Browsing by Author "Owiti, Winnie Sarah"

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Determinants of Demand for Community Differentiated Service Delivery among People Living with HIV in Kakamega County
(International Journal of Professional Practice (IJPP), 2023) Owiti, Winnie Sarah; Njoroge, Kezia; Mapesa, Job
Community differentiated service delivery model (CDSD) is community level health system strengthening intervention that addresses barriers to accessing health services. Increased number of stable people living with human immunodeficiency virus (PLHIV) has prompted more emphasis to promoting CDSD model utilization as a significant policy to improve health outcomes and meet the international commitment to make health services accessible. However, key health systems policy makers have put more emphasis on improving physical access rather than its patterns of utilization. This study seeks to understand demand for CDSD model and its determinants among PLHIV in order to device appropriate strategies that will encourage better utilization. The objectives were to assess CDSD model of choice, and factors that determine its demand among PLHIV. A quantitative design was conducted in Kakamega County, Kenya. Systematic random sampling was used to select 402 participants from facilities with high number of stable patients. A pretested interview schedule, and structured questionnaire was used to collect data using an open data kit app. Non parametric test was used to determine determinants for demand for CDSD model. A total of 402 (depicting a response rate of 100%) participants took part in the study. The tests revealed 66 % (264) of participants prefers the family model, 25 % (100) community anti-retroviral treatment groups, 8% (30) community drug distribution points, and 2% (8) community pharmacies. Determinants of demand were awareness 76% (307), acceptability 44% (176), service availability 78% (314), and service cost 78% (315). The findings indicate that the model of choice is the family model. Determinants for demand that affect utilization of the model include awareness, service availability and cost of the services. Policy makers in the ministry of health need to use these key determinants of demand to estimate its impact on health service delivery and health outcomes.
Evaluating Quality of Services in Community Differentiated Service Delivery Model. A case of Kakamega county
(African Journal of Health Sciences, 2023-12) Owiti, Winnie Sarah; Njoroge, Kezia; Mapesa, Job
The provision of high-quality services is a prerequisite for the successful implementation of community-differentiated service delivery. The service quality influences the clients' satisfaction, perceived value trust in the model and eventual utilization. Evaluating the quality of services in community differentiated service delivery will inform policymakers of existing quality gaps and in turn, this will assist in formulating strategies that will improve service quality and increase utilization. METHODOLOGY This was a cross-sectional study conducted in Kakamega County between September and December 2021 involving 402 participants. using purposive sampling, clients already established on ART were selected and data was collected through a structured questionnaire. Descriptive and inferential statistics were used to analyze data using SPSS version 25. RESULTS The results on dimensions of service quality established a high mean score (4.27) related to client literacy and a low score (2.64) on the package of services. There was a moderate positive relationship between client literacy and package of services (0.641) and a strong positive relationship between package of services and competence of the service provider (0.894). On the package of services (79.9%) of participants reported that ART refill and referral services were available, (12.7%) adherence and psychosocial support, 11.7% and 5% viral load sample collection. Regarding quality, the Freidman test ranged from client literacy (7.84), cost of services (7.79), accessibility (5.71), competence of the provider (4/06) and comprehensive package (2.54). CONCLUSION The study established a service quality gap in the package of services and the competence of the provider. The package of service provided is not comprehensive enough to address the needs of the clients. RECOMMENDATION Policymakers and leaders should re-distribute resources to allow for the training of providers using the differentiated service delivery manual 2023. The dimensions of quality can be reorganized to prioritize the appropriate package of services followed by the competence of lay health providers and lastly client literacy.
Implementation of Kenya quality guidelines for efficient delivery of health care services.
(KeMU, 2016-06) Owiti, Winnie Sarah
Quality is a key principle in health service delivery a pillar in health systems strengthening. The Kenya Quality Model of health was initiated across all health facilities to guide the implementation of quality standards. The Kenya quality guidelines are guidelines for defining, measuring and improving performance of health services across different care facilities that targets organizations and clinical leaders. Despite having, guidelines there are disparities in the quality of services delivered at Kakamega County. The objectives of the study were to determine the comprehensiveness of quality guidelines implementation in Kakamega County, to establish the institutional factors of quality guidelines implementation, to establish the human resource for health factors of quality guidelines and to establish management practises of quality guidelines implementation. In a cross-sectional design, 127 clinical managers in 6 public health facilities were selected using random sampling of public health facilities, stratified and proportionate sampling of clinical managers. Data collection was through interviewer administered closed ended questionnaires and key informants schedule. SPSS version 22 was used to analyze data in frequency distributions and percentages. To determine the profile of respondents and quality guidelines implementation, institutional factors and human resource factors were analyzed using means scores, standard deviations and Anova one way. Clarity of quality guidelines had a mean score of 3.3 and objectives a mean score of 2.2. Most respondents indicated that guidelines were unavailable since most of them were kept on shelves (48%), the services that implemented the guidelines included HIV services with mean 3.7, medical services 3.6, nursing services 3.3 and pharmacy 3. The human regource for health factors that affected implementation of guidelines were awareness of guideline contents 3.7 and motivation 3. The management practices used to implement guidelines were steps in quality management with mean 3.8, planning 3.3 and use of data 3. Monitoring and evaluation was done by health workers 40 (36%) using check lists 48(40%). The findings on quality guidelines comprehensives had P-Value of 0.231 indicating no significant relationship between comprehensiveness of quality guidelines and improved health services. For institutional factors the P-value was 0.32 indicating a relationship between institutional factors and improved health services, human resource for health P-value there was 0.033 which indicated a relationship between human resource for health and improved services. Management practices P-value was 0.042 indicating a significant relationship with improved quality of health services. The study recommended formulating a policy that can be used to train human resource before implementing guidelines, sensitizing all services to implement quality guidelines and establishing strong quality teams and developing quality implementation monitoring tools. The study further recommends development of customer satisfaction feedback form to daily monitor quality of health services