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 Implementation of User Fee Policy in Psychiatric Hospitals in Kenya: A Case of Mathari Hospital, Nairobi(Journal of Medicine, Nursing and Public Health, 2024-08) Munene, Winnie Kanana; Tenambergen, Wanja Mwaura; Muiruri, LillianIn Kenya, user fees were implemented as a form of cost-sharing to lessen the financial burden of health financing on Kenyan patients. This occurred in 2004. The Kenyan Ministry of Health offers a financing mechanism through risk pooling to the greatest extent possible to achieve universal coverage for mental health care. The use of services is based solely on need for care, with no additional tax funding or required health insurance; contributions are determined by ability to pay. Diseases such as mental health have been on the rise in Kenya due to a change in lifestyle and as a result of other emerging diseases. In Kenya, the high expense of healthcare continues to be a major obstacle to receiving timely, high-quality medical care. Despite the increase in prevalence of diseases related to mental health, the government’s user fee policy has not been able to keep up with inflation. The purpose of this study was to assess the implementation of user fee policy in psychiatric hospitals in Kenya: A Case of Mathari Hospital, Nairobi. The study was guided by objectives that were seeking to determine the utilization of user fee policy at Mathari Hospital and to establish how hospital policies influence user fee policy implementation at Mathari Hospital. A cross-sectional study design was used. Findings from this study established that utilization of the user fee policy at Mathari Hospital was aligned with the existing hospital policies. The management of Mathari Hospital should streamline user fee collection by constantly providing on the job training to the employees.Item Healthcare Workers Training and Implementation of Occupational Health and Safety (OSH) Measures at Kitale County Referral Hospital, Kenya(American Journal of Health, Medicine and Nursing Practice, 2023-08) Ngoga, Edward Otieno; Muiruri, Lillian; Ouma, Ogol JaphethPurpose: Many people, including healthcare workers, spend one-third of their adult lives in hazardous work environments. Despite significant advancements in safety management over the last few decades, occupational health continues to contribute to work-related health problems around the world, including in Kenya. The study's main goal was to investigate factors influencing the implementation of occupational health and safety measures at Kitale County Referral Hospital. Methodology: The research was cross-sectional, descriptive, and mixed-methods. The targeted study population was 246 healthcare workers at Kitale County Referral Hospital, and 146 were randomly sampled. Key Informant Interview (KII) guidelines and a structured questionnaire were utilized to collect data. Data was coded, entered, and analyzed in STATA v15. A thematic method was utilized for analyzing KII qualitative data. Findings: Spearman's correlation coefficients (0.687, p<0.05) for training show a strong link between these HealthCare’s training and OHS implementation. This means that traning directly affects hospital OHS implementation. Ordered regression results include age (Φ = 0.055; p<0.01), gender (Φ = 0.208; p<0.05), education (Φ = 0.105; p<0.01), cadre (Φ = 0.098; p<0.1), staff training (Φ = 0.090, p<0.05 confirmed that there existed a direct and positive relationship between the occupational health and safety implementation and some of the independent variables. Unique Contribution to Theory, Practice and Policy: Thus, the study proposes that public hospitals teach staff to promote occupational health and safety. The facilities should also establish a management committee to drive OSH implementation, and the county government should guarantee that policies encourage OSH in county referral hospitalsItem Factors Influencing Reporting of Medical Errors Amongst Nurses in Pediatric Wards in Three Teaching And Referral Hospitals in Nairobi Kenya(Journal of Nursing and Practice, 2022) Ngivu, Jane N; Kyalo, Carol Kawila; Muiruri, LillianService delivery is among the six health system strengthening pillars by World Health Organization. Successful health services bring about effective, quality, safe, personal and non-personal health care actions or interventions to those who need them, where they need them and when required with minimal resource wastage. Medical error is unintended commission or omission or the failure of an action which was planned which cause, or have potential to cause patient harm. It is a leading challenge in service delivery today and the incidence rates are an emerging international concern. Medical errors are underreported today, yet reporting helps in implementing measures which help prevent recurrence thereby enhancing patient safety and reducing harm and suffering. This study aimed at determining factors influencing reporting of medical errors amongst nurses in paediatric wards in three teaching and referral hospitals in Nairobi Kenya. The specific objectives of the study were to establish if nurses’ knowledge on medical errors reporting influences reporting of medical errors, to establish if management support for medical errors reporting influence the reporting, to establish if medical error reporting systems influence reporting of medical errors and finally to establish if organizational safety culture influences reporting of medical errors, all these, amongst nurses in three teaching and referral hospitals in Nairobi Kenya. The study was cross sectional and utilized both quantitative and qualitative approaches in data collection. The target population comprised of 195 nurses; from Aga Khan University hospital Nairobi, Gertrude’s Children’s Hospital and Kenyatta National Hospital, all in Nairobi Kenya. Sample size was 131 nurses and response rate was 88%. Quantitative and qualitative data was collected from the nurses using a pretested questionnaire. Key Informant Interview Guide was utilized to collect qualitative data from three nurse managers. Data was coded and analysed using SPSS version 25 and presented in form of charts and graphs. Bivariate analysis showed that nurses’ knowledge on medical errors (p < 0.039), management support on reporting (p < 0.031), and medical errors reporting systems (p < 0.002), all had significant association with reporting medical errors in the three facilities. Organizational safety culture however did not, (p = 0.623). This study recommends that nurses’ knowledge and understanding of medical errors be promoted through trainings; starting from college and university levels and later during orientation and in-service. Management to disseminate policies and procedures to staff in their health facilities and ensure the same is well understood and implemented correctly. In addition, feedback about changes put into place based on those errors need to be communicated to staff in a timely manner. Additionally, just culture need to be embraced and cultivated to ensure objective approach to medical errors. Finally, medical error reporting systems to be simplified, made readily accessible and should have capabilities for anonymous reporting.Item The Influence of Staffs’ Knowledge on Preparedness of Catholic Mission Hospitals for Health Service Delivery during Emergency Inflow of Patients in Nairobi County, Kenya(American Journal of Health, Medicine and Nursing Practice, 2022) Kiteng’u, Petronella Mueni; Muiruri, Lillian; Musa, OluochPurpose: To determine the influence of staffs’ knowledge on preparedness of catholic mission hospitals for health service delivery during emergency inflow of patients in Nairobi County, Kenya. Methodology: A cross sectional descriptive study design was used with quantitative approach for data collection and analysis. Four tier-3 Catholic Mission Hospitals were purposively selected and a stratified random sample of 647 members of staff from different cadres was taken. A structured questionnaire was used to collect data. Data was analyzed using STATA software v.16, where descriptive statistics were presented using frequencies and percentages whereas inferential statistics were presented using correlation and regression analysis. Findings: The study found out that staff training and exercises for knowledge and skills influenced preparedness of Catholic Mission Hospitals for health service delivery during emergency influx of patients. A positive and significant relationship was found at (r=0.211; p<0.01). This means that the hospitals are perceived as prepared for health service delivery during emergency influx of patients. However, staff drills (staff exercises) at (r = -0.147; p<0.05) were found insignificantly influencing services delivery. This means that the hospitals would be unprepared even if staff drills were in place. Recommendations: The study recommends that the managers of catholic hospitals should have scheduled staff trainings and drills for efficient and timely response in times of need for emergency service deliver. Policy guidelines on skills acquisition for the staff in the health institutions need to be developed to guide the trainings and frequent drills to sharpen the theory and practice of the healthcare team.Item Adoption of Computerised Health Information System Focusing on Kenya’s Health Facilities(Journal of Biology, Agriculture and Healthcare, 2016) Githiom, Samuel; Muiruri, Lillian; Osuga, BenAlthough the benefits of information technology are clear adapting new information systems to health care has proven difficult globally and rates of use have been limited. With the challenge of inadequate health workers and low quality of service delivery, Information Communication Technology is essential to ensure availability of Information to multiple users and multiple settings. It is also important for Integration of variable types of data media, data legibility, reduced medical errors, complete and quality data. It also enable structured data entry, accurate calculation of processes, provision of tools for decision support and data based analysis. Although Kenya as a developing country has invested in Information Communication Technology with the aim of improving patient care, all indications have shown slow adoption of technology in healthcare industry. Therefore it is important to focus on means of hastening adoption of HIS in order to enhance service delivery in the health sector and hence effective service delivery for Kenyan peopleItem Utilization of Service Charters in Public Hospitals in Kenya: A Case of Thika Level 5 Hospital, Kiambu County(International Journal of Scientific and Research Publication, 2016-06) Masese, Charles Onyambu; Tenambergen, Wanja Mwaura; Muiruri, LillianService delivery in government health facilities in Kenya still faces multiple challenges. These challenges can still be identified ten years down the line since the introduction of Service Charter. The objective of the study was to assess how the service charter utilization would influence health service delivery in Thika Level 5 Hospital (TL5H) in Kiambu County. Cross sectional study design was employed. Quantitative data was collected using questionnaires. A sample size of 156 technical employees of TL5H and patients participated in this study. Collected data was edited, coded, and entered into the computer using the Statistical Package for Social Scientists (SPSS v 23). The respondents strongly agreed that the hospital charter content is not viewed annually creating unfriendly services (mean 1.73, SD 0.97), (mean 1.74, SD 0.997) indicated the respondents strongly agreed that the service charter is not clearly understood by the majority of patients informing them of their rights when seeking services. The respondents disagreed that the hospital management is always active in monitoring performance and playing the oversight duty according to the SC (mean 2.19, SD 1.20) on whether failure to utilize the service charter may lead to deterioration of quality and equity of healthcare, the respondents agreed (mean 2.05, SD 1.54). Most of the respondents strongly agreed there is availability of support for the service charter (Mean 1.72, SD 0.93), while the respondents also indicated that the waiting time has not improved despite the availability of service charter (Mean 2.98, SD 1.09). The study also established that there was uncertainty in the amount of waiting time in TL5H (Mean 1.775, SD 0.91). The channels used for communication were not clear (Mean 1.993, SD 1.12) while the communication at TL5H does not ensure clarity on issues (Mean 1.9, SD 1.07) while the respondent agreed on communication at TL5H was not always done to get commitment from staff (Mean 1.923, SD 1.047) and there was inadequate open communication of most issues at TL5H (Mean 1.846, SD 1.075). The study recommends that 1) TL5H should improve the contents of the service charter to make it clear, to ensure that the patients fully understand the contents, 2) there should be proper monitoring of the members of staff to ensure that the service charter is fully implemented to minimize the amount of complaints by patients, 3) the service charter contents should be embedded in the organization culture to ensure that is fully and properly implemented to the satisfaction of the service users.Item Human resource capacity for information management in selected public healthcare facilities in Meru County, Kenya(Pan African Medical Research, 2015-04) Kiilu, Elizabeth Mueke; Okero, Dominic Charles; Muiruri, Lillian; Owuondo, Pacific AkinyiIntroduction: Reliable health information is essential for decision making in the healthcare system. Information management in Kenya was considered the weakest area under the Health Information System pillar mainly due to inadequate health workers capacity. The study therefore aimed at assessing health workers skills and current training needs for information management in the selected healthcare facilities. Methods: Cross-section research design was adopted and both purposive sampling technique and censuses were used to establish the study participants. Analysis was done using SPSS version 20 and results were presented in tables, charts and graphs. Results: It was established that capacity building was usually undertaken through on-job trainings i.e. 85.1% (103) health workers had on-job training on filling of data collection tools and only 10% (13) had received formal classroom training on the same. Further, only 9.1% (11) health workers had received information management training while 90.9% (110) had not received such training. Health workers demonstrated below average skills on information management i.e. only 17.4% (21) could check for data accuracy, only 16.5% (20) could compute trends from bar charts and only 16.5% (20) could transform the data they collected into meaningful information for use. Conclusion: The researcher recommended that healthcare facilities management teams develop a competency based framework for defining the desired skill mix for information management and have a yearly Training Needs Assessment for assessing training needs for information management among the health workers.Item Organizational Factors Influencing the Adoption of the District Health Information System 2 in Uasin Gishu County, Kenya(International Journal of Medical Research & Health Sciences, 2018) Kuyo, Richard Ole; Muiruri, Lillian; Njuguna, SusanBackground: Sound and reliable information is the foundation of decision-making across all health system building blocks that include service delivery, health workforce, health information, medical products, vaccines and technology, financing, leadership, and governance. This study is built on health information system pillar. Objectives: To determine the organizational factors influencing the use of DHIS2 in Uasin Gishu County. Methods: Study was conducted in Uasin Gishu-Sub County health facilities. A questionnaire was used to collect quantitative data from 283 health workers selected randomly while 10 key informants were selected purposively from this sample for in- depth interviews. Results: Total 50.0% of the participants acknowledged that finances were adequate to run DHIS2. The main champions of DHIS2 used in decision-making were the county health records and information officers (56.2%) and the sub-county health records and information officers (39.0%). Up to 78.5% agreed or strongly agreed that organizational hierarchy influenced DHIS2 use and 80.8% agreed or strongly agreed that there was improved staff performance due to DHIS2 utilization. On the other hand, the major challenges experienced in the use of DHIS2 for evidenced-based decision-making were the lack of management support (34.3%), poor skills among the users (48.6%), lack of adequate computers (36.7%), unreliable internet connectivity (47.1%), lack of power backup (27.6%), and resistance to change (21.0%). Conclusion: The main funding for the DHIS2 system comes from the County government while health records and information officers are the main promoters of DHIS2 use. The main determinants of DHIS2 used are the availability of computers, network and internet services, trained staff and legislation. The main challenges inhibiting DHIS2 use are lack of management support, poor skills among the users, lack of adequate computers, unreliable internet connectivity, lack of power backup and resistance to change.Item FACTORS RELATED TO QUALITY DATA WHICH DETERMINEHEALTH INFORMATION UTILIZATION IN MAKING DECISION AMONG HEALTHCARE MANAGERS IN MOMBASA COUNTY, KENYA(American Journal of Public Policy and Administration, 2020) Otieno, Moses Ochieng; Muiruri, Lillian; Kawila, Dr. CarolinePurpose:This was a study based onHealth Information Systems pillar.The study sought toexplore factors related toqualitydatawhich influence health information utilization in makingdecisionamong healthcare managers in Mombasa County.Methodology:This was a Descriptive Survey Study design where desired data was obtained from selectedrespondents by semi-structured questionnaires. The research targeted a total of 303 healthcare managers in Mombasa County which comprised of 21 County Health Management Team (CHMT) members, 56 Sub-county Health Management Team (SCHMT) members from the four sub-counties, 43 facility In-Charges from the 43 public health facilities and 183 Heads of Departments (HODs).A sample size of91 healthcare managerswas used in the study. This was 30% of the target population and were randomly selected. Aresponse rate of 98.9% wasachieved. Descriptive and Inferential analysis was done. Data was analyzed with SPSS version 23.Findings:Resultsrevealed that quality data factors(β4= 0.298; t = 4.079; p < 0.01) were significant predictors ofhealth information utilization in making decision among healthcare managers in Mombasa County. These results imply that improvement inthese variables(dataaccuracy, completenessand timeliness)will enhance health information utilization. How these variables are accomplished influence the level of health information utilization in making decision.Unique contribution to theory, practice and policy:When the study recommendations are implemented, there will be assured qualitydata which will assist in coming up with the design of disease prevention, interventions and to monitor and evaluate the progress made on the measures put in place. By doing so, the study will have validated the theory of Evidence Based Health Information System by Carbone, (2009), on which the study was anchored.Quality data is, therefore, not only crucial in securing health status description, service coverage, and performance, but also inspires confidence in the HISamong healthcare managers. The study recommends thatthe MOH introducesHMIS as a subject in the pre-service curriculum of all healthcare cadres in order to improve HIS.Mombasa County Governmentshould ensure that qualitydatais generated (with regards toaccuracy, completeness and timeliness) at all levels of the health systemsfor purposes of accountability and more importantly its utility to improve healthcare programs, to survive and prosper in the current dynamic healthcare environment.Item FACTORS RELATED TO QUALITY DATA WHICH DETERMINE HE ALTH INFORMATION UTILIZATION IN MAKING DECISION AMONG HEALTHCARE MANAGERS IN MOMBASA COUNTY, K ENYA(2020) Otieno, Moses Ochieng; Muiruri, Lillian; Kawila, CarolinePurpose: This was a study based on Health Info rmation Systems pillar. T he st udy sought to explore factors related to quality data which influence health information utilization in making decision among healthcare managers in Mombasa County . Methodology: This was a Descriptive Survey Study design whe re desired data was obtained from selected respondents by semi - structured questionnaires. The research targeted a total of 303 healthcare managers in Mombasa County which comprised of 21 County Health Management Team (CHMT) members, 56 Sub - county Health Ma nagement Team (SCHMT) members from the four sub - counties, 43 facility In - Charges from the 43 public health facilities and 183 Heads of Departments (HODs). A sample size of 91 healthcare managers was used in the study . This was 30% of the target population and were randomly selected. A response rate of 98.9% was achieved . Descriptive and Inferential analysis was done. Data was analyzed with SPSS version 23. Findings: R esults revealed that quality data factors (β 4 = 0.298; t = 4.079; p < 0.01) w ere significant predictors of health information utilization in making decision among healthcare managers in Mombasa Coun ty . These results imply that improvement in these variables (data accuracy , completeness and timelin ess) will enhance health information utilization. How these variable s are accomplished influence the level of health information utilization in making decision . Unique contribution to theory, practice and policy: When the study recommendations are impleme nted, there will be assured q uality data which will assist in coming up with the design of disease prevention, interventions and to monitor and evaluate the progress made on the measures put in place. By doing so, the study will have validated the theory o f Evidence Based Healt h Information System by Carbone, (2009), on which the study was anchored. Quality data is, therefore, not only crucial in securing health status description, service coverage, and performance, but also inspires confidence in the HIS a mong healthcare manag e rs. The study recommends that the MOH introduce s HMIS as a subject in the pre - service curriculum of all healthcare cadres in order to improve HIS . Mombasa County Government should ensure t hat quality data is generated (with regards to accuracy, completenes s and timeliness) at all levels of the health systems for purposes of accountability and more importantly its utility to improve healthcare programs, to survive and prosper in the current dynamic healthcare environment .