Factors Influencing the Utilization of Home-Based Care in Kisumu Central Sub County

Abstract

Kenya’s healthcare system faces various challenges such as resource constraints, understaffing and overcrowded facilities. For instance, by 2016, the ratio of doctors to the population was 14 doctors per 100,000 population and only 42 nurses per 100.000, respectively, against a recommendation of 1:1000 by the WHO for doctors while a ratio of 83:10,000 for nurses (WHO, 2019). However, formal home-based care have not been implemented by MOH; instead, in place are NGOs, donor-funded agencies and religious-owned organizations that run throughout Kenya (WHO, 2001). The demand for hospital-based care often surpasses the available resources; leading to long waiting times, compromised quality of care, and increased healthcare costs. Kenya, like many other low- and middle-income countries, grapples with significant healthcare disparities, with marginalized populations often bearing the brunt of inadequate access to quality healthcare services. The study set out to determine the factors influencing the utilization of Home-Based Care in the Kisumu Central sub-county. Specific objectives of the study were to: i) establish the influence of predisposing factors on Home Based Care utilization, ii) establish the influence of enabling factors on the utilization of Home-Based Care, iii) establish the influence of the environment on the utilization of Home home-based care, iv) establish the influence of health behaviors on utilization of Home-Based Care in Kisumu Central Sub County. A mixed research design involving both quantitative and qualitative methods was used. The target population is comprised of 384 households with the potential to use home-based care services and home-based care staff and a total of 120 questionnaires were administered. Simple random sampling was used for those in the Home-Based Care homes, and purposive sampling was used for the key informant interviews. Using NF formulae, a sample of 384 households at a 95% confidence level and a 5% margin of error was used. Research ethics was observed with ethical approvals from Kenya Methodist University Scientific Ethics Review Committee and the National Commission for Science, Technology and Innovation. The data was analyzed using SPSS version 27. Descriptive statistics, Bivariate correlation and multivariate regression models were adopted. The results indicated that a significant association existed between age groups and Home Based Care utilization(X2=29.619, p<.001) with older age groups more likely to utilize Home Based Care, marital status and Home-Based Care utilization(X2=19.70, P=.012), religious affiliation and Home-Based Care utilization(X2=11.23, p=.024), occupation and home-based care utilization(X2=38.89, p<.001), education and Home-Based Care utilization(X2=27.29, p=.002), personal income and Home-Based Care utilization(X2=22.20, p=.001), There was no significant association found between household income bands and Home Based Care utilization(X2=.069, p=.966). The study recommends that the county government of Kisumu make deliberate interventions like setting aside funds, passing legislative laws and regulations, and investing in Home Based Care initiatives and programs that would lead to improvement in perceptions, uptake and utilization, which will translate to better provision of health care to the people.