Master of Science in Health Systems Management

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External and internal factors affecting management of hospital drug formularies by health facilities in Nairobi
(KeMU, 2012-07) Njeru, Nancy Mucogo
The use of formularies in drugs management is a widely accepted practice and Kenya has adopted the World Health Organization (WHO) drug formulary model to develop its own formularies or essential drug lists. This study explored factors affecting management of drug formularies by both private and public health facilities in Nairobi. Specifically, the study sought to determine the type of formulary in use by various health facilities in Nairobi as well as exploring extents to which both identified external and internal factors influence the management of drug formularies in the said health facilities. A cross-sectional descriptive study was employed where the researcher used stratified random sampling as well as convenient sampling to draw a sample of 189 health facilities from the population. Results: There is 94% awareness of drug formularies, only 41.8% have participated in development of an Standard Treatment Guidelne or a drug formulary. 71.4% of respondents considered drug formularies very important. 73.5% of registered health facilities in Nairobi have adopted the Kenya Essential Ddrug List (KEDL). Out of the 73.5% above, 49.2% of the facilities have developed facility own drug formularies while 26.5% confirmed to not have used the national essential drug list at all. All ministry of health local authority facilities used the National essential drug list. Majority, 93.6% considered their formularies open while only 6.4% considered their formularies closed. Drug promotion poses the greatest influence to drug formulary non compliance while insurance was considered the least external factor in Nairobi health facilities. Under internal factors, lack of pharmacy and therapeutic committees or its equivalent topped the most challenging internal factor affecting the drug formulary availability and compliance. Conclusion: Drug formulary mangement in Nairobi health facilities is not fully developed and is also facing alot of challenges. Recommendations: There is need to base all facilities-own formularies on set standards while exploration of higher levels of formulary management will ensure more benefits to patients. Individual facilities must be more proactive in ensuring they operate within the national medicine policies which is possible through self regulation. Pharmacy and Therapeutic Committee in facilities to be enforced and also for health centres and dispensaries on need basis.
Implementation of hospital management information systems on service delivery: a case of Moi Teaching and Referral Hospital
(Kenya Methodist University, 2019-09-01) Cheruiyot, Bethwel Kipkorir
Hospital Management Information Systems (HMIS) has the potential of improving the quality of services delivered as well as the efficiency and effectiveness of healthcare providers through integration of various hospital functional units. However, the benefits of this implementation in service delivery have not been adequately addressed. This study sought to appraise the impact of implementation of Hospital Management Information Systems, on service delivery in Moi Teaching and Referral Hospital, (MTRH). The objectives of the study were: To examine the level of implementation of Hospital Management Information Systems in MTRH, to establish the strategies motivating implementation and utilization of Hospital Management Information Systems, to assess benefits that have been realized in utilizing Hospital Management Information Systems, and to assess the effect of HMIS on service delivery in MTRH. Cross sectional descriptive research design was utilized in the study where sample size formula proposed by Cooper and Schildler formula was used to obtain 240 respondents from a target population of 587 users of HMIS. The researcher employed stratified sampling technique. A structured closed end questionnaire was administered for data collection, as well as interviews. Quantitative data was obtained, coded and entered into the computer using Statistical Package for Social Sciences version 25 software for analysis. A pilot testing was carried out at Rift Valley Hospital, Nakuru. Data was analyzed using descriptive statistics, i.e. mean and standard deviations and inferential statistics i.e. Pearson Correlation Analysis and Multiple Regression Analysis. A total of 240 questionnaires were distributed to the respondents and 192 were filled and returned, a response rate of 80%. With respect to familiarity with Hospital Management Information System results indicated that majority of the respondents 37.8% were familiar with the system. For the extent of implementation on the modules the Hospital Records module had the highest implementation level mean (4.0) with a while consulting doctor module posted the lowest mean (2.1). On the level of utilization of HMIS result indicates that the mean values were above average on a five point Likert scale. Further records module had the highest utilization level, mean (3.8) while consulting doctor module posted the lowest utilization level mean (2.0). On the strategies motivating the utilization of HMIS results indicate that the presence of information strategy is the leading motivator of utilization of HMIS mean (3.73). Results indicated that the anticipated benefits of HMIS were all in above the average. The results of the regression analysis suggested that HMIS implementation (β= .215, p˂0.05), HMIS utilization (β= ..697, p˂0.05), motivation strategy (β= .193, p˂0.05), and HMIS benefits (β= .045, p˂0.05) had a positive significant effect on Service Delivery, therefore the null hypothesis is rejected. The value of the F-statistic is (F=172.917, p˂0.05) is robust to indicate the variable relationships. The coefficient of determination value of R2= .787 means that 78.7% of the variation in service delivery at the hospital can be explained by HMIS. The study recommends that a policy be drafted to entrench HMIS implementation and utilization in the Country.
Factors influencing uptake of antenatal care in Taita Taveta County, Kenya
(KeMU, 2019-09) Ndegwa, Mwanyoha Ndegwa
49% of pregnant women are able to make four or more ANC visits in Sub Saharan part of Africa. General objective of the study was to find out factors influencing uptake of ANC in public health facilities in Taita Taveta County. The specific objectives were; to assess influence of early initiation of ANC on uptake of ANC in, determine influence of skilled health providers’ attitude on uptake of ANC, establish influence of availability of community health volunteers on uptake of ANC and determine effects of skilled health providers’ availability on uptake of ANC. A total of three hundred and eighty four mothers and eighteen health facility in-charges participated in the study. The study adopted survey research design and data collected using structured questionnaires for the sampled mothers and key informant interview for the in-charges. The researcher analysed data using Statistical Package for the Social Sciences (SPSS) version 23. Descriptive analysis (percentages and frequencies) and inferential analysis (Chi-square and Spearman’s correlation tests, and regression analysis at significance level of alpha=0.05) were performed. Results indicated 43.6% of the mothers managed 2 ANC visits, 41.7% 3 visits and14.7% just 1 ANC visit. The findings also indicated that timing of ANC initiation had significant association (X2 (6) = 102.854, p < 0.001) and weak negative relationship (Spearman’s R = -0.201, p < 0.001) with uptake of ANC. An R2 of 0.071 (7%) showed early ANC initiation had low degree of influence on ANC uptake. Reception during ANC visits had significant association (X2 (8) = 564.235, p < 0.001) and strong positive relationship (Spearman’s R = 0.905, p < 0.001) with ANC uptake; and adequacy of privacy had significant association (X2 (8) = 459.447, p < 0.001) and moderate positive relationship (Spearman’s R = 0.763, p < 0.001) with ANC uptake. An R2 of 0.819 (81.9%) showed skilled health providers’ attitude had high degree of influence on ANC uptake. Moreover, number of CHVs visits had significant association (X2 (8) = 317.099, p < 0.001) and high positive relationship (Spearman’s R = 0.870, p < 0.001) with ANC uptake; and CHVs perceived importance had significant association (X2 (8) = 321.872, p < 0.001) and strong positive relationship (Spearman’s R = 0.863, p < 0.001) with ANC uptake. An R2 of 0.784 (78.4%) showed that availability of CHVs had high degree of influence on ANC uptake. Lastly, the results indicated that waiting time had significant association (X2 (6) = 354.829, p < 0.001) and moderate negative relationship (Spearman’s R = -0.745, p < 0.001) with ANC uptake; presence of skilled health providers had significant association (X2 (4) = 668.9, p < 0.001) and strong positive relationship (Spearman’s R = 0.947, p < 0.001) with ANC uptake; and adequacy of sessions had significant association (X2 (8) = 321.872, p < 0.001) and strong positive relationship (Spearman’s R = 0.899, p < 0.001) with ANC uptake. An R2 of 0.920 (92%) showed that availability of skilled health providers had high degree of influence on ANC uptake. The researcher concludes that; pregnant women in the county are knowledgeable about ANC, however initiation is poor; Staff attitude contributes significantly towards improved ANC uptake; Pregnant mothers who have been visited by CHVs initiate ANC in time; Availability of healthcare providers in the right number and mix contribute to improved ANC uptake. The researcher, therefore recommends that County should recruit additional healthcare providers to render better quality ANC services.
Influence of structural arrangement on provision of quality primary care health services in public health centers in Nakuru County, Kenya
(KeMU, 2019-08) Kandagor, Amos Kipngetich
The Alma Ata Declaration of 1978 emphasized the importance of primary care as an approach to achieve health for all. Kenya has gradually expanded primary care health service delivery to increase access and comprehensiveness of healthcare services. It has equipped referral facilities with modern equipment, while primary care health facilities continued to struggle with limited resources. As a consequence, this gap has become a big impediment to Kenya’s quest to achieve universal health coverage. Structural arrangement has been cited as the major contributing factor to quality health services delivery. This study examined relationship between structural arrangements and provision of quality primary care health service in public health centers. The objectives was to assess whether infrastructural resources, financial resources, staffing and governance influence provision of quality primary care services in public health centers in Nakuru County. Across-sectional study design with mixed data collection methods was adopted for this study. A total of 110 respondents from 33 public health centers in Nakuru County were included in the study sample. The respondents were Clinical officers, Nurses, Pharmaceutical Technologist and Laboratory Technologists. Data entry and analysis was done using SPSS Version 20. Descriptive analysis was used to profile the characteristic of the respondents. Mean, Standard deviation, correlation and regression was used to determine the relationships. The findings showed that modern equipment and adequate supply of essential commodities was associated with high quality primary care health service delivery (r=0.453, p<0.01). Sufficient funds and effective management of resources significantly determined quality of primary care health service (r=0.365, p<0.01). Health worker skills, experience and training were statistically associated with quality primary care service (r=0.567, p<0.01). Transparency and accountability were strongly and positively associated with improved quality of primary care service at the public health centers (r=0.613, p<0.01). Regression analysis showed financial resource (β= 0.32) and governance (β= 2.49) significantly improved quality of primary care health service delivery. Study concludes good structural arrangements lead to good processes and ultimately good health outcome. The study recommends that county government of Nakuru should i) supply adequate equipment to perform the necessary work, ii) provide sufficient allocation and timely release of funds to health centers, iii) provide career progression and continuous professional development among its health workforce, and iv) institute staff retention measures and frequent auditing of health centers assets and liabilities and provide a report to the public.
Human resource management practices influencing performance of nursing officers in Nyeri County, Kenya
(KeMU, 2019-08) Ongori, Jeremiah Motari
Various organizations employ different human resources initiatives in order to increase efficiency. The most common initiatives employed to improve efficiency include performance contracts, internal contracting, contracting-out and outsourcing of services among others. Employing such initiatives are considered among the primary HRM practices, which are aimed at determining the equilibrium between workforce supply and the ability of healthcare practitioners to practice effectively and efficiently to ensure improved and quality care in healthcare systems. This study deliberated on HRM practices that influence the performance of nursing officers at Nyeri County, Kenya. The explicit objectives of this study were to determine how recruitment affects the performance of nursing officers, to examine how training influences performance of nursing officers, to determine the influence of deployment practices on the performance of nursing officers, and to determine the influence of motivation on the performance of nursing officers. The study targeted nursing staffs and managers in Nyeri County public health institutions and at the County Director’s Office. A stratified sample of 248 was selected and surveyed. Data was collected using self-administered questionnaire. Descriptive and inferential statistics using statistical package for social sciences SPSS 23 was conducted. The researcher found that recruitment processes in Nyeri County comprised of internships (f=109, 44%) and field placements (f=82, 33%). Selections were made via individual interviews (f=225, 91%) while job orientation (f=237, 96%) was the main orientation technique. Through the study, the researcher found that training of nurses was conducted but there was a limitation in the diversity of approaches used. Results showed indicate that on the job training (f=156, 63%) training courses (f=70, 28%) were the major approaches of training. The researcher found that there were gaps in the deployment practices with mean value of 2.73, SD=1.132. Deployment in some departments was deemed as disciplinary action (M=3.09, SD=1.325) and managers response to deployment needs per department or ward or facility (M=3.07, SD=1.218) were rated to moderate extent. The researcher also found that motivation of nurses was not well done with a mean of 2.84, SD=1.090, and there were no upgrading and promotion opportunities (M=1.81, SD=1.133) for nurses in the county. There was a moderate performance of nurses with a mean value of 3.75, SD=1.100. Chi-square analysis showed that training (χ2= 34.500, df=12, p=0.001) and motivation (χ2 = 28.860, df=16, p=0.025) were significant at 95% confidence level. All the Cramer’s V values were positive indicating that HRM practices enhance performance. The Cramers’ V values show that motivation (v=0.473) was the most influential factor followed by training (v=0.422). The researcher concluded that unsatisfactory performance of nurses is due to inadequate training and lack of motivation. The researcher therefore recommended that training programs in the health sector should be reviewed in order to employ more techniques in the training of nursing officers in service. In addition, motivation approaches and techniques used in the health sector should be overhauled as they are not effective. In particular, remuneration of nursing staffs who have upgraded should be reviewed according to human resources policy.
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.
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.
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.
Determinants of uptake of national hospital insurance fund primary care scheme among service providers within the scope of NHIF Nakuru town branch
(KeMU, 2019-09) Wagura, Elizabeth Wanjiku
There is a growing international consensus on the importance of providing social protection through financing and providing access to healthcare services. Kenya has embraced this through the National Hospital Insurance Fund (NHIF). Despite these efforts, the uptake of the NHIF primary care scheme among service providers in the country is still low. This study sought to assess the uptake of NHIF primary care scheme amongst service providers within the scope of NHIF Nakuru Town branch. The study objectives were to: determine the influence of knowledge of service providers, examine the influence of perceived benefits of the NHIF primary care scheme, establish the influence of health facility organization capacity, and determine the influence of barriers associated with NHIF and health facilities on the uptake of NHIF primary care scheme. The study adopted a cross-sectional research design targeting 120 service providers from 60 health facilities as well as getting key information about the scheme from officers in NHIF office managing the scheme as key informants. A random sample of 96 service providers was drawn from 48 health facilities and 2 officers from NHIF Nakuru branch. Data was collected using a structured questionnaire and an in-depth guide. Quantitative data was analyzed using descriptive and inferential statistics with the aid of Statistical Package for Social Sciences version 21.0 while content analysis was used to analyze qualitative data. From the findings of this study, there was a significant, weak, positive correlation between knowledge of NHIF and uptake of NHIF primary care scheme (r =.266, p<.05). Pearson correlation computed between perceived benefits of NHIF Primary care scheme and uptake of NHIF scheme was significant, moderate and positive (r=.297, p<.05). The health facilities had adequate; ICT facilities, human resource and physical facilities for effective implementation of NHIF primary care. Pearson correlation coefficient between health facility organization capacity on the uptake of NHIF scheme was not significant (r=.109, p<.05). Thus, it was concluded that variations in the level of the health facility organization capacity was independent of the uptake of NHIF primary care scheme. All the constraints combined were likely to negatively impact on the uptake of NHIF primary care. Results of Pearson correlation revealed that the relationship between barriers of the health facilities on the uptake of NHIF primary scheme was moderate, significant and negative (r =-.246, p<.05). The study therefore concluded that NHIF should develop clear policy details on the various benefits and risks involved for health facilities that are not willing to take up the implementation of the scheme. The study recommends that the management of the NHIF scheme should i) embark on a campaign of knowledge dissemination and education of all potential consumers of their services, ii) develop clear policy details on the various benefits and risks involved for health facilities, and iii) sensitize the management of health facility on the requirements for accreditation for provision of NHIF out patient services.
Determinants of utilization of national hospital insurance fund outpatient services by private university employees in Nairobi
(2019-09) Kironji, Keziah M.
The NHIF is a mandatory health insurance fund covering public and private formal sector workers and their dependents as the main health insurer in Kenya. NHIF has embarked on an ambitious reform program intended to convert it to a Social Insurance Health Scheme with an aim of serving as workers’ first pillar of social insurance. The national formal scheme members are entitled to all outpatient services after selecting their preferred facilities from a list of the NHIF accredited ones. However, there are some members on the National formal scheme whose contributions are remitted to NHIF by their employer every month but do not utilize the outpatient services. This study sought to determine if the NHIF benefit package, the perceived quality of care, the NHIF communication strategy and the administrative processes influence utilization of outpatient services by the national formal scheme members in Nairobi County with a focus on private University employees. It sought to assess the reasons for none or underutilization of NHIF outpatient services. This study adopted a cross-sectional descriptive design. Multistage sampling with simple random sampling was used. Quantitative data was corrected using self-administered questionnaires and analyzed using descriptive statistics. Likert and semi-structured type of questions were used as the main tool for collecting data. SPSS version 24 was used to analysed the data. The rationale of this study was to inform top management of NHIF to undertake decisions in regards to utilization of outpatient services by NHIF members in the formal National Scheme by understanding how quality service, benefit package, NHIF communication strategy and administrative processes influence utilization of outpatient services. The study finds that respondents have and will utilize NHIF outpatient services (M=3.80, SD= 0.84). They agree with NHIF administrative processes (M=3.4, SD= 0.89) and have knowledge of NHIF benefit package (M=3.42, SD= 0.82). They disagree with quality of NHIF outpatient services (M=3.21, SD= 0.66) and NHIF communication strategy (M=2.94, SD= 0.73). The study found that knowledge of NHIF outpatient benefit package (X1; t = 1.142, p = 0.255 ˃ 0.05), perceived image of NHIF outpatient services (X2; t = 1.196, p = 0.241 ˃ 0.05) and NHIF communication strategy (X3; t = 1.196, p = 0.241 ˃ 0.05) have no influence on utilization. However, NHIF administrative processes (X4; t = 4.579, P = 0.000 ˂0.05) positively contribute to and have a significant influence on utilization of NHIF outpatient services by private university employees in Nairobi county. The study recommends that a) NHIF creates awareness on the NHIF outpatient benefit package to the members, b) NHIF should vet facilities they accredit to offer outpatient services to ensure safety of healthcare services, availability of physicians, sufficient number of health workers and a well-stocked pharmacy, c) NHIF should improve on their means and frequency of communication, feedback and complains mechanisms, engage the citizens more for improvement and ensure staff are available to respond to issues, and d) Staff in NHIF accredited facilities should be made aware of patient’s entitlement to care, ease patients identification and facility selection process. This will strengthen health systems and thus improve utilization of primary health care services.

Master of Science in Health Systems Management

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