Determinants of Commodity Management Practices In Public Health Facilities in Devolved Health Systems: A Case of Essential Medicines in Makueni County, Kenya

Abstract

The rationale for decentralization of health sector enabled lower level governance structures to design health sector interventions using innovative models that are context-specific and that take into consideration the unique health needs of different localities and encourage effective and active citizen engagement. The governance structures are able to facilitate autonomous and expeditious decisions regarding management and mobilization of resources efficiently. However, the health function in almost all counties is affected by significant challenges. Top among them being poor management of essential medicine leading to frequent stock-outs. Essential medicine is one of the six pillars of health systems and plays a key role in ensuring the population remains healthy. This research therefore aimed at analyzing some of the determinants of good management practices in the field of essential commodities especially medicines in publicly owned health facilities in a devolved system. The specific focus of the research was on the impact of healthcare worker training, policy and institutional framework, healthcare budgetary allocations and available infrastructure on effective management of essential medicines in publicly owned health facilities in a devolved system. The researcher used descriptive cross-sectional research design and a mixed method of qualitative and quantitative data collection techniques in collecting both primary and secondary data. The study population was all the health facilities in Makueni County. The study population comprised pharmacist, procurement officer, nurses, laboratory staff, clinical officers, and bio medics and stores clerks in each of the health facilities. The study adopted a stratified random sampling procedure to choose targeted 50 public health facilities in Makueni County from a population of 162 health facilities. The calculated size of the sample was 96 respondents. The sampling technique used was stratified sampling in selecting the sample according to various categories of health facilities. The researcher used a questionnaire and key informant interview guide as the main research instruments. Analysis of data collected was through qualitative and quantitative methods with the presentation done using tables, charts and narration for qualitative data. The study findings established that health worker training (β=3.232, p-value= 0.000), healthcare budgetary allocations (β=2.185, p-value= 0.008) and available infrastructure (β=5.296, p-value= 0.000) had significant and positive effect on management practices of essential medicine in Makueni County, Kenya. However, the effect of policy and institutional framework (β=1.374, p-value= 0.093) was found to insignificant in predicting the management practices of essential medicines in Makueni County. The study concluded that healthcare sector is a dynamic sector that faces different on a daily basis, health worker training, policies and institutional structures, budget allocation and infrastructure need to be advanced to meet the expectation in the evolving healthcare sector. The recommendations of the study included that County Government of Makueni through its ministry of health in collaboration with its counterpart at national government should work in collaboration on ensuring adoption of emerging best practices in management of essential medicines.