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Item Preparedness of County Referral Health Facilities in Implementing Adolescent Friendly Health Services: A Case of Mama Lucy Kibaki County Refferal Hospital, Kenya(Global Journal of Health Science;, 2015) Owuondo, Pacific Akinyi; Mwaura-Tenembergen, Wanja; Adoyo, Maureen; Kiilu, Elizabeth M.Background: Health service delivery is a key pillar of health system management. However, there is limited peer reviewed literature on health services to adolescents necessitating assessment of whether the existing health facilities were prepared to implement the adolescent friendly health services. Staff capacity, health resources and health system factors were assessed in regards to health service delivery to adolescent cohort study. Methods: Cross-sectional research design was adopted, census, stratified random sampling and simple random sampling were used to establish study participants. Data was collected using structured questionnaires and focused group discussions for adolescents. Analysis was done using Statistical package for the social science Version 17.0 programme for data analysis and results were presented in tables and graphs. Results: The study established that there is limited adolescent friendly health services implementation in the facility. Even though 107 (73.3%) of the healthcare providers referred to the adolescent health services offered at the facility as friendly. Health workers capacity was limited in regards to adolescent friendly health service delivery. On the other hand 212 (100%) adolescents recommended specific health resources to be incorporated within the health system to improve the services rendered to them. Conclusion: The link between health care resources and adolescent health is not well understood by health workers and managers leading to inadequacy of services specific to adolescents. Laborious awareness drives to sensitize county referral health facilities to make a significant investment in the health system that supports adolescent friendly health service implementation. Similar studies need to be done in other county referral health facilities to generate more supportive evidence.Item Attitudes of Primary Health Care (PHC) Gatekeepers Towards Patient Referral Policy, Machakos County, Kenya(Science Journal of Public Health, 2016-06) Nshimirimana, Desire Aime; Mwaura-Tenambergen, Wanja; Kokonya, Donald; Adoyo, MaureenPrimary Health Care (PHC) serves as the foundation for building a working healthcare system that provide good health outcomes. The quality of PHC delivery and the decision to refer patients depends on some behavioural factors (knowledge, skills and behaviour) of primary care providers. The study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for analysis. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). About 62% of the respondents reported to know about PHC gatekeeper system and 38% don’t know about PHC gatekeeper system. The gate keepers at a majority rate 86.7% reported to have participated in workshops of which at least 40.3% participated in at least one workshop per year, means that the majority of gatekeepers don’t fill the required continuing professional development (CPD) to renew their licenses. Bad behavior, poor communication, don’t care attitude, long waiting time and no courtesy were mentioned by patients by 60% of respondents as the main contributing factors to non-compliance of patients with the national patient referral policy. Attitudes (knowledge, skills and behaviour) are crucial in primary care gatekeeper policy implementation. It has been made clear that nurses acquire enough knowledge from college to take care of patients but still need more practical knowledge and experience to increase their performance. This study recommends an innovative plan using incentive driven model and performance rewards in the implementation process.Item Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya(American Journal of Health Research, 2016-07) Nshimirimana, Desire Aime; Mwaura-Tenambergen, Wanja; Kokonya, Donald; Adoyo, MaureenThe low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.Item Efficiency and Organizational Arrangements in the Utilization of Resources at Primary Health Care (PHC) in Machakos County, Kenya(International Journal of Health Economics and Policy, 2017-05) Nshimirimana, Desire Aime; Kokonya, Donald; Mwaura-Tenambergen, Wanja; Adoyo, MaureenHealth care is costly and there is need for rational use of health care resources for the world to achieve universal health coverage (UHC). The preventive Primary Health Care (PHC) service is cheaper than the Secondary Health Care (SHC). PHC is strengthened through gatekeeper system, so the emphasis on the PHC for cost control is self-explanatory. This study aimed at determining the efficiency and organizational arrangements using human resources for health (HRH), laboratory services and supply of drugs as the performance indicators that determined rational use of resources in Machakos County, Kenya. This was a convergent parallel mixed methods cross-sectional study that employed qualitative and quantitative data collection techniques. The study targeted facility health managers in charges and policy implementers namely the Chief Officer of health, the Director of Prevention and PHC and the Medical Superintendents and patients seeking health care. A response rate of 83%was achieved (n=83), of whom 84.3% were nurses and 15.7% diploma medicine practitioners. Over (70%) of the health facilities had less than 3professional health workers. Exactly 75% of the community-based self-referrals cases would be treated at PHC level. Self referrals were largely due to patients’ perceived need for laboratory services (53.8%) and medicines (60%). On the contrary, 89.6% of the residents of Machakos County, Kenya were informed about PHC services, 91.7% were accessible to PHC and 93.7% had faith in health care providers at PHC level. The HRH, diagnostic equipment and essential drugs were not the main reasons for self-referrals, but perceived needs for drugs and laboratory services. The inverse and disproportionate attendances of patients at both PHC and SHC levels caused dissonance in service delivery and subsequent inefficiency in service delivery in Machakos County, Kenya. Proper supervision and implementation of referral policy available at county level should be emphasized.Item DETERMINANTS OF NURSES PERFORMANCE IN TIER THREE HEALTH FACILITIES: A CASE STUDY OF KAJIADO COUNTY, KENYA(Journal of Health, Medicine and Nursing, 2018-07) Kokwaro, Brenda; Oluoch, Musa; Adoyo, Maureen; Kimemia, Fredrick; Tenambergen, Dr. WanjaPurpose: Human Resources for Health (HRH) is critical for improved productivity and efficient delivery of health services. However, insufficient health personnel in terms of numbers and level of performance are a major constraint in disease control and maintenance of a health population. A study was carried out to determine the relationship between jobrelated factors, the work environment, organizational factors and policy practices that affect the performance of nurses in tier three health facilities in Kajiado County. Method:A cross sectional, descriptive study design was utilized, adopting qualitative and quantitative data collection approaches. Four tier three health facilities were included and one hundred and thirty (130) respondents were involved in the study. Purposive sampling was used Nurses working in the various departments in the respective facilities were issued with questionnaires to fill in and return. The heads of the different departments were interviewed using an interview guide. Inferential statistics was used to analyze the data. Quantitative data was analysed using SPSS version 23.0 and qualitative data was analysed through thematic content analysis. Results:Results on organizational-relation aspects revealed lack of necessary support provision for incompetent nurses. It also revealed a substantial lack of an appraisal and reviewsystem. The findings on job related factors showed that most of the nurses were diploma holders hence the need for opportunities for further training and enhancement in education levels to advance their knowledge. Findings on organizational factors showedthat inadequate staff levels led to increased workload on available staff which in turn affected the performance of nurses. Unique Contribution to Theory, Practice and Policy:The study recommends thatthere should add more refresher and training courses for the nurses, recruitment of more nursing staff and improvement of resources available.