• Login
    View Item 
    •   KeMU Digital Repository Home
    • Journal Articles
    • School of Medicine and Health Sciences
    • View Item
    •   KeMU Digital Repository Home
    • Journal Articles
    • School of Medicine and Health Sciences
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya

    Thumbnail
    View/Open
    Full text (1.518Mb)
    Date
    2016-07
    Author
    Nshimirimana, Desire Aime
    Mwaura-Tenambergen, Wanja
    Kokonya, Donald
    Adoyo, Maureen
    Type
    Article
    Language
    en
    Metadata
    Show full item record

    Abstract
    The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.
    URI
    doi: 10.11648/j.ajhr.20160404.14
    http://repository.kemu.ac.ke/handle/123456789/1171
    Citation
    Desire Aime Nshimirimana, Wanja Mwaura-Tenambergen, Donald Kokonya, Maureen Adoyo. Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya. American Journal of Health Research. Vol. 4, No. 4, 2016, pp. 91-99. doi: 10.11648/j.ajhr.20160404.14
    Publisher
    American Journal of Health Research
    Subject
    PHC, Gatekeeper, Effectiveness, Policy, Rationalization
    Collections
    • School of Medicine and Health Sciences [137]

    Copyright © 2019  | Kenya Methodist University (KeMU) Library
    Deposit Agreement Form
    | Privacy and Cookies | Send Feedback
     

    Browse

    All of KeMU Digital RepositoryCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjects

    My Account

    LoginRegister

    Copyright © 2019  | Kenya Methodist University (KeMU) Library
    Deposit Agreement Form
    | Privacy and Cookies | Send Feedback