School of Medicine and Health Sciences
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Welcome to School of Medicine and Health Sciences collection.This collection contains Journal articles published by faculty affiliated to the school.
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Item The Influence of Human Resource Factors on Access to Mental Health Services in Primary Care Facilities in Kiambu and Makueni Counties, Kenya(Food and Public Health, 2025-01) Musyoki, Milcah Ndinda; Njoroge, Kezia; Kyalo, Caroline KawilaThe incidence of mental health issues in Kenya has increased over the years. Although Kenya has adopted a policy framework to integrate mental health services in primary healthcare facilities, only 29 of the 284 hospitals in level four and above offer mental healthcare services, with Mathari National Referral Hospital serving as Kenya's sole referral for such services. This scenario clearly demonstrates that access to mental health is not fully mainstreamed in primary healthcare facilities. Worse still, the existing service statistics show that Kenyan psychiatry is under-resourced in terms of personnel. This study, therefore, explores the influence of human resource factors on access to mental health services in primary care facilities in Kenya. The study adopted a cross-sectional mixed methods research design. The target group was healthcare providers from Kiambu and Makueni primary healthcare facilities. The Yamane formula was used to calculate the sample size of 179 healthcare facilities as a unit of analysis. Two health practitioners were selected in each health facility, yielding 358 respondents. Respondents were clinical officers and nurses who directly interacted with patients in primary health facilities. A structured questionnaire was used to collect data from staff members in the selected counties. Collected data was analyzed using descriptive statistics and logistic regression. Results indicated that human resource factors significantly predict access to mental health services in primary care health facilities in Makueni and Kiambu Counties.Item Influence of Procurement Process on Availability of Essential Drugs in Public Health Facilities in Mombasa County, Kenya(International Journal of Health Sciences, 2024) Chikophe, Riziki Mwangolo; Tenambergen, Wanja Mwaura; Kyalo, Caroline KawilaPurpose: Procurement process and practices are crucial components in the successful realization of universal healthcare and in particular the availability of essential drugs. Despite multifaceted efforts and inputs to promote the quality of the procurement process challenges still exists in the availability of essential drugs. This study aimed to establish the influence of procurement planning, supplier selection, procurement financing and needs assessment on availability of essential drugs in the public health facilities in Mombasa County, Kenya. This was a cross-sectional descriptive study design which targeted level 4 and 5 health facilities in Mombasa County. The study target population was 1216 health workers who included medical laboratory personnel, clinical officers and medical officers, nurses, pharmacists and pharmaceutical technologists. The study sample was 301. Methodology: Stratified sampling approach was used to distribute the sample among the cadre and random sampling method was used to select the respondents from each strata. Quantitative data was collected using a structured questionnaire. Findings: The study found that procurement planning, supplier selection, procurement, financing and needs assessment were significant factors in influencing the availability of essential drugs with P<0.05. Unique Contribution to Theory, Policy and Practice: The study recommended that counties conduct a comprehensive and regular need assessment of essential drugs in public health facilities, that they develop a robust procurement planning strategy that aligns with the identified needs and available financing, that there should be a transparent and competitive supplier selection process, and to establish strategic partnerships with international organizations, non-governmental organizations, or donor agencies that are committed to improving healthcare access.Item Drivers of a Functional Integrated HIV/NCDs Care Model for a Sustainable Healthcare System; Lessons from Nakuru County, Kenya(Public Health Research, 2023) Njuguna, David; Kyalo, Caroline Kawila; Mwangi, Eunice MuthoniHealthcare financing and resourcing have always been of great concern to low- and middle-income countries and households. Stakeholders must devise innovative ways to remain in operation amidst reducing financing and dynamic disease etiology to ensure that there is consistent access to quality healthcare services. The integration of Human Immunodeficiency Virus (HIV) and non-communicable disease (NCD) services has emerged as a crucial approach to optimize healthcare delivery and improve health outcomes. NCD and Human HIV programs are currently managed separately, despite frequent interconnections. The study aimed to conduct a regression analysis of an HIV/NCD integration model for healthcare providers to improve the performance of healthcare services in Nakuru County. Methods: This study explains the effect of the explanatory variables - institutional support, health information processes, pooled resources, and collaboration-on the explained variable- Healthcare System performance-, utilizing a multiple regression model. Organizational culture was also used to moderate the relationship between the explanatory variables and the explained variable. Data were collected from a representative sample of 123 healthcare workers drawn from 106 healthcare facilities providing both HIV/NCD services in Nakuru County, Kenya. The explanatory and moderating variables were selected based on their potential to influence healthcare system performance. The regression models were adjusted for potential confounding variables to ensure the robustness of the findings. Results: In the Multivariate analysis, organizational culture was significant in moderating the relationship between the integration of health services and the performance of the healthcare system, with a p-value of less than 0.05. Specifically, health facilities that embraced a team-oriented organization culture in delivering HIV/NCD service treatment and care were 2.142 times more likely to achieve sustainability of the services as compared to those that did not adopt a team-oriented organization culture. These results were statistically significant at a 95 percent confidence level. The findings of the study also revealed that institutional support in monitoring outcomes had a positive and significant influence on the performance of the healthcare system. Health information processes have a significant influence on healthcare system performance in Nakuru County. Health facilities that utilized functioning information systems during the provision of HIV/NCD services were 1.987 times more likely to achieve sustainability of the services compared to those without such systems. The findings also indicate that the performance of the healthcare system in Nakuru County was significantly influenced by human resources and funding models. Conversely, the findings suggest that there is no significant association between the collaboration guidelines and the performance of the healthcare system in Nakuru County. Conclusions: This study highlights the importance of cultivating a team-oriented organizational culture within healthcare facilities and a need for institutional support. Additionally, the availability and the ability to leverage on available resources contribute greatly to the sustainability of services, leading to a better-performing healthcare system. These findings can guide healthcare providers in developing strategies and interventions to enhance the integration of health services and improve overall healthcare outcomes.Item Integration of HIV and NCD Service Provision: Cost Savings and Implications in Nakuru County, Kenya(Public Health Research, 2023) Njuguna, K. David; Kyalo, Caroline Kawila; Mwangi, Eunice MuthoniDwindling donor funding has been on the rise. Therefore healthcare systems are forced to strategize on how to manage their service delivery with the available resources. There is need to sustain the healthcare services delivery. Integration of Human Immunodeficiency Virus (HIV) and (Non-Communicable Diseases) NCDs services has emerged as a potential solution to improve patient outcomes and optimize resource utilization. This study aimed to evaluate the cost savings associated with integrating HIV services with three common NCDs: Diabetes Mellitus (DM), hypertension (HTN), and the combination of diabetes and hypertension (DM/HTN) in Nakuru County. Methods: This study utilized a hybrid costing approach that combined both top-down and ingredients approaches. The costing analysis took a health system perspective and for acute conditions, the time horizon considered was a case management episode. To determine cost savings, integrated service costs were subtracted from the cumulative costs of individual services on a per-case basis. Results: Integration of HIV and diabetes services resulted in annual cost savings of KES 7,086 (21%) per case. Similarly, integrating HIV with hypertension services yielded cost savings of KES 6,166 (19%) per case. The greatest cost savings were observed when integrating HIV with both diabetes and hypertension services, with annual savings of KES 10,653 (29%) per case. Conclusion: The study results prove that integrating HIV/NCD services would save the healthcare system costs incurred while delivering the services in a parallel model. Hence recommends that healthcare service delivery be supported using an integrated care model to enhance sustainability of the services that have been heavily funded by donors in this country.Item The Influence of ICT Infrastructure Support for Management of Essential Medicine Supply Chain in Health Facilities in Kenya(International Journal of Research Publication and Reviews, 2024-03) Nalebe, Robert Mugubi N.; Otieno, George W. Odhiambo-; Kyalo, Caroline KawilaWhile application of ICT to support management of essential medicine supply chain in public facilities in Counties is increasing, full utilization of digitalization is slowed down by poor or inadequate ICT infrastructure, frequent system breaks down, lack of internet bundles and inadequate digital skills to support management of essential medicine supply chain at all levels of the health system. The aim of this study was to investigate the influence of ICT infrastructure support for essential medicine supply chain management in public healthcare facilities in Kenya. The study employed both quantitative and qualitative research design. The study sites were Kajiado, Makueni and Mombasa Counties. Simple random sampling and purposive sampling were used to identify respondents to the study. The research focused on medical professionals including medical officers, clinical officers, pharmacists, health records personnel, pharmaceutical technologists, and procurement officers, along with key informants selected from 11 level 4 and 3 level 5 public healthcare facilities across three counties. A total of 150 participants were selected using the formula devised by Nasiurma D.K (2000) at a confidence level of 95%. Quantitative and qualitative data were collected through a combination of 12 key informant interviews and 143 semi-structured questionnaires. The collected data underwent cleaning, transformation, and analysis using NVivo, Qualitative Data Analysis (QDA) Miner, and SPSS software. The study revealed that most public hospitals in Kenya do not have sufficient functional computers to support processing of digital information for managing essential medicine supply chain. The findings also reveal that while most public hospitals in the counties of Kajiado, Makueni and Mombasa have electricity connectivity, most of them do not have reliable internet to support inter computer connectivity and timely digital essential medicine information communication between units and departments for timely management of essential medicine supply chain process. The study is significant to all stakeholders because it provides evidence for strengthening ICT infrastructure and digitalization information processing and sharing to support efficiency in management of essential medicine supply chain.Item Factors Influencing Utilization of Health Information System in the Management of Missed Appointments among HIV Positive Patients in Mombasa County(Journal of African Interdisciplinary Studies (JAIS), 2021-10) Mbiya, Odilia Amalemba; Kyalo, Caroline Kawila; Kawila, CarolineA health system requires a well-functioning health information system as it enhances measurement of health outcomes, accountability for resource allocations and assists in arriving at effective health care decisions. An effective health information system captures individual patient data including demographics and data related to clinics on management of population, analysis and reporting of patient risk elements and pinpointing of proactive patients therefore providing reminders where care is delivered. This process of utilizing health information reduces missed appointments, increases retention rate and improves patients’ health outcome .With low retention rates among HIV positive patients, this study aimed at determining the factors associated with the utilization of health information in curbing missed appointments. Utilization of health information involve collection, collation and monitoring in identification of key areas worth addressing within the health structures to direct designing of suitable health mediation to advance health. The research study was guided by the following specific objective to establish infrastructural factors influencing health information utilization. This study utilized descriptive cross-sectional study design using quantitative method of data collection to assess utilization of health information among healthcare workers. The study population for this research was approximately 215 CCC, a sample size of 69 health care workers in three high volume hospitals offering HIV care in Mombasa County (Coast general, Bomu Hospital and Portreitz). Primary data was obtained via questionnaires while secondary data was obtained from hospital records available, the registers, EMR and reports generated. The data was coded and analyzed using the statistical package for social sciences (SPSS). A p-value of less than 0.05 was considered as statistically significant. From the findings, half of the staff had been trained on data management while half was not. All the health facilities used Electronic Medical Records however with unstable local network connectivity. It was also noted that staff supervision was inconsistent and that staff had negative attitude towards data use. There is need for users and utilizers of health information to be trained in all aspects of data to enhance data quality; there is also need to ensure availability of data collection tools either soft or hard. Advocacy for consistent support supervision to facilitate data utilization; this would improve the staff attitude on data capture, demand and use.Item Towards a Well-functional Computerized Health Management Information System: A case of Mbagathi County Hospital, Kenya(International Journal of Computer Applications (0975 – 8887), 2017-03) Kyalo, Caroline Kawila; Otieno, George W. OdhiamboHealth Management Information Systems (HMISs) initiatives in Kenya have traditionally been donor-driven with minimal, if any, organizational input in their design. This has consequently led to predictable failures due to lack of sustainability of these initiatives upon donor pullout. The objectives of the study were to investigate the design, implementation and operation of Medboss computerized system at Mbagathi County Hospital in Kenya. Medboss is a locally developed computerized HMIS software, specifically designed for government hospitals in Kenya. However, private hospitals have also adapted it. A descriptive case study research design was conducted in the month of August 2015. The target population was sixty staff members who use Medboss, out of the sixty, thirty two participated in the study. Semi-structured questionnaires and key interview guides were used to collect data. Ten key informants, involved in the design and implementation of the system were interviewed. Questionnaires were used to collect data from twenty two health workers on their knowledge of the factors affecting the operation of the system. Collected data was analyzed using descriptive statistics and multiple regression analysis. Results: Design, implementation and operationalization revealed 73.3% effect on functionality of HMIS. Design was found to significantly influence functionality of HMIS, with a coefficient of 0.815. The coefficient of implementation of HMIS was 0.703, which was equally significant. Operationalization had the least influence on functionality of HMIS with a coefficient of 0.412. Recommendation: Establish a fully functional computerized system. Develop an HMIS policy for the Hospital that documents its vision, mission and objectives therefore implementation will be based on the policy. Fully implement the remaining modules of the system, such as, pharmacy, nursing, human resource, logistics management, and special clinics to enable well-functioning in the operation of the system. Invest more in IT infrastructure in order to enjoy the full benefits of the current system.Item The Role Leadership Style Plays in the Integration of Health Management Information System(International Journal of Computer Applications, 2018-07) Kyalo, Caroline Kawila; Odhiambo-Otieno, G. W.; Otieno, George; Tenambergen, Wanja MwauraThis study aimed to establish the role played by leadership style in the integration of health management information systems (IHMIS). An integrated HMIS is a software solution that spans the range of business processes that enables organizations to gain a holistic view of the business enterprise (Alvarez, 2007). An IHMIS supports the different levels of healthcare in terms of information exchange and flow, and the integration of business functions as diverse as patient care, accounting, finance, human resources, operations, sales, marketing, patient information and even the supply chain. Three approaches of leadership styles were tested to see how they influence integration of HMIS; i) Lassiez-faire ii) Transactional and iii) Transformational. A mixed method research design was used. A sample size of 288 respondents stratified in three levels of healthcare (tier 1, 2, and 3) were purposively selected to participate in this study. The respondents included the in-charges, health records and information officers and sub-county and county health management teams members. A questionnaire and a key informant interview guide were used to collect primary data. The questionnaire was analyzed using SPSS and the Key Informant Interview using content analysis. The selection and appropriateness of leadership styles are significant factors for assuring organization success. Good execution of leadership transpires through the availability and access to information during decision making. The information system in an organization is dependent on the leadership behavior on decision making authority in groups. To a great extent Laissez-faire leadership style was found to dominate in the health sector in Kenya, with a few managers practicing Transactional Leadership Style. Laissez-faire leadership style was however found to have a negative and none significant effect in the integration of HMIS, (r=.121, P=.060), this type of leadership plays the role of fragmenting the information systems. Transactional leadership style was moderately significant (r=478**, P=.000), its role was in between fragmenting HMIS and Integrating them at the same time. Transformational leadership style was quite significant in the integration of HMIS (r=.765**, P=.000), this type of leadership style portrayed a positive and significant role in integrating HMIS. The study therefore recommends that healthcare managers should embrace the leadership style that fully encourages team work, because this kind of a leadership style automatically leads to integration of HMIS.Item Transforming the Health Sector in Kenya by Adopting Integrated Health Management Information System(International Journal of professional practice (IJPP), 2019-05) Kyalo, Caroline Kawila; Odhiambo-Otieno, George.W.Achieving better health outcomes is every health organization’s dream.Several health management strategies have been developed;a key one being production of quality information for purposes of informed decision making.Most public health facilities in Kenya are by large extent using manual health information systems,which are cumbersome and fragmented leading to delayed or uninformed decision making. Five key drivers are viewed to influence Integration of Health Management Information System(IHMIS): i) organizational factor, ii) technical factor, iii) behavioral factor, iv) adopted leadership style and v) operationalization of the functions of management.The purpose of the study was to prescribe an ideal design of an IHMIS.A mixed method research design was adopted to determine the significance of the drivers identified in influencing the IHMIS.Both semi-structured questionnaire and a key informant guide were used to collect data that was analyzed and reported using mean scores,correlation and regression analysis.Integration of HMIS was found to positively and significantly correlate with organizational factor,technical factor,behavioral factor,leadership style adopted and operationalization of the functions of management.The study also showed that all variables accounted for total variation in the integration of HMIS.In a multiple regression analysis,the study found the model valid.However only 4 out of 5 of the predictor variables(operationalization of management functions,behavioral factor,technical factor,leadership style adopted) were good in explaining total variations in the integrated HMIS in Kenya. This implies that the more these variables are improved the better it gets in achieving integration of HMIS which is achievable if all the study variables are taken into account.The study suggests that the ideal design of an integrated HMIS would be in the form of an automated web based system in each health organization as opposed to the current manual system.IHMIS will be more successful,if integration within a single health organization is successful.The study recommends a central database for each level of care.