Thesis

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The role of teacher trainees' in the management of behaviour change programmes in prevention and protection aganist HIV and AIDS
(KeMU, 2011-05) Gikunda, Susan Maigene
Over the past 25 years, nearly 25 million people have died from AIDS in the world. In 2007, globally about one million people were living with HIV and AIDS and about 2.5 million people were newly infected with the virus. HIV causes debilitating illness and premature death in people during their prime years of life and devastated families and communities (UNAIDS, 2007). The purpose of the study was to establish the role of teacher trainees in the management of behavior change programs in preventing and protecting themselves against HIV and AIDS in three public primary teacher training colleges in Meru and Embu counties. The study involved 356 respondents (15 tutors and 341 teacher trainees). The researcher used questionnaires to collect data from tutors and teacher trainees. Stratified random sampling was used to get the sample size. The descriptive research design was used as it described the state of affairs as they were. A pilot study was carried out to help validate the research instruments. The data was tallied and frequencies got. Descriptive statistics such as percentages, means, graphs, and charts were used. The study found out that teacher trainees and tutors were aware and were involved in behavior change programs in place in colleges and social-cultural and religious factors affected the implementation of these programs. The study recommended that dark comers or pairing zone be lit and patrols made. The college administration to encourage tutors and trainees to be more involved in the management of behavior change programs and check on detrimental cultures. The research was conducted in an ethical manner so as to build, uphold trust and cooperation that was aimed at generating valid and reliable
Factors influencing non-adherence to antitroviral therapy (ART) among people living with hiv/aids (PLWHA): A case of Isiolo district, Kenya
(KeMU, 2012-06) Godana, Robe
In HIV/AIDS treatment adherence to antiretroviral therapy is of paramount importance. To achieve suppression of viral replication, decrease in viral load and improving quality of life needs near perfect adherence of 95%. The researcher had sort to establish factors influencing non adherence among people living with HIV/AIDS in Isiolo District. The researcher used descriptive survey design. Sample population of 193 participants which is 30% of the 640 total study populations was used. This was obtained from the district comprehensive care clinic through document analysis. The raw data was collected using structured questionnaires and focused group discussion which was cleaned, classified, coded processed, analyzed and presented using pie-charts, graphs and tables. Findings show: individual’s income, multiple drugs combination, health care workers perceptions, beliefs and taboos influence non adherence to antiretroviral therapy while counseling helps to create positive altitude and minimizes stigma. The study recommends: Ministry of Health with other stakeholders to solicit funds to form support groups that will stabilize clients emotionally, psychologically and economically. To improve infrastructure, health care workers and public perceptions and altitudes through trainings, public education, barazas and pamphlets. Free treatment of opportunistic infections for patients with pneumonias, malaria and others infections to minimize admissions and improve quality of life.
Assessment of nutrition counseling services offered to diabetic patients and its effect on adherence to therapies and treatment at the Nakuru Provincial General Hospital, Kenya
(KeMU, 2012-06) Karanja, Lucy W
Poor health has been a global issue which has been associated with the impediment of productivity, economic growth and poverty eradication. It has been estimated that 32 percent of the global burdens of disease are caused by dietary complications. All millennium development goals are in one way or the other related to good nutrition intake. Nutritional Counseling has been credited for ensuring that people are aware of their dietary choices hence avoiding nutritional complications. This is more essential to diabetic patients. The purpose of this study was to assess the effectiveness of Counseling services offered to diabetic patients in Nakuru Provincial General Hospital, Kenya. In order to have the study carried out successfully, a descriptive survey was used to assess the effectiveness of nutritional Counseling services. The sample consisted of 283 respondents that included 8 dieticians and 275 diabetic patients. Stratified random sampling where the total population was split into two distinct samples (diabetic patients and dieticians) based on their demographics. After obtaining permission from all relevant authorities, the researcher collected the data in form of responses through structured questionnaires. Expert judgment was used to improve on content and construct validity of the items. The Statistical Package for Social Sciences (SPSS) was used to analyze the data. The study established that there was a significant relationship between the patient’s nutritional knowledge and recovery rate. Majority of the patients were not adhering to the recommended therapy. There was a statistically significant influence of nutritional counselors’ knowledge of diabetic management and diabetics’ recovery rate. There was also a significant relationship between the economic status of patients and adherence to therapy. This study recommends that the government must take an active role in promoting the nutritional counseling services offered in hospitals by employing more dieticians, intensifying awareness campaigns on the recommended diet for the diabetics. Civil society and religious groups must also take an active role by holding workshop and seminars to sensitize the community about the diabetic condition, psychological support and fighting against stigma to the patients. Additionally, dieticians need to be aware of the current recommendations for diabetic patients so as to pass it on to their clients. Male nutritionists/dieticians should also be trained to encourage more male patients to attend counseling sessions. The researcher suggests a further research on the level of stakeholders input in promoting nutritional counseling in hospitals and an assessment on whether patients actually adhere to the diet by doing a 24 hour recall.
Occupational stress among probation officers in central province of Kenya
(KeMU, 2012-07) Muteshi, Eugene Musoga
Probation is a people business, oftentimes requiring intense, stressful confrontations with unmanageable offenders. Presently, there are more felons receiving probation than ever before. The impact of current probation supervision conditions on probation officers has not been fully documented. Since human capital is the greatest investment an organization can make, the ongoing assessment and management of employee stress effects becomes critical to maximizing the effectiveness of probation. Considering the fact that probation officers have contact with more offenders than most other justice practitioners, and probation caseloads have continued to increase at unprecedented levels, there is a need to understand more about the work of probation. The proposed study sought to investigate occupational stress among probation officers in Central Province of Kenya. It aimed at determining the prevalence, the causes and effects of occupational stress among probation officers, and the role of counseling in addressing occupational stress among the officers. The Rational Emotive Behavioral and Person-Environment Fit Theories formed the theoretical framework of understanding the concept of occupational stress. The study was conducted in Central province of Kenya. The population of the study comprised of 98 probation officers serving in Central Province at the time of the study. The study employed convenient sampling of the existing five counties in Central Province to arrive Nyandarua and Nyeri Counties. All the officers in these two counties totaling to 24 were the respondents of this study. Structured questionnaires were used for data collection. Descriptive and inferential statistics were used, and methods of data analysis included percentage score and mean. Data presentation was done by the use of tables. The findings revealed that probation officers experienced normal range of occupational stress with mild levels of stress on Role Ambiguity and Responsibility with combined T-scores of 57.92 and 51.04 respectively. Low remuneration, lack of sufficient resources to carry out job responsibilities and lack of opportunities for career development were found to be significant causes of occupational stress among probation officers. These causes of occupational stress were organizational in nature and not job related. The effects of occupational stress on the officers that were found to be statistically significant (p<0.05) were burnout, demotivation, anxiety/depression, conflict with colleagues, and low productivity. Counseling was cited by the respondents as being functional and pivotal in addressing incidences of occupational stress among them through referrals for counseling, psych education, supervision and debriefing. The study findings are useful to the probation department in Kenya in developing policies and effective Employee Assistance Programs (EAP) and other strategies for prevention and management of stress among probation officers. Furthermore, this study on occupational stress among probation officers in Kenya enlightens the public more on this crucial yet less recognized element of the criminal justice system.
Analysis of factors that influence drugs and substance abuse among secondary school students in Imenti North District.
(KeMU, 2014-06) Mukomunene, Pamela
Drug and substance abuse has continued to be an issue of great concern during the past several years with a great number of people reported as drug abusers in the world and being a serious problem affecting secondary school students. Drug and substance abuse has numerous biological, psychological and social adverse consequences. The menace has been reported as being influenced by different factors which include mass media, availability of drugs, peer pressure, curiosity, and availability of funds, boredom, harsh school rules and poor parenting. The study being carried out is aimed at analyzing the factors that influence drug and substance abuse among secondary school students in lmenti North District. The research objectives for the study were whether peer pressure, mass media, amount of money given to students and availability of drugs influence drug and substance abuse among secondary school students in Imenti North. The target population was composed of 10,663 students from the 43 secondary schools in Miriga Mieru East and West divisions. Questionnaires were prepared and used in the collection of primary data from the deputy principals, teachers and students. Prior to administration, the questionnaires were pilot tested to facilitate validation and assessment of reliability. The data was analyzed manually at the end of which results were displayed using frequency distribution tables, percentages and pie charts. The study concluded that drugs and substance abuse was influenced by different factors. These were categorized into major and minor factors, the major factors included mass media, peer pressure, availability of. Drugs and the amount of pocket money given to the students. The study, therefore, recommends that parents and guardians should avoid giving a lot of pocket money to their children; the government should come up with ways to fight drugs found within the students' reach.
Implementation of adolescent friendly health services in county referral hospitals.
(KeMU, 2015-06) Owuondo, Pacific Akinyi
Health service delivery is a key pillar of the health system management .The World Health Organization recently emphasized the need to develop adolescent -friendly health services to improve the care provided to young people throughout the world. However, there is limited peer reviewed literature on this subject therefore necessitating assessment of whether the existing health facilities are prepared to implement the adolescent friendly health services. Adolescent friendly health services remains a relatively new and sensitive area mainly due to restrictive norms and policies guiding the services. After International Conference on Population and Development in 1994, countries started implementing adolescent friendly health services. The Government of Kenya together with partners in an attempt to address the health challenges came up with the Adolescent package of care (APOC) in 2013 whose guidelines were finalized in November 2014 and released for use by service providers. Despite this package of care, there is still ineffective staff capacity in relation to skills and knowledge gap of health professionals, training needs, health resources as well as health system factors that can affect implementation of AFHS. The study explored ways of mitigating or addressing the barriers to implementation of these services. The study used both quantitative and qualitative approaches to collect data. The study utilized survey research adapting descriptive cross sectional design and semi-structured questionnaire to interview 348 health care providers and 472 adolescents in Mam Lucy Kibaki Hospital from 3rd May 2014 to 16 June 2014 .The respondents were mainly nurses, clinical officers and Medical doctors who were working at the health service delivery area at the time of study and were interviewed using an interview guide. The managers at the hospital were interviewed using an in-depth interview guide while the adolescents were interviewed through interview schedule. A total of four (4) focus group discussion was held with adolescents. Quantitative data was analyzed using SPSS Version 18.0. Descriptive statistics and chi-square tests were performed to determine significant associations. The study established that sex, age, level of education and adolescent awareness about existence of friendly health services offered were significantly associated with utilization at p<0.05. Long queues, unfavorable working hours and lack of money negatively affected consumption of AFHS. The study concluded that the utilization of health services among the adolescents was low largely due to unfriendliness of the health care providers at health facilities and lack of awareness of AFHS services. In view of the findings, this study recommends need for the Government through the Ministry of Health and partners in health service provision to increase the number of AFHS and ensure that the recommendations of adolescent package of care is implemented fully with good evaluation strategies in place. Laborious awareness drives to sensitize the adolescents about availability of adolescent friendly services through rigorous health education and increased involvement of both parents/guardians and teachers to scale up implementation are also recommended. Keywords: Preparedness, Staff Capacity, Health resources and Adolescent friendly Health Services.
Community health information system utility.
(2015-12) Pepela, Wanjala David
A wealth of data is available within the healthcare systems more so at community level. However, lack of effective use of information shared during dialoguing at the community level in Bungoma County posed a great challenge despite efforts by government in recognising community care services as critical level 1 service. Health indices have remained on a worsening trend with service utilisations very low. The purpose of the study was to inform service utilisation, promote use of community health information to improve health outcomes. The main objective was to determine the community health information system utility to improve health outcomes in Bungoma County. The specific objectives were to assess the community units level of use of information processes for improved community health services; to identify the technical tools for sharing information during community dialogue and action days; establish community health information system capacities affecting sharing of available information and determine what organisational factors influence sharing and use of community health information. The study was descriptive cross-sectional design. The study employed a combination of stratified clusters proportionate to population size and applied simple random sampling technique with a proportion of 30% of target population as representative sample. The target population was (N =163) with a sample size of nh =54 community units. A structured interview questionnaire both closed and open-ended was administered to Community Health extension workers and 3 in-depth focus group discussions. Data analysis generated univariate frequencies and interpretation using tables and charts. The expected outcome was utility of health information. Results showed that response rate 44 (81.5%), 35 (79.5%) with knowledge on data management and 39 (88.6%) generated monthly summaries with 34(77.3%) with overall utility of community information using white/chalkboards. 27(60.6%) provided feedback and shared information during dialogue days monthly at 41(93.2%) and 17(38.6%) respectively. Information had inadequate involvement in design 14(32%), unavailability of data tools in 39(89%) and less use of appropriate technologies. 26(59.1%) had knowledge on kind of information required, 27(61.4%) analysed this information while, 42(95.5%) used information for evidence based-decision making. Income generating activities supported by partners in 6(13.6%) of the units. Community formal structures was in 32(72.7%) units and shared information in dialogue 54(100%), 36(81.8%) using "Barazas" while, 31(70.5% through health promotion and education. Majority 40 (90.7 %) were empowered through support supervision using standard procedures and checklists. Regression analysis using ANOVAa showed that results were moderately correlated with utility of community information with correlation Coefficientsa 0.017 at 13 0.538b, while Pearson Chi-Square Tests compared with use of information with linear association of 0.910 had a likelihood ratio of Fisher's Exact Test of 0.658 thus, result moderately significant. In conclusion knowledge was above average; information was regularly shared through community dialogues; while design, technical tools and empowerment of communities were weak and inadequate and finally the system was well structured though not resourced and uncoordinated. It was recommended that both National and County governments to emphasize on regular feedback to promote information utility; adequately provide technical capacities and mentorships;
Factors Associated with Stunting among Children Aged 0-23 Months.
(KeMU, 2016) Musyoki, Clementina Ngina
Globally, childhood stunting is one of the most significant impediments to human development, affecting approximately 162 million children under the age of 5 years (WHA Global nutrition target, 2025). Stunting, or being too short for one's age, is defined as a height that is more than two standard deviations below the World Health Organization (WHO) child growth standards median. In Kenya, stunting rates are at 26% according to Kenya Demographic Health Survey 2014 (KDHS, 2014).The study was conducted on stunted children who visited the maternal child clinic (MCH) at Mbagathi sub-county hospital in Nairobi County. The study objectives were to investigate the social —economic and demographics variables, Child feeding and care practices and maternal feeding and care practices of the population under the study. The study adopted a across-sectional design and the sampling process was calculated using Emergency Nutrition Assessment software (ENA). The sample size included in the study was 287 children. Data was entered using the CSPro software Version 6.1 while the analysis was done using SPSS version 22. The study revealed that 80% of the households were headed by male while 82.9% of mothers interviewed were married. The mothers who had attained secondary education was at 53% and most of the families were less than five at 81.5%. Mothers who initiated breastfeeding within the first hour of life was at 87%. Exclusive breastfeeding was at 28% while complementary feeding was at 66.7%. Under health seeking behavior,97.6% of the mothers took their children for treatment to health facilities during illness .Hospital delivery was well practiced at a rate of 94.1% while ANC visits at least four times was at 39.4% with majority of the ANC visits happening within the third trimester. Extra foods during pregnancy and lactation were at 69.3% and 71.4 % respectively. The study concluded that there was inappropriate breastfeeding practices and early introduction to complementary foods as well as poor ANC attendance. Nutrition education should begin from ANC and continued at the MCH as a key recommendation.
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
Factors influencing uptake of maternal health services initiatives among mothers: a case study of Nakuru-Kenya.
(2016-06) Wairia, Samuel Kingori
Strengthening health Service delivery is very important in improving maternal mortality which remains an urgent problem to be addressed in developing countries around the world. Kenya has a very high maternal mortality rate which stood at 471 per 100,000 live births compared to other developing countries of 230 per 100,000 live birth and 16 per 100,000 in developed countries while Nakuru County had a maternal mortality rate of 374 per 100,000 live births despite being one of the counties with the best infrastructure, high number of health workers and better health care financing. This revelation is an indication of an ineffective health systems leading to poor uptake of MHS. The broad objective of this study was to assess factors influencing uptake of maternal health services initiatives among mothers in Nakuru County. The specific objectives were: to determine if the clients characteristics influenced uptake of maternal health initiatives, to assess levels of awareness of maternal health initiatives and to establish if the organization of health services influenced uptake of maternal health services in Nakuru County. The study was undertaken in Nakuru County between January and April 2015. The study was a cross-sectional in design where both qualitative and quantitative approaches were used. A total of fifteen level 4 hospitals (9 private and 6 public) were purposively selected for the study. The sample size was obtained by use of Cochran 1963 formula where 233 mothers were included in the study as respondents and sampled using systematic sampling and purposive sampling was used 8 health workers who were in-charge of MCH services in their respective facilities, these were included to be part of a focus group discussion (FGD). The data was collected using semi structured questionnaires for mothers and FGD guide. Quantitative data was analyzed using SPSS version 20 and presented in tables, percentages and pie charts while Qualitative data was analyzed using excel sheet software. To understand the relationship between variables, inferential statistics was done using Chi-square Test and P-values obtained. The response rate was 233(100%). The finding of the study indicated that a client's characteristics like age, education, religion, marital status and employments have significant influence on the uptake of MHS and the level of education was the best predictor of uptake of MHS initiatives, mothers had low levels of awareness of MHS initiatives with the least being in emergency obstetric care (EmOC) and free maternity services (FMS) which had a median of 1 (that is slightly aware). The least P-value was in free maternity services (P-value=.037). The poor organization of services affected the uptake of maternal health services especially due to acute shortage of staffs (that is hospitals operating below 50%), intermittent supplies of drugs, poor healthcare financing and services setup. In conclusion, client's characteristics influence uptake of MHS, mothers had low levels of awareness on MHS initiatives and poor organization of health services affect uptake of MHS. Therefore, the researcher recommended that :Community opinion leaders should be involved in decision making process to increase uptake/utilization of maternal health services among the low education class, door to door awareness campaigns especially of free maternity and emergency obstetric services be carried out within community through community own resource persons (CORPs) and Health facility management forums should be created to improve organizational approaches that will make services more user friendly to the community. Further Studies can be done on the impact of devolution of health services on access to maternal health services among mothers.
Factors Influencing Provision of Nutrition Education and Counselling To Pregnant Women by Nurses during Antenatal Care in Nairobi County.
(KeMU, 2016-06) Njoroge, Charity Wairimu
Good maternal nutrition is essential for health, development and reproductive performance of the pregnant woman, and for the growth, survival and general health of the child. One strategy for ensuring pregnant women get information on the importance of adequate nutrition is through nutrition education and counselling. However many barriers hinder effective provision of nutrition education and counselling; one may be inadequate nutrition knowledge by nurses among other factors. The objective was to determine the factors that influence provision of nutrition education and counselling to pregnant women who attend antenatal care by nurses in Nairobi County. A cross-sectional descriptive study was used. The sample comprised of 150 nurses working in the antenatal clinics from 30 health centres in Nairobi County. A semi-structured self-administered questionnaire was used to collect quantitative data, and seven key informant interviews with clinic in-charges for qualitative data. Data was analysed using SPSS version 21. Descriptive statistics was done on all variables. The chi-square tests was used to determine relations between key study variables. Nurses who had a clear understanding of nutrition education and counselling were 36%. The nurses who had knowledge on the importance of nutrition to birth outcomes were more likely to provide NEC (P=0.002). Nurses self -perceived knowledge and skills for provision of nutrition education was 34%. 66% reported that they were not adequately trained. Inadequate knowledge on was similar to all levels of nursing training, whether trained in private or public institutions. Majority (73%) reported they provided nutrition education in group sessions. However the content and quality provided is likely to be affected by inadequate knowledge and skills of nurses and lack of structure. 47% reported they had guidelines at the health facilities. In conclusion, this study has found that nurses' self—perceived knowledge and skills for provision of nutrition education and counselling was inadequate. Secondly. lack of structure lead to inconsistency in the content and quality provided. Thirdly, unavailability of guidelines and irregular use affected delivery of services. It is recommended that basic nursing training should provide trainees with adequate competences. Nurses should have continuing education on nutrition to enhance their knowledge and skills. There should be a structure to guide and ensure uniformity of NEC service provision and guidelines should be provided to all health facilities and used as reference materials.
Functionality of community-based health information systems in Embakasi sub-county, Nairobi County, Kenya.
(KeMU, 2016-07) Kaburu, Emily Wanja
A functional Community-Based Health Information System (CBHIS) is poised to collect, collate, analyse, evaluate, store, and disseminate community health-related data and information for use by the community. There is inadequate information available of what influences the functionality of CBHIS in Embakasi Sub-county. This is an impediment to informed strategies that can enhance focused improvement and maintenance of functional CBHIS. The main objective of the study was to assess functionality of CBHIS in Embakasi Sub-County, Nairobi County, Kenya. The specific objectives were: To determine the relationship between workers individual characteristics and functionality of CBHIS; to assess the internal factors that influence functionality of CBHIS and to assess the external factors that influence functionality of CBHIS. The target population was 10 functional Community Health Units (CHUs) in Embakasi sub-county. A sample size of 80 health workers from CHU and link health facilities was used. The study was descriptive cross sectional in nature where both qualitative and quantitative methods of data collection were used. The study adopted Key Informants interview, for link health facility workers, and 2 sets of questionnaires for CHU workers. The data acquired was analyzed using thematic analysis, MS Excel and Statistical Package for Social Sciences Software respectively and presented in frequencies, percentages, tables, charts and graphs. Relationship between the independent variables and the dependent variable was established using Chi-square test of association, fisher's exact test and Logistic regression models since the responses were categorical. A total of 68 respondents were interviewed with a response rate of 67%. There was a significant relationship between marital status, age of the Community Health Volunteers (CHVs), and ability to collect data at (p=0.024 and p=0.016 respectively). However, at a=0.05 there was no significant evidence linking gender and ability to collect data (p =0.637). Besides, at a=0.05 there was a strong relationship between experience and CHVs ability to understand indicators (p=0.033). There was no sufficient evidence linking CHV education level, age and understanding of indicators (p=0.696 and p=0.469 respectively). The tools, feedback forums, training and support supervision were available but inadequate and that CHUs did not have data analysis capacity. There was acute shortage of workers, inadequate tools and the reporting lines were not clear. The community was very supportive to CHUs activities and the linkages were effective as stated by all the respondents. However 3(60%) of the Community Health Extension Workers (CHEWs) pointed out that the county leadership was unsupportive to the CHUs while 2(40%) reported the county leadership supportive. The study recommends that CHUs functionality be reinstated in order to strengthen the functionality of CBHIS, HIS and the entire health system. Marital status, age and experience of workers should be considered when selecting the CHVs; the local leadership should provide the workers with adequate tools, capacity build them on data analysis, strengthen dialogue and action days, offer frequent refresher training and equip the workers with supervisory skills. Finally, the linkages between CBHIS and FHIS should be strengthened and that the local leadership should support the community health unit activities. The researcher proposed that further research be done to determine the role of Community-Based health data in strengthening decision making at the national and local level.
Drivers of Health Services' Sustainability in Selected Mission Hospitals in MT. Kenya
(KeMU, 2016-07) Ndege, Josephine Muthoni
Mission hospitals were initiated by missionaries and were heavily subsidized. The situation has changed; donor support is no longer reliable and cost of providing services has increased tremendously. The subsidy which enabled the services to be cheap and accessible has largely ceased hence the full cost of delivering services has to be met by the patients. A number of mission hospitals are befallen by crisis due to weak governance structures leading to poor oversight of health institutions. The health providers market has also become very competitive with private and public health units mushrooming in both urban and rural areas. Due to the financial constraints, sustainability of mission hospitals has been difficult and is in dire need of exploring other factors to enable it sustain health services. The study was conducted to explore drivers of health services' sustainability in mission hospitals so as to enhance service provision, accountability and growth while embracing best practices. The specific objectives were to find out if governance, continuous quality improvement and stakeholders engagement influence sustainability. The study was carried out in 10 faith based Hospitals in Kirinyaga, Murang'a, Embu, Nyeri and Meru counties with bed capacity of 60 and above. A descriptive cross sectional study design was used and a non-probability sampling method was used to select subjects of the study. Questionnaires and key informant interviews with selected chief executive officers was used to collect data that was analyzed using Statistical Package for Social Sciences and presented in the form of frequency tables at p < 0.05. A multivariate regression model was applied to determine the relative importance of each of the three variables with respect to Health Services' Sustainability. The study found out that mission hospital adheres to quality improvement practices such as presence of quality improvement teams and standard operating procedures but lacks top management support; they have a board of directors but lack a clear documented organization structure (organogram) while board composition was biased to church leaders. Study also indicated that stakeholder's engagement was a key drive to sustainability but there was little engagement within the catchment population. The study concluded that Mission hospitals lack sufficient funds from their sources of income to sustain quality health services since main source of funds is user fee which is also affected by dwindling patient numbers. The study recommends that Governance of mission hospitals should be strengthened and professionalized to ensure that it has the essential competence and Mix of skills and employees trained on sustainable procurement concept. It is recommended to further research on how mission hospitals can gain competitive advantage through service differentiation.
Human resource management practices on performance of health workers in public hospitals: a case of Mbagathi hospital, Nairobi City County.
(KeMU, 2016-07) Musyoka, Felistus Ndanu Musyoka
Sound human resources management practices are essential in strengthening the health systems. Human resource management practices like use of job descriptions, use of performance appraisal and use of supervision can transform health workers into a productive, motivated, and supported workforce capable of improving healthcare services and saving lives. Kenyan health system is designed such that human resource managers are based at county and national offices only and not hospital levels therefore the hospitals lack managers to champion human resource management practices at facility level. The specific objectives of the study were to determine the extent to which the practice of performance appraisal at Mbagathi Hospital (MH) influences the performance of health workers; To assess the level to which use of job descriptions at MH affect the performance of health workers; to examine the degree to which supervision practiced at MH contribute on performance of health workers; and to determine the challenges faced by health service managers on human resource management practices at MI-1. Mixed research design was applied in this study. The targeted populations were 22 health service managers and 275 technical staff. 11 health service managers were purposively selected to the study and stratified sampling was applied to sample 179 technical staff Research instruments were key informant interview guide for the health service managers and self-administered questionnaire for the technical staff. Data analysis from the self-administered questionnaires was done using SPSS 20 and results displayed on graphs, charts and tables. Analysis of the data from key informant interview guide was transcribed verbatim, coded and analyzed through content analysis. Results from quantitative data were triangulated with qualitative results. Responsiveness had a mean score of 56%, availability at 53.5%, productivity at 54.6%, and competency at 65.9%. The health workers performance was rated at a mean score of 57.6% with a standard deviation of 4.2%. The health service managers at the hospital were not aware of policies on human resource management practices. There were no trainings in the hospital on human resource management practices. Performance appraisal was minimally used (20.7%). Job description was moderately used (42.5%). Supervision was minimally used (36.4%). Health workers' performance was not significantly associated with use of perfonnance appraisal, existence of job description and use of supportive supervision. The MH management should embrace performance appraisal as a tool to motivate its health workers and improve its customer service rather than just using it to fulfil requirements by the parent ministry. Health service managers at MH require basic training on human resource management practices so as to be able to support heath workers in their daily activities and there is need to establish human resource management department to champion these practices.
Health systems factors influencing utilization of essential health package in public hospitals.
(KeMU, 2016-07) Opon, Shadrack Ochieng
Availability of health care services does not guarantee that patients will optimally use them. In Homabay County, lack of access to health services is among the top reasons for low service utilization. This study focused on service delivery pillar and in particular the utilization of essential health packages (EHP), which include infectious diseases, maternal and newborn health, nutritional deficiencies and common injuries. According to Kenya Demographic Health Survey 2014, the health care utilization rate is 77% for those who are sick in Kenya. Among those who are ill and do not seek care, 44% and 18% were hindered by cost and distance respectively. The Health Sector Statistics Report also suggests that the overall child mortality rate is 121 per 1,000 live births. In Homabay County, child mortality rate is 91 per 1,000 live births, and maternal mortality rate is 583 per 100,000, compared to the national average of 488 per 100,000. The study assessed health systems factors influencing the utilization of EHP in public hospitals in Homabay County. Specifically, the study assessed how human resources for health, availability of drug, the role of health infrastructure, and organizational practices influence the utilization of EHP. The study adopted cross-sectional research design. Two hospitals were conveniently sampled (Homa-bay County Hospital and Mbita Sub-County Hospital) due to their large volume of patients. Yamane's formula was used determine the respondents' sample size. The study used stratified and simple random sampling methods to sample 138 health workers (Pharmacists 5, Clinicians 13, Health Management Information System Officers 8, Nurses 104, and Hospital Managers 8), and simple random sampling to sample 186 patients. Structured questionnaire and key interview guide (with 8 hospital heads) were used to collect data. Findings revealed that, all the health workers 138 (100%) said that Homabay County has shortage of health workers, the hospitals have inadequate drugs and patients are referred elsewhere due to lack of medical equipment. Majority 115 (83.3%) health workers say hospitals lack operational ambulances. Majority 153 (82.3%) and 135 (72.6%) of patients are hindered by cost and distance respectively to access health care. Among organizational factors, majority 159 (85.5%) patients do not always find all services they wanted and had ever failed to seek care because of the long waiting time. The regression model revealed at least 0.06 coefficients, indicating that a positive change in the independent variables (human resources for health, availability of drugs and supplies, health infrastructure, and organizational practices) results in a positive change in the dependent variable, utilization of EHP. Positive Pearson's correlation of 0.11 showed a close relationship between the variables. Conclusively, Homabay County lacks adequate health workers, drugs and hospital infrastructure, in addition to poor organizational practices leading to low utilization of EHP. The study recommends that the county employs more health workers, improves the procurement system, invests on health infrastructure including medical equipment, emergency ambulances, and buildings and should review costs of services to improve utilization of EHP in Homabay County.
Determinants of availability of tracer essential medicines in public health facilities in Nyeri County, Kenya
(KeMU, 2016-07) Kawira, Micheni Stella
The goal of the health system is to improve health and health equity in ways that are responsive, financially fair and make the most efficient use of the available resources. This is supported by six Health Systems Strengthening (HSS) pillars of medicines, vaccines and technologies, human resource, financing, leadership and governance, service delivery and health information systems. A well-functioning health care system ensures equitable access to medicines, vaccines and technologies which results in overall HSS. Tracer essential medicines are supposed to be 100% available at all times to treat the common ailments in a region. Despite the large number of patients that visit public health facilities, the inadequacy of trained pharmaceutical personnel, inefficiencies of the supply chain system and inadequate funding, no study has been carried out to ascertain the availability of tracer essential medicines in these facilities. The objectives of the study were to determine the stocking level of tracer essential medicines, to establish human resource factors affecting availability of tracer essential medicines, to find out the supply chain factors affecting availability of tracer essential medicines and to assess the organizational factors affecting availability of tracer essential medicines. A cross sectional study design with a mixed method approach was used. A questionnaire was used to collect data on the human resource factors and supply chain factors affecting availability of tracer essential medicines. A Focus Group Discussion (FGD) guide was also conducted with seven respondents comprising of six sub County public health nurses and the County pharmacist. The sample population comprised of 17 public health facilities and 30 pharmacy personnel. The response rate was 25 (83.3%). The average stocking level in tier three facilities was 94% while that in tier two facilities was 63.75%. The overall mean percentage stocking level of the 20 tracer essential medicines in all the facilities was 72.65%. Human resource factors that affected availability were unavailability of Standard Operating Procedures (SOPs), inadequate training of pharmacy personnel and pharmacy personnel not aware of tracer medicines. There was a significant relationship between availability of tracer essential medicines and pharmacy personnel awareness of tracer list (r=0.850), pharmacy personnel receiving training in commodity management (r=0.834), availability of SOPs (r=0.817) and designation of pharmacy personnel (r=0.746). The supply chain factors that affected availability of tracer essential medicines were long lead times, unavailability at Kenya Medical Supplies Agency (KEMSA), long ordering and delivery schedules and incorrect quantification. The organizational factors that affected availability were inadequate supportive supervision, inadequate financing and absence of Revolving Drug Funds (RDFs) within the facilities. The study concluded that the stocking level of tracer essential medicines in Nyeri County was below the World Health Organization recommendation of 100%. In addition, human resource factors, supply chain factors and organizational factors affected availability. The researcher recommends that a community pharmacy with subsidized medicines prices be introduced in the facilities; the County should facilitate training of all pharmacy personnel on commodity management, all facilities should have buffer stocks to cover at least two months as they await new stocks and the County should provide supportive supervision to the facilities.
Influence of community health referral practices on antenatal care attendance.
(KeMU, 2016-07) Shibonje, Janet Mukoshi
health system strengthening. In line with the pillar, a Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project's goal was to strengthen health systems at the facility and community levels; thus, improve demand for health services, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. Although studies conducted in various contexts demonstrate the potential of such referral systems in improving ANC indicators, in Kenya, there was a dearth of academic information regarding the subject. This study was initiated to achieve three objective: determine whether providing maternal health education to pregnant women had any influence on ANC attendance in Mirihini (an intervention community in Bamba Division) and Midoina (a control community in the neighboring Bahari Division); determine whether issuing referral advice forms to patients has any influence on ANC attendance in the two communities; as well as establish whether promoting partner support had a significant influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in the intervention and control communities. Primary data were sourced from 246 mothers of children aged below 2 years; male and female parents of children aged 2 to 4 years, as well as Community Health Volunteers (CHVs). Quantitative analysis yielded descriptive statistics and cross-tabulations with Chi-square (x2) tests. Qualitative data were transcribed, described and analyzed systematically to reveal themes and patterns. Maternal health education: In Mirihini, there was no significant association between providing maternal health education on the ideal number of ANC visits and women's achievement of optimal ANC attendance (x2 = 1.423, df=1 & a p-value = 0.233); hence, the null hypothesis (H01) was not rejected. In Midoina, a significant relationship between the two aspects was obtained (x2 = 3.109, df = 1 & p-value = 0.078), which led to rejection of the null hypothesis (H01). Referral documentation: In Mirihini, issuing referral documents to pregnant women significantly associated with their achievement of optimal ANC attendance (x2 = 8.308, df =1 & p-value = 0.004). Consequently, the null hypothesis (H02) was rejected. In Midoina, there was no significant association between two aspects (x2 = 0.823, df = 1 & p-value = 0.185); hence, the null hypothesis (H02) was not rejected. Male involvement: In Mirihini, partner counseling significantly associated with women's achievement of optimal ANC attendance (x2 = 14.175, df = 2 & p-value = 0.001), which led to rejection of the null hypothesis (H03). However, in Midoina, there was no significant relationship between the two aspects (x2 = 3.710, df = 2 & p-value = 0.156); thus, the null hypothesis (H03) was not rejected. The intervention and control communities varied in terms of the influence of maternal health education, issuance of referral documentation and partner counseling, on women's achievement of optimal ANC attendance. The study recommends the need for: improved facilitation of CHVs to deliver more information on maternal health; project officers to strengthen supervisory support to CHVs by engaging with MoH to provide reporting materials and ensure consistency of monthly review meetings. Besides, there is need for MoH to involve more male CHVs to influence changes in knowledge and perceptions towards ANC attendance among men.
Factors influencing routine health management information use in public health facilities in Tharaka Nithi County, Kenya.
(KeMU, 2016-07) Mucee, Elizabeth Munda
Routine health management information systems are the foundations of all health systems which strengthen other five pillars hence, strengthening health systems performance. But despite their essential benefits, at the facility level, health workers commonly spend 40 percent or more of their time filling in Health Information Systems forms but may make little or no use of the information for decision making. Information use is determined by multiple factors ranging from technical, organizational and behavioural factors which were drawn from the theoretical framework. The objectives of the study were to determine the technical factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County; to establish the organizational factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County and to establish the behavioural factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County. A descriptive cross-sectional study was conducted in 12 Dispensaries, three Health Centres and one Sub County Hospital in Tharaka Nithi County. Data was collected through researcher administered questionnaires and observation checklist. The respondents were purposely selected from the sampled public health facilities, which included 22 information producers and 53 users in Tharaka Nithi County. The study results identified a set of factors influencing health information use for each of the three categories of factors: technical factors (lack of staff competence at 74 (98.7%), multiple HIS tools at 74 (98.7%) and lack of computers at 74 (93.7%); organizational factors (lack of information use culture promotion at 73 (97.3%) lack of staff training in HIS skills at 69 (92%), and lack of support supervision on information use at 71 (94.7%) and behavioural factors (lack of staff motivation at 73 (97.3 %) and recognition for well done job at 74 (98.7%). The researcher concludes that, for health systems to use health information for evidence-based decisions, technical factors, organizational and behavioural factors must be provided to information producers and users in public health facilities in Tharaka Nithi County. The study recommends: To provide adequate positive technical factors in terms of competent personnel, computers and user-friendly HIS tools to enhance information use; To promote positive organizational factors in terms of promotion of information use culture, support supervision on HIS and support staff training in HIS skills to enhance information use; To initiate and implement motivation and recognition mechanisms in workers' accurate information for use in evidence-based decisions. The researcher suggests further studies to; establish other factors influencing health information use in the public health sector other than those covered by this study; establish interventions to enhance health information use in decision making in public health setting.
Health systems support factors' influence on uptake of immunization services in Kajiado North sub-County.
(KeMU, 2016-07) Toweett, John Kipngetich
Access to health care services is described as the ability by patients to reach and demand health services based on individual needs. Immunization is one of the most effective, safest and efficient public health interventions as it is estimated to save at least 3 million lives from vaccine preventable diseases. Many cultural, religious, or social factors may impede the demand for health care. This study focused on the service delivery pillar. The overall objective was to determine the health system support factors and their influence on access of immunization services in Kajiado North Sub-County. Specific objectives were a) to determine the socio-cultural values that contribute to low access of immunization health services, b) to assess how the packaging of immunization services in the health facilities influence access and c) to establish the relationship between the health promotion activities. This was a cross-sectional study design with a sample size of 280 respondents who were mothers with children below 12 months. Nine health workers were purposively selected for a focused group discussion. Data was analyzed using of ms-Excel, SPSS version 20 and results presented in narratives, tabulations, and graphs. The results revealed that in 2012 and 2013 in Ngong hospital and Fatima health center had a drop in immunization coverage of 128 and 273 children respectively. In addition, the comparative analysis of Kajiado sub-counties on immunization coverage indicated that the sub-county antigen specific coverage reduced as follows: BCG dropped by 4% to 61%, OPV increased by 5% to 75% and measles increased by 3% to 77%. The mean age of respondents was 26.7 years and analysis indicated that level of education negatively influenced immunization access. The distance between households and health facilities ranged from a hundred meters to 20Kms. Approximately 48(17.1%), of mothers visit facilities which are outside the 5 kilometer distance advocated by Kenya health policy. 120(42.8%) suggested that there is need for health promotion activities in the community. The correlation of visits to awareness indicated a p-value of 0.209. 233 (83%) agreed that immunization program is well explained to them when they visit health facilities. The correlation of health education with awareness indicated a p-value of 0.406. The modes of communication clearly portrays that 183(65.4%) of mothers got the information about immunization through continuous health education that is routinely offered in health facilities, whereas 39 (13.9%) mothers got the information through community health promotion. The study recommends a) form outreach teams to trace defaulters of immunization schedules, b) sub-county health office to frequently conduct community health promotion in the villages to discourage cultural believes which contribute to low access to immunization services, and c) package simplified information about the benefits of immunization services shared in health education sessions and during community health promotion.
Relationship between Strategic Planning Practices and the Performance of Devolved Healthcare among Selected Public Hospitals in Meru County
(KeMU, 2018-02) Ngera, Anthony Kiama
The study investigated the relationship between strategic planning and performance of devolved healthcare, through a survey of public hospitals in Meru County.Strategic planning refers to the process of envisioning the future of the organization and breaking it down into executable strategies, goals, tactics and timelines. Organizational performance on the other hand refers to the outputs/results realized by an organization in line with their goals and objectives. The specific objectives of the study were to establish the relationship between the individual components of strategic planning (mission and vision statements, business environmental analysis, strategic formulation, strategic implementation and strategic monitoring and evaluation) with the performance of public hospitals in Meru County. Despite the evident challenges in devolved healthcare in form of frequent industrial strikes, lack of medical equipment and essential institutional structures among others, no studies had investigated these problems from a strategic planning standpoint, justifying the study. Performance of devolved healthcare was considered in light of the WHO framework for measuring the performance of health systems, which focuses on health improvement, health responsiveness and financial fairness. The study covered six Level 4 hospitals in Meru County (Nyambene, Kanyakine, Muthara, Timau, Mikinduri, Miathene) and one level 5 facility (Meru Teaching and Referral Hospital). It took the design of a descriptive survey with a semi-structured questionnaire used in data collection. Analysis of collected data was done using SPSS version.21 with descriptive statistics such as means and percentages generated. Elsewhere, linear regression model was used in inferential analysis that establishes the relationship between the dependent and independent variables. The results were consequently presented using charts and tables. It was established that four out of the five strategic planning components included in the study were significantly associated with performance of Meru County public hospitals. Specifically, the study determined that mission and vision statement, business environmental analysis methods, strategy implementation process, and strategic evaluation and monitoring practices were significantly associated with performance of Meru County public hospitals. The study concluded that effective communication of mission and vision statement would inspire the employees and all the hospital stakeholders towards achieving a common goal, an effective environmental analysis would give a healthcare institution an edge in the industry, a strategic plan however well drafted, if not implemented, would be a waste of a hospital's resources and that the continuous comparison between the actual performance versus the set targets and addressing the variances therein would positively impact the hospital's performance. The study recommended that: i) deliberate steps should be taken by the hospital management boards in communicating the mission and vision statement in an effective way to inspire the stakeholders towards the desired envisioned future, ii) the hospital management board should perform effective business environmental analysis aimed at formulating strategies that would give the hospital a competitive edge in selected areas of operation, iii) the hospital management board should avail adequate resources and motivate the employees to pursue strategic objectives and effectively implement the strategy formulated, and iv) the County government and the hospital management board should design clearly spelt out targets against which performance can be compared and corrective measures taken to address the variances. Since the study focused on public hospitals in Meru County, it is suggested that the study be extended to other Counties to assess whether different findings may be reached regarding the relationship between strategic planning elements. and performance of hospitals.