Master of Science in Health Systems Management

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Assessment of factors affecting healthcare waste management system in Machakos County, Kenya
(KeMU, 2019-09) Mwania, Michael Musango
In general, most local authorities in Kenya have been unable to cope up with the segregation, the treatment and methods of waste disposal especially healthcare waste. Health facilities in Machakos County have poor practices when it comes to the segregation of healthcare waste, its treatment & disposal; the general population, the patients, the health workers including waste handlers are exposed to certain risks such as needle stick injuries, a higher risk of infection of HIV/AIDS and hepatitis B&C. This study, therefore, focused on the reinforcement of the service delivery pillar of Health Systems, through addressing aspects of securely managing healthcare waste in medical facilities in Machakos County. The general objective of this study was to ascertain factors affecting the management system of healthcare waste in Machakos County in Kenya. The study was governed by four specific objectives; to determine the process of healthcare waste management, the role of health Managers, human resource factors, and how the implementation of healthcare waste management policy affect the management of wastes in the healthcare facilities in Machakos County. To obtain data for the study, a survey research-based study was used. Stratified random and purposive sampling techniques were used in drawing a sample size of 187 respondents. Questionnaires and interview guides were used in the collection of primary data, whereas existing literature that is related to the current research topic under study was used for the purposes of secondary data. The study findings showed that all the four independent variables healthcare waste management process health manager’s role, human resource factors, and healthcare waste management policy implementation had positively and significantly influence on the management of healthcare waste system. From the findings, the health manager’s role had the strongest positive and significant influence on the management of the healthcare waste system. The study concluded there is an inefficient healthcare waste management process in Machakos county health facilities, Health Managers understands their role in waste management but lack capacity building and enough funding to purchase required healthcare waste management commodities. Main human resource factors were lack of capacity building through continuous medical education on healthcare waste management and enough healthcare waste management commodities hence leading to inefficiencies on waste management. Most Health workers had little or no information on customized healthcare waste management policies and guidelines. The study recommended there a need for training on healthcare waste management to all healthcare staff and waste handlers in line with existing healthcare waste management policies for the healthcare waste management in Machakos County and in Kenya. County governments need to provide adequate budgets to health facilities to enable procurement of adequate healthcare waste management commodities and also adopt safe treatment technologies.
Assessment of Factors Influencing Service Delivery at Sub-County Hospitals in Meru County, Kenya
(KeMU, 2020-11) Anampiu, Jason Maingi
Integrated and people-centred health services are critical for realizing universal health care coverage. This can only be achieved through provision of efficient and effective health services. Service delivery is one of the key building blocks of any health system; it is an immediate output of the inputs into the health system, such as the health workforce, procurement and supplies, infrastructure and financing. The rising burden of disease and weak health systems are being compounded by the poor health service delivery. The purpose of the study was to determine factors influencing service delivery at sub-county hospitals in Meru County, Kenya. The objectives of the study was to determine the influence of staff on service delivery in sub-county hospitals in Meru County; to assess the influence of facilities on service delivery in sub-county hospitals in Meru County; to establish the influence of management practices on service delivery in sub-county hospitals in Meru County and to evaluate the influence of Drugs procurement process on service delivery in sub-county hospitals in Meru County. The study adopted a descriptive cross-sectional design. The target population consisted of five officers from each of the twenty three sub-county hospitals which totalled up to one hundred and fifteen. Open and closed ended question were used to collect data. Data was analyzed using Epidata and SPSS version 22.0. Correlation and multi linear regression analysis were respectively used to establish the strength and direction of the relationship between the variables and the extent of independent variable on service delivery while descriptive statistics were used to generate means and standard deviation from the collected data. There was a positive significant relationship between staff, facilities, management practices and drugs procurement (Staff r= 0.892, p=.000; Facilities r= 0.969, p=.000; Management practices r= 0.891, p=.000; and Drugs procurement r=0.930, p=.000.respectively) and service delivery in Meru sub-county hospitals. It is concluded that staff, facilities, management practices and drugs procurement had positive and significant effect on service delivery among Meru sub-county hospitals. This study recommends that management of Meru sub-county hospitals should motivate and have the required number of staff, have adequate and useable facilities, engage in management practices that will add value to hospital operations as well as procure drugs in a timely manner, of the right quality and quantity.
Assessment of health workers perinatal knowledge and practices related to service delivery in Makueni County, Kenya
(KeMU, 2019-09) David, Benard Kasanga
A health system has six interdependent and interrelated pillars: health workforce; service delivery; information; financing; medical products, vaccines and technologies; leadership and governance. This study addressed health workforce pillar in order to strengthen maternal and new born services delivery in Makueni County. Globally, new born (neonatal) mortality remains unacceptably high. Neonatal mortality accounts for 60% of infant mortality rate in Kenya. In Makueni County, 1 in 22 children does not live to his or her first birth day. This unacceptable high mortality is despite existence of cost-effective evidence-based interventions which could reduce up to 70% of current deaths. Review of client complaints in Makueni has revealed gross medical mismanagement raising concerns whether health workers attending to them are knowledgeable. This study assessed perinatal knowledge and practices among health workers in Makueni County. It specifically established prenatal care knowledge and practices, pre-eclampsia knowledge, postnatal care knowledge, home visits and hand hygiene knowledge among health workers in Makueni County. The study was cross sectional in design where 163 health workers selected randomly were interviewed using a structured questionnaire and a checklist used to observe antenatal care consultation practices. Data analysis was done using SPSS v25 and chi-square statistic test used to examine associations within variables. On prenatal care, 89 (54.6%) of health workers were rated as having good knowledge. However, practice did not conform to guidelines since 10 (30.3%) and 23 (69.7%) of mothers didn’t have full history taken and general physical examination done respectively. On pre-eclampsia 78 (49.4 %) had poor knowledge while on use of recommended drugs for pre-eclampsia, 70 (42.9%) had moderate knowledge and 39 (23.9%) poor knowledge. On postnatal care, 132 (80%) had good knowledge on young infant feeding while 35 (21.5%) had poor knowledge on new born care. On management of neonatal infections, 58 (37.4%) had good knowledge while on home visits 80 (48.5%) knew the importance of home visits but 88 (80.4%) did not know the optimal time for the visits. On hand hygiene 127 (77%) of health workers knew the four critical times for washing hands with soap under running water. The study concluded that workers had good knowledge on prenatal care, young infant feeding and hand hygiene. There were critical gaps in knowledge on pre-eclampsia, use of recommended drugs for pre-eclampsia, new born care, management of neonatal infections and home visits. Prenatal care practice did not conform to guidelines. The study recommended refresher courses and continuous medical education in focused antenatal care, management of pre-eclampsia, newborn care, management of neonatal infections and home visits. It also recommended strengthening of supportive supervision to ensure guidelines are available and adhered to in practice.
Call Center Influence on the Delivery of Mental Health Services Among Young People: A Case of One2one Call Center in Nairobi, Kenya
(KeMU, 2024-10) MUTWIRI, ROBERT KIMATHI
Mental health issues among young people have become increasingly prevalent, with potentially severe consequences for their well-being and societal development. Kenya faces a significant mental health burden, with high rates of disorders among adolescents and young people. Despite the need for accessible mental health services, challenges like limited information dissemination, unclear community support pathways, and a shortage of health professionals persist. Call centers play a critical role in enhancing accessibility, reducing stigma through anonymity, and improving resource allocation by prioritizing urgent cases. This study examined the influence of call centers on mental health service delivery in Nairobi County, focusing on four objectives: To evaluate the influence of crisis intervention on the delivery of mental health services, to examine the influence of round-the-clock availability on the delivery of mental health services, to determine the influence of resource sharing on the delivery of mental health services, to establish the influence of follow-ups on the delivery of mental health services among young people in Nairobi County. Grounded in the Information Systems Success Model and Lean Thinking in Healthcare, the research employed a descriptive cross-sectional design. The study population comprised healthcare providers linked to the one2one call center, with a sample size of 112 selected through simple random sampling. Data were collected using questionnaires and analyzed with descriptive and inferential statistics using the SPSS program version 25. The findings indicated significant positive correlations between crisis intervention and round-the-clock availability (ρ = .424, p < .001), resource sharing (ρ = .354, p < .001), follow-up (ρ = .292, p = .002), and mental health service delivery (ρ = .439, p < .001). Round-the-clock availability was also significantly correlated with resource sharing (ρ = .336, p < .001), follow-up (ρ = .389, p < .001), and service delivery (ρ = .384, p < .001). Resource sharing was significantly associated with follow-up (ρ = .470, p < .001) and service delivery (ρ = .198, p = .042). Follow-up positively correlated with service delivery (ρ = .348, p < .001). The study concludes that call centers, through crisis intervention, round-the-clock availability, resource sharing, and follow-ups, significantly improve the delivery of mental health services to young people in Nairobi County. The study recommends that call center management strengthen crisis intervention strategies and train staff, ensure 24/7 availability of human support services, promote resource sharing among stakeholders, and develop policies prioritizing responsive mental health interventions and supporting digital systems for timely referrals. The study recommends further study on the effectiveness of call center interventions in addressing youth mental health needs, examining the impact of technological advancement, and exploring beneficiaries' perspectives to determine how crisis intervention, round-the-clock availability, resource sharing, and follow-ups independently influence mental health outcomes
Community based health insurance and utilization of health services.The case of Tanykina community health insurance plan, Nandi County, Kenya.
(2016-07) Terer, Erick Kiprotich
Health financing mechanisms aims to achieve universal coverage for all and protection against the financial burden during illness. Community Based Health Insurance is one of the alternative sources of health financing especially in the rural and informal sectors. Tanykina Community Health Plan (TCHP) is a community based health insurance targeting the rural population and dairy farmers of Nandi North Sub County of Nandi County. Despite the wide coverage of the program, there is still low health care utilization in the sub-county. Using the Health Belief Model as the theoretical framework, the study purpose was to evaluate the clients and community perception of the services offered by Tanykina Community Health Plan and the influence they have on the utilization of health services by clients. The specific objectives were to evaluate the clients and community perceptions on the services offered by TCHP, to review the respondents' characteristics that determine the utilization of health services and to review the health provider factors that affect the utilization of health services by the clients of TCHP. This was a cross-sectional study design. Data was collected in March 2015 on a sample of 336 patients attending health facilities that offer services to clients of TCHP and the community at large. Systematic random sampling technique was used to determine the study sample. Data was collected using a structured interviewer administered questionnaire and analyzed by STATA version 10. Statistical tests were employed at 0.05 level of significant. Qualitative data was analyzed based on thematic framework to support the quantitative results. A total of 336 patients participated in the study of which 169(50.2%) were enrolled members of TCHP while 167(49.8%) were none members. Of all the respondents 183(54 %) were female and 163(48.5%) had attained at least secondary level of education. The enrolled members had the majority 94(55.6 %) being female and 91(53%) having attained college level of education compared to 82(49%) of the none-members. The average age of all the respondents was 41years. The level of education was highly correlated with increased healthcare utilization (p=0.069) though this was not statistically significant. Increased level of satisfaction correlated positively with increased used of outpatient services and this was statistically significant (p=0.05). The perceived availability of information was however no statistically significantly associated with increased utilization of health services in either outpatient department (p=0.112) or inpatient department (p=0.939). The increased level of perceived acceptance was highly associated with increased utilization of inpatient services (p=0.04). Being male increased the level of perceived acceptance by 10 % compared to the female counterparts. With regard to in-patient health services an additional increase in the level of education of the insured members and the duration of membership significantly increases the utilization of these services by 0.19 and 0.89 respectively. However, the duration of membership was statistically significant (p=0.008) in influencing the level of in-patient utilization. I recommend managers of community based health insurance to continuously evaluate the perceptions that the members have in order to improve utilization of health services. There is need to regularly monitor community based health insurance with respect to client satisfaction to enable prompt action by managers to act to increase the effectiveness of these schemes in achieving universal coverage.
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;
Covid Vaccination Uptake amongst Public Transport Crew in Meru Matatu Stage, Meru County
(KeMU, 2023-08) Thuranira, Muthee Justin
The uptake of COVID-19 vaccinations is an essential aspect towards enabling effective control on the spread of the virus. It is important that matatu crew, together with the vulnerable groups should receive vaccination to lower the incidence and disease transmission rate. In the Covid 19 vaccination campaign this group has been greatly sidelined. The study was aimed at determining predictors of Corona Virus vaccine uptake amongst Matatu crew within the Meru matatu stage. The study therefore assessed the individual factors, established the contextual factors, evaluated perceptions and established experiences that predict uptake of the Corona Virus 19 vaccine amongst the Matatu crew in Meru matatu stage. The study population was Matatu crew in Meru matatu stage. Sampling size determination was done using the Fischer’s formula. The sampling technique was systematic among the drivers, touts and conductors in Meru Matatu stage. While purposive selection was done among the key informants. The study used of questionnaire for quantitative and for qualitative data collection an interview guide was used. Data analysis from the self- administered questionnaire was analyzed quantitatively using descriptive statistics frequencies, proportions. Chi-square analysis was used to capture associations amongst the categorical variables. Further, statistical significance was placed at p<0.05. Qualitative data was analyzed through the use of thematic analysis. Results are presented in tables, pie charts and bar graphs for ease of understanding. The study found a low uptake of Covid 19 vaccine among the Matatu operators. The individual characteristics associated with COVID -19 uptake on different aspects of knowledge included knowledge on mode of administration Chi square =110.45, d.f= 4, P value<0.00, knowledge on the doses required, Chi square = 136.521, d.f=4 and p value <0.000. Contextual issues including politics and sources of information were also to be factors influencing vaccine uptake among the Matatu operations. This study concluded that there was low uptake of Covid -19 vaccine among the Matatu crew in Meru Uptake was influenced by age, gender, marital status, nature of duty as well as the level of education a participant holds.On Individual factors associated with COVID – 19 vaccine uptake, knowledge and beliefs were statistically significant. Knowledge on mode of administration (Chi square =110.45, d.f= 4, P value <0.00) and knowledge on the doses required (Chi square = 136.521, d.f=4 and p value <0.000) were found to be statistically significant. Belief that COVID-19 is preventable was associated with vaccination for COVID-19 Chi square, 129.02, df=3 and P value <0.00. Belief that COVID-19 is manmade was also significantly associated with vaccination for COVID-19 Chi square106.584, df=4 and P value <0.00.Only a small proportion (9%) had prior experience with other vaccines in adulthood. The study therefore concluded that knowledge and beliefs influenced uptake of Covid 19 vaccine. Mass media and Sacco influence were Contextual factors associated with Covid 19 Vaccine uptake. The study concluded that communication and media, Politics and Sacco influence can significantly influence Covid 19 vaccine uptake. Therefore, the study recommended that the ministry of health and other partners to come up with programs to undo the misconception towards COVID-19 vaccine, and that there was continuous need to educate the masses and create awareness on risks and benefits associated with Covid 19.
Critical review of training process towards strengthened service delivery in Dagoretti sub-county.
(2015-05) Maina, Lydiah wairimu
Human resources are the most important assets of any health system. Training is one of the principal means by which health professionals such as Nurses and Clinical Officers maintain, improve, and broaden the knowledge and skills required. Despite progress in developing more effective training methodologies, training initiatives for health workers continue to experience common pitfalls that have beset the overall success. To improve the quality of healthcare services, the shortage of healthcare workers must be addressed by giving quality training and education needed to fill the gap to increase the output of qualified healthcare workers. The study area was in Dagoretti Sub County and 7 facilities were selected owned by the Ministry of Health and the County Government namely Mbagathi District Hospital, Dagoretti Sub County Hospital, Riruta Health Center, Waithaka Health Center, Ngong Road Health Center, Chandaria Health Center and Woodly Clinic. The sample size was 170 Nurses, 50 Clinical Officers, 6 Facility in Charges and 14 Sub County Managers. The research study examined the training process: Selection criteria; Follow up mechanism; and Coordination of activities and how this could strengthen service delivery. The study followed a descriptive cross sectional study design. A survey method using structured questionnaires for facility in charges, nurses and Clinical Officers and a key informant interview was conducted for the sub county managers. Sampling technique used was convenient sampling method. The reaction to the study was positive with a questionnaire response rate of 75.1%. Data analysis included identifying and comparing findings using Statistical Package for Social Scientists software. Data was presented using APA tables, pie charts and bar graphs. The results of the study showed that selection criteria could influence training process by 44.6% at a significance level of 0.03, follow up mechanism could influence training process by 58.4% at a significance level of 0.01 which is very significant and coordination of training activities could influence training process by 43.1% at significance level of 0.03. The findings revealed disconnect between sub county managers, facility in charges, nurses and Clinical Officers on how the training process is carried out. The study concluded that selection criteria is not need based; there is no data base of trainings held. Follow up mechanism is not in place and action plans are not implemented. The activities coordinating training are not well defined since there is no information on trainings available. Based on the conclusions, the recommendations made are improving Human Resource Information System; establishing a training schedule; and a system to evaluate service delivery. This would strengthen the Human Resources for Health pillar and the service delivery pillar in Health system strengthening.
Data quality of routine health management information system.
(2015-12) Cheburet, Samuel Kiprono
Effective and efficient management of today's health system depends on well-functioning Health Management Information System (HMIS) in design and implementation. Good quality data are the foundation of health systems in generating information for policy-making, planning, monitoring of health outcomes and evidence based decision making. Taking the cognizance of deficiencies in data quality, where vital health decision often depend on political speculation, donor demand and studies which are insensitive to changes over time. The aim of the study was to contribute to improvement of data quality of Routine Health Management Information System to facilitate efficient and effective decision making in Uasin Gishu County Hospital and possibly in similar settings. The objectives were; to assess the current state of data quality of routine health management information system; to determine socio-demographic characteristics that affect data quality of routine health management information system; to identify process factors influencing data quality of routine health management information; to find out technological factors affecting data quality of routine health management information system and to establish organizational factors influencing data quality of routine health management information system in Uasin Gishu County Hospital. This was a cross-sectional study which adopted quantitative and qualitative approaches. The study used purposive sampling to select study site with a target population of 82 respondents. Data extraction form, structured questionnaire and key informant interview guide were used for data collection. Questionnaire results were edited, coded, tabulated and analyzed using SPSS Version 23, StataSE version 13 and Microsoft excel. The results showed availability of data were at 88 (56%). 32623(44%) of the data elemets in all the reports dully filled. The reliability of data using Cronbach's Alpha were at .729. which fall within acceptable value and 48(16%) marginal error. 65(80%) of respondent are permanent and pensionable, 55(68%) staff who collect data are nurses. 81(100%) had gone for leave while 61(75%) found pending work. 38(47%) knew RHMIS through workshops while 78(96%) participate in data collection and 51(63%) had not been trained on HMIS while 37% (30) had been trained in the last 12 months of the year 2014. 69 (85%) had responsibilities while 53 (65%) were able to accomplish the task (x 2 = 26.665, df=1, p=0.000), 32 (40%) affirmed availability of standard operating procedures with 0% availability of quality protocol with an index of 18% institutional documentation. In conclusion the study found that current data quality from routine health management information system had major gaps if used to generate information and recommended the need for advocacy for continuous information use as a culture; data review and verification. The Ministry of Health require to advocate for increased human resource in terms of numbers and skills which has implications on the process factors. There is also need to ensure continuous supply of data collection tools with minimum datasets. . Stakeholders should strengthen capacity building through mainstreaming HMIS into various professional curriculums and strengthening of institutional documentation especially policy, standard operating procedures, guidelines and data quality protocols to enhance data quality.
Design, implementation and operation of health management information system at Kenyatta national hospital.
(2016-07) Omambia, Salim Matagi
Embracing modern technology is one among very many ways of improving efficiency and reducing costs within Health care organizations. While the integration of information and health services potential benefits cannot be disputed, there are many challenges which affect its adoption, in fact, majority of organizations have abandoned their newly acquired system only to go back to their old manual system. This study sought to review the design, implementation and operation of Health Management Information System (HMIS) in Kenyatta National Hospital (KNH) Nairobi County. Specific objectives were a) to determine the design criteria phase of HMIS at KNH, b) to assess the implementation of HMIS at KNH, and c) to evaluate the operation of HMIS at KNH. This was a descriptive cross-sectional study. The study sample was 263 respondents who filled a structured questionnaire and 40 key informant interviewees. Data collected from the field was analyzed through the use of univariate and bivariate statistics. The study revealed that in the design phase, there was significant stakeholder involvement and this manifested through definition and identification of the KNH's HMIS, clear understanding of the purpose and process in the design requirements and thus an indication that the design criteria was observed during the HMIS implementation. In the implementation phase, the fmdings indicated that while the other attributes had a significance, gender did not have a significant association with HMIS implementation p=0.901. The fmdings indicated that the level of management and duration of employment were significantly associated with HMIS implementation at KNH. In the operation phase, respondents said the benefits of electronic HMIS were improved efficiency and reduced workload. More than half (53.1%) of health workers felt that the electronic HMIS in KNH had achieved its objectives which will lead to effective utilization of HMIS and better healthcare service delivery. Overall KNH had successfully implemented HMIS. In recommendation KNH in collaboration with the MOH need to come up with a standardized policy for implementing interventions, improve the current infrastructure, and develop a plan for monitoring and evaluation of the HMIS.
Determinants of a functional referral system in Kisumu County, Kenya. Patients’ perspective.
(KeMU, 2019-09) Nango, Wilbert Otieno
Most referral health facilities are faced with challenges ranging from congestion of patients at these health facilities, limited resources both human and material to deal with the voluminous clients, slow rate of service delivery due to high numbers as a result of the by-passing tendencies. Self-referrals normally results in compromised quality of medical care provided to the patients. The problems mentioned above affects most of the high level health facilities which are traditionally meant to be referral health facilities. The study conducted in the month of August 2017 therefore aimed to find out the determinants of a functional referral system in two level 5 health facilities; Jaramogi Oginga Odinga Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCH). The objectives of the study were to; examine the extent to which the primary health care centres characteristics, patients’ characteristics, receiving health facility characteristics and proximity to a health facility influence a functional referral system. A cross sectional study was conducted using a qualitative approach to data collection. Three hundred and thirty eight patients were systemically selected to participate in the study. Data was collected using an individual questionnaire through one on one interview between the dates 14th- 22nd August 2017. The collected data were coded and analyzed using the SPSS 25.0 Computer program. The qualitative data collected were analyzed quantitatively using the descriptive statistics and linear regression models. The results indicates that there was a positive and significant influence of the primary health facility characteristics (r=.474**, p<0.001) and receiving facility characteristics (r=.475**, p<0.001) on a functional referral system at the two high level facilities. There was also a negative but significant influence of proximity to health facility (r=- 0.137**, p=0.017) on a functional referral system at the two level 5 facilities. On patients characteristics, a significant interaction was found on gender χ2 (1) = 4.64, p= 0.031, education level χ2(2) = 20.37, p<0.001 and Marital status χ2(2) = 8.78, p= 0.012 with a functional referral system. Conclusion – Factors influencing functional referral system are primary health centre characteristics, patients’ characteristics, proximity to a health facility and referral health facility characteristics. It is therefore recommended that the County government of Kisumu should improve the supply of drugs and quality of service delivery at the primary health facilities to attract more patients seeking primary care services, specialists movement especially to the lower level health facilities need to be reinforced by the Ministry of Health to boost the citizen’s confidence in quality of care at these facilities, more sensitization strategies need to be put in place to educate both the patients and health care providers on the recommended referral practices that should be upheld to improve efficiency and effectiveness of service delivery.
Determinants of Adverse Drug Reactions Reporting In Retail Chemists In Nairobi County, Kenya
(KeMU, 2020-11) Njiru, June Wanjiru
Access to safe essential medicines is a key success indicator of a functional health system of which the private sector such as retail chemists plays a critical role. Despite their obvious benefits, medicines have the potential to cause harm in form of Adverse Drug Reactions that may not be determined in the drug development process. Reporting of Adverse Drug Reactions leads to regulatory action that improve the safety profiles of medicines. However, reporting of adverse drug reactions has not been extensively reviewed in retail chemists. The purpose of this study was to assess the factors that affect reporting of Adverse Drug Reactions in retail chemists. The objectives of this study were to determine the role played by the regulatory body, The Pharmacy and Poisons Board, in reporting Adverse Drug Reactions in the retail chemists; establish the operationalization of pharmacovigilance implementation strategies on Adverse Drug Reactions reporting in the retail chemists; determine the effect of the retail chemist personnel capacity on Adverse Drug Reactions and establish the effect of underlying motivation factors of the personnel on reporting of Adverse Drug Reactions. The research adopted a descriptive cross-sectional study design using structured questionnaires for the staff in the retail chemists and interview schedules. Nairobi County was selected as the study area due to its high concentration of retail chemists. The target population was the personnel in 895 registered chemists according the Pharmacy and Poisons Board database. Using the Yamane sample size calculation formula a study sample size of 276 respondents was elicited as one personnel was considered adequate for each retail chemist which were sampled purposively. The study also targeted key informants at the Department of Medicine Information and Pharmacovigilance at the Pharmacy and Poisons Board. The data collection tools used were the Retail Chemist Personnel Questionnaire and the Key Informant Interview Guide. The data were analyzed using Statistical Package for Social Scientists Version 23. Results shows that there was a positive relationship between the Regulatory body, Pharmacy and Poisons Board factors (r=0.275, p<0.001), Pharmacovigilance implementation strategies in the retail chemists (r=0.374, p<0.001), Retail chemist personnel capacity (r=0.466, p<0.001), Underlying motivation factors (r=0.466, p<0.001) and Adverse Drug Reactions reporting. Multiple regression analysis showed that in a combined relationship, Pharmacovigilance implementation strategies (P<0.05), retail chemist personnel capacity (P<0.05) and underlying motivation factors (P<0.05), all had a significant influence on adverse drug reporting among Chemist in Nairobi County. In conclusion therefore, this study established that the Pharmacy and Poisons Board did not influence reporting of adverse drug reactions in retail chemists, pharmacovigilance implementation strategies were not fully operationalized to facilitate reporting of adverse drug reactions, retail chemist personnel did not have adequate capacity and knowledge to optimally report adverse drug reactions and while their underlying motivation factors influenced reporting of adverse drug reactions, they were not adequately motivated to report. This study therefore recommends that there should be improved engagement between Pharmacy and Poisons Board and the retail chemists on pharmacovigilance, continuous in-service pharmacovigilance training for retail chemist personnel, review of the adaptability of the implementation strategies in place and provision of consistent feedback on reported adverse drug reaction by pharmacy and poisons board as a strategy to motivate retail chemist personnel to report adverse drug reactions.
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.
Determinants of Commodity Management Practices In Public Health Facilities in Devolved Health Systems: A Case of Essential Medicines in Makueni County, Kenya
(KeMU, 2022-10) Irungu, Mwangi Daniel
The rationale for decentralization of health sector enabled lower level governance structures to design health sector interventions using innovative models that are context-specific and that take into consideration the unique health needs of different localities and encourage effective and active citizen engagement. The governance structures are able to facilitate autonomous and expeditious decisions regarding management and mobilization of resources efficiently. However, the health function in almost all counties is affected by significant challenges. Top among them being poor management of essential medicine leading to frequent stock-outs. Essential medicine is one of the six pillars of health systems and plays a key role in ensuring the population remains healthy. This research therefore aimed at analyzing some of the determinants of good management practices in the field of essential commodities especially medicines in publicly owned health facilities in a devolved system. The specific focus of the research was on the impact of healthcare worker training, policy and institutional framework, healthcare budgetary allocations and available infrastructure on effective management of essential medicines in publicly owned health facilities in a devolved system. The researcher used descriptive cross-sectional research design and a mixed method of qualitative and quantitative data collection techniques in collecting both primary and secondary data. The study population was all the health facilities in Makueni County. The study population comprised pharmacist, procurement officer, nurses, laboratory staff, clinical officers, and bio medics and stores clerks in each of the health facilities. The study adopted a stratified random sampling procedure to choose targeted 50 public health facilities in Makueni County from a population of 162 health facilities. The calculated size of the sample was 96 respondents. The sampling technique used was stratified sampling in selecting the sample according to various categories of health facilities. The researcher used a questionnaire and key informant interview guide as the main research instruments. Analysis of data collected was through qualitative and quantitative methods with the presentation done using tables, charts and narration for qualitative data. The study findings established that health worker training (β=3.232, p-value= 0.000), healthcare budgetary allocations (β=2.185, p-value= 0.008) and available infrastructure (β=5.296, p-value= 0.000) had significant and positive effect on management practices of essential medicine in Makueni County, Kenya. However, the effect of policy and institutional framework (β=1.374, p-value= 0.093) was found to insignificant in predicting the management practices of essential medicines in Makueni County. The study concluded that healthcare sector is a dynamic sector that faces different on a daily basis, health worker training, policies and institutional structures, budget allocation and infrastructure need to be advanced to meet the expectation in the evolving healthcare sector. The recommendations of the study included that County Government of Makueni through its ministry of health in collaboration with its counterpart at national government should work in collaboration on ensuring adoption of emerging best practices in management of essential medicines.
Determinants of Eight Contacts Antenatal Care Uptake Among Prenatal Mothers in Changamwe Sub-County Mombasa, Kenya
(KeMU, 2025-10) Bahati, Sophia Swalehe
Optimal antenatal care (ANC) uptake is critical for improving maternal and neonatal health outcomes. Despite global efforts to promote ANC, maternal and neonatal mortality rates remain high. In Kenya, neonatal mortality stands at 21 deaths per 1,000 live births, emphasizing the need to enhance ANC uptake. In Changamwe Sub-County, data from the MOH 711 digital reporting tool revealed persistently low adherence to the recommended eight ANC contacts, alongside rising fresh and macerated stillbirths and fluctuating maternal deaths. This study assessed the determinants influencing ANC uptake among prenatal mothers in Changamwe, Mombasa, Kenya. Specifically, the study examined the role of community health promoters, the quality of ANC services, health need-related factors, and household status in determining the completion of eight ANC contacts. A mixed-method research design incorporating both qualitative and quantitative approaches was employed. The target population included postnatal mothers attending maternal child health clinics in public health facilities and maternal child healthcare clinic nurse managers as key informants. A total of 370 mothers and 4 nurse managers participated in the study, selected using purposive and simple random sampling techniques. Data collection involved structured questionnaires for mothers and key informant interviews with nurse managers. Descriptive statistics were used to summarize the findings, while correlation and multiple regression analyses assessed relationships between study variables. The results indicated that household status, health need-related factors, and the quality of ANC services significantly influenced ANC uptake. Specifically, household status was positively associated with ANC uptake (β = 0.45, p = .002), indicating that increased support within the household correlates with higher ANC attendance. Health need-related factors also showed a significant positive relationship (β = 0.38, p = .005), suggesting that mothers with greater health needs are more likely to attend ANC services. The quality of ANC services was another significant predictor (β = 0.42, p = .003), emphasizing the importance of service quality in encouraging ANC visits. However, community health promoters had no statistically significant impact on ANC uptake (β = 0.10, p = .08). Based on the findings, the study recommends strengthening household support systems by involving spouses in ANC education and empowering women in healthcare decision-making. Enhancing ANC service quality through respectful care, skilled provider training, and ensuring reliable supply chains for ANC commodities is also advised. Addressing health need-related barriers by promoting early screening for pregnancy complications and increasing maternal health literacy is crucial. Additionally, re-evaluating the role of community health promoters through targeted training, supervision, and structured home visit and referral frameworks is necessary. Implementing broad community sensitization campaigns to boost awareness and dispel myths surrounding ANC. Further research on community health promoters’ effectiveness in ANC promotion within varied contexts and explore the underlying factors contributing to the low rate of antenatal care (ANC) initiation before 12 weeks of gestation recommended. These recommendations underscore a need for multi-level interventions ranging from household empowerment to service delivery improvements to increase ANC uptake and ultimately reduce maternal and neonatal morbidity and mortality.
Determinants of Health Facility Preparedness in The Management of Gender Based Violence: A Case of Primary Health Facilities in Mombasa County
(KeMU, 2023-09) ONKOBA, PHYLLYS KEMUNTO
Gender based violence (GBV) is an affront to human rights and the attainment of sustainable development goals (SDGs). In Mombasa county 65% of the population live in informal settlement which exacerbate GBV due to poverty. However, health systems are not prepared to deal with the health consequences that are brought about by this vice such as injuries and trauma. To better understand the components that could improve primary health facilities' preparedness in managing this problem, this study Independent variable were to investigated the influence of budget allocation, physical infrastructure, health information management system, and professional approach. While depended variable was Primary Health Facilities Preparedness in the management of gender based violence. Relying on the Theory of Reasoned Action/Planned Behavior and the Intellectual Capital Theory, a descriptive cross-sectional research design was used to ascertain factors that affect health facility preparedness in the management of GBV. A sample of 334 health workers was selected; stratification sampling was employed to categorize them while simple random sampling was used to select respondents in each category. Primary data was collected using questionnaires, which was then analyzed through the Statistical Package for Social Sciences version 25. Correlation and multi-linear regression analysis were used respectively, while descriptive statistics were used to produce means and standard deviation from the collected data. It was found that that budget allocation and primary health facilities preparedness had insignificant correlations with value of P=.095. Further, physical infrastructure and Primary Health Facilities Preparedness insignificantly correlated with a correlation value of P=.079. Also, Health Information Management System and Primary Health Facilities Preparedness significantly and positively correlated with a correlation value P=.243. Additionally, Professionalism and Primary Health Facilities Preparedness positively and significantly correlated with a correlation value of P=.424. Based on these findings the study recommends that county government should ensure appropriate allocation of budget to improve the physical infrastructure of primary health facilities that is adequate lighting, and separate entrances and exits to maintain confidentiality. The study also recommends hospital management should enhance the health information management system that specifically addresses the management of GBV cases in primary health facilities for standardized data collection tools and protocols for recording and reporting GBV incidents. The county government should support capacity building programs focused on professionalism and ethical conduct for healthcare providers and staff members in primary health facilities in order to respond to GBV.
Determinants of Health Products and Technologies Management in Level Four and Five Hospitals in Nyeri County
(KeMU, 2024-09) Machanga, Alice Muthoni;
As Kenya moves toward universal health coverage, ensuring the constant availability of quality medicines and technologies in primary health facilities is essential. Effective management of Health Products and Technologies (HPTs) requires proper planning, organization, and leadership. Nyeri County has made efforts to improve HPTs management by establishing dedicated HPT units, passing legislation (Supplement No. 16, Acts No. 5), and investing in the development of 9 rural health facilities and 2 health centers. Despite these efforts, HPTs management remains ineffective, with high maternal mortality rates (110/100,000), infant mortality rates (30/1,000), and a fully immunized population at 68%, compared to the national rate of 75%. This study sought to determine the influence of financing, health worker factors, supply chain practices, and health management information systems (HMIS) on HPTs management in level 4 and 5 hospitals in Nyeri County which was based on management theory. The study was located in Nyeri County. A mixed-methods research design was employed, using both descriptive cross-sectional surveys and interviews. The study targeted 51 health professionals through a census method and 6 key informants were purposively selected. Data was collected using interview schedules and interview guides. Prior, the study pre-tested the tools in Laikipia County on 30 respondents. Quantitative data was analyzed by use of SPSS and presented in tables while qualitative data was analyzed thematically and presented verbatim. The study adhered to research ethics. The study found the model explained 43.3 per cent of the variance on management of HPTs and 43.9 % when controlled for by leadership practices. The regressed model was; Management of HPTs = 20.162 + 0.321 Financing + 0.090 health workers’ factors + 0.007 supply chain practice +0.331 health management information system. HMIS provided the highest unique contribution on total variance on management of HPTs. The study concluded financing and HMIS provided significant influence on management of HPTs in level 4 and 5 hospitals in Nyeri County while health workers factors and supply chain practices had no significant influence on management of HPTs in level 4 and 5 hospitals in Nyeri County. From the multiple linear regression analysis conducted to establish the underlying prediction of the model financing, health worker factors, supply chain practices and health management information system on management of HPTs, it was observed that the model explained 43.3% on total variation in HPTs management. This implied that there are other factors accounting to 56.7 % which influence HPTs management in level four and five hospitals in Nyeri county. Therefore, the study recommended a further study should be conducted to interrogate the probable factors such as regulatory environment, patient needs and preferences, healthcare provider adoption, healthcare infrastructure and global health challenges in these hospitals in Nyeri county and across the board. The findings support existing health system theories and have significant policy implications, urging stakeholders to prioritize these factors for effective HPTs management in hospitals. Additionally, the study highlighted the importance of proper budgeting, staffing, motivation strategies, inventory optimization, and HMIS in improving HPTs management practices.
Determinants of Health Workers Productivity in Public Health Facilities: A Case in Laikipia County
(KeMU, 2024-09) LEKURTUT, CHRISTINE
Health worker productivity in Laikipia County's public health facilities often falls short of desired standards, leading to inefficiencies and compromised patient care. This issue is particularly problematic during periods of high patient demand and limited resources. Low productivity affects multiple stakeholders: patients experience compromised care and longer wait times, health workers suffer from burnout, low morale, and job dissatisfaction, while health administrators and policymakers struggle to manage effective healthcare delivery and achieve desired health outcomes. The study sought to establish determinants of health workers’ productivity in public health facilities in Laikipia County. Specifically, the study sought to establish the influence of motivational strategies, leadership styles, facility resources, and health worker appraisal on the productivity of health workers. The study was guided by McClelland’s acquired needs motivation theory, and adopted a descriptive cross-sectional survey design. The study’s target population comprised of 228 health workers including doctors, clinicians and nurses working at the Nanyuki teaching referral hospital and two of the largest sub-county hospitals. There were 145 medical professionals in the sample, including doctors, clinicians and nurses. Primary data was gathered via interviews and questionnaires. In Nyeri County, a pilot research was carried out. Validity and reliability tests were conducted on the pre-test results. Data analysis was carried out with the SPSS version 26 tools. Descriptive data like frequencies, percentages, averages, and standard deviation as well as inferential statistics like Pearson correlation and binary logistic regression analysis were computed during the analysis. Tables and narratives were then used to display the data. The study found that health workers' productivity in public health facilities in Laikipia County was favorably influenced by leadership style, facilities resources, health worker appraisal, and motivational tactics. It was suggested that in order to improve employee performance, leaders in any member association should empower staff members and cultivate an environment that values learning, creativity, and innovation. This includes training staff members on how to provide and receive feedback. The management and human resources department at the facilities should also make this clear and explain the rationale behind the assessment's necessity. Additionally, the management of a member association's organization should influence and motivate subordinates by exchanging rewards for a specific performance. Finally, human resource management should guarantee that salaries are based on an unbiased annual increment, that health care workers are paid on time, and that terminal benefits are standardized and in line with performance, all of which will improve worker motivation.
Determinants of Hospital Emergency Preparedness in Machakos Level 5 and Kangundo Level 4 Hospitals
(KeMU, 2020-11) Kahare, Munanie Mercy
Emergency preparedness is a key security priority globally. Plans are needed, not only to maintain services continuity but also to guide in emergencies in hospitals. Kangundo level 4 and Machakos Level 5 Hospital have recorded 27% and 39% increase of emergency cases in 2018 respectively. In the face of these emergencies, the ability of Kangundo level 4 and Machakos Level 5 Hospital to provide emergency service quite literally make the difference between life and death. This study assessed the determinants of Hospital Emergency Preparedness in Kagundo level 4 and Machakos Level 5 Hospitals in Machakos County. The study adopted cross-sectional design and stratified random sampling method. Whereby a sample size of 128 respondents was obtained using the Yamane 2008 formula; 49 respondents from Kangundo level 4 and 79 from Machakos level 5 hospital. Self-administered questionnaire was applied. The findings reveal high understanding of the meaning of emergency preparedness with mean of 4.29±0.67. Ninety-four (74%) of the respondents considering themselves prepared for emergency. While 80 (64%) considered themselves key leadership figure in emergency preparedness with a mean of 3.67±1.06. One hundred and eleven (88%) of the respondents agreed with the statement that training on emergency preparedness should be conducted quarterly with mean of 4.27±0.95. Respondents agreed that emergency tray is well equipped with various equipment for management of emergency with a mean of 3.51± 1.101 and that hospital has a drug supply system with drug suppliers with mean of 3.51±1.108. Majority of the respondents agreed with the statements that financial allocation for emergencies preparedness should be increased (4.07±1.195), and that the facility has transport and logistics support in case of any emergency (3.4±1.231). There results showed strong and positive relationship between commodity availability, financial resources, policies and emergency preparedness with coefficient of correlation of r=0.619, p<0.001, r=0.626, p<0.001, and r=0.702, p<0.001 respectively. In a combined relationship Commodities (p<0.05), Finance (P<0.05) and Policies (P<0.05), all had a significant influence on hospital emergency preparedness. The study found that policy formulation and implementation, commodities and finances significantly influenced emergency preparedness. The study variables under this study are important in determining emergency preparedness, and that emergency preparedness will work well if the variables are taken into account. Therefore, hospital management need to build stable drug supply system with adequate drug suppliers. Resources should be allocated to purchase ultra-modern equipment. Additionally, clear mechanism of access of emergency commodities should be developed by hospital management and staff be made aware of it. There is need for staff participation in emergency policy formulation, guidelines, emergency plans, and lobbying for emergency preparedness. In addition, the facilities need to make emergency drills, and safety inspections regular.
Determinants of in-Hospital Cardiac Arrest Survival Rates of Adults in Selected Counties in Kenya
(KeMU, 2024-09) TOLE, EUNICE BEATRICE NJERI
In-hospital cardiac arrests are a significant reason for illnesses and deaths in hospitals worldwide. Roughly 1-5 patients in a group of 1000 people admitted, experience in hospital cardiac arrest around the world. This contributes to eighty percent of deaths occurring in hospitals hence low survival rates. The purpose of this study was to evaluate the determinants of in-hospital cardiac arrest for survival rates of adults in selected counties in Kenya. The specific objectives were to: Determine the influence of healthcare provider training, area of deployment within the hospital, skill mix (health care cadre), and availability of medical equipment on the survival rate of cardiac arrest among adults in Kenya. The study was guided by two theories which were cardiac pump theory and five-star theory of quality of medical services. A cross-sectional design was used on collecting data from 2,037 doctors and nurses in Machakos Level 5 Hospital, Muranga Level 5 Hospital and the Aga Khan University Hospital, Nairobi. The medical doctors were selected using inclusion and exclusion criteria resulting to 72 doctors. The study used 30% to get a sample size of 402 nurses. Nurses answered questionnaires while the doctors were interviewed and secondary data was gathered from general medical reports on CPR operations from 2022- 2023. Pilot test was done in Nairobi and Kenyatta hospitals whereby the results enabled examine reliability and as well as validity. Descriptive and inferential statistics were examined and the findings presented through tables, figures and explanations. Participants were guaranteed anonymity and confidentiality such that the interview guides and questionnaires did not require them to give personal details. The regression results indicated that the Pearson correlation coefficient of ‘healthcare provider training’ r was 0.495** at α < 0.002; area of deployment of the healthcare provider within the hospital r was 0.117** at α < 0.000; skill mix (health care cadre) r was 0.309** at α < 0.000; availability of medical equipment’ r was=0.412** at α < 0.000. Therefore, the study rejected all the null hypotheses. It was noted that the effectiveness of healthcare providers was greatly affected due to low number of staff assigned tasks at night in different units. Additionally, there was low team work effort hence resulting to work related divisions and sidelining each other during critical scenarios like assessment of the chest compressions. Further, the hospitals lacked advanced medical equipment to ensure that the IHCAs were amicably monitored and treated on time. The recommendations are that, the hospital management should enact learning and development policies that make it mandatory for various staff in different units to attend CPR training. Additionally, the hospital board should push and seek more funding from various sources so as to recruit more staff. Further on, the hospital management should provide more department bonding activities such as retreats, and office meetings, for the staff to create a working connection. Also, the hospital management should come up with unique fund-raising programs that would enable the hospitals purchase the much-required medical equipment.