration