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Item Influence of Hospital Infrastructure On Quality Healthcare Service Provision at Kenyatta National Hospital(EPRA International Journal of Multidisciplinary Research, 2025-05) Olinyo, Diana Chebet; Kariuki, Caroline Kawila; Mwangi, Eunice MuthoniQuality healthcare service provision is pivotal for achieving Sustainable Development Goals, particularly in national referral hospitals like Kenyatta National Hospital, Kenya. This study aimed to identify determinants influencing quality healthcare provision at KNH, focusing on human resources, infrastructure, system optimization, and health financing. This paper focuses on the influence of hospital infrastructure on quality healthcare service provision at Kenyatta National Hospital. A descriptive crosssectional design was employed, targeting 5,779 healthcare workers with a stratified random sample of 374. Data were collected using pre-tested questionnaires, achieving an 88.2% response rate (n=330). Reliability was confirmed with Cronbach’s α=0.811. Descriptive statistics revealed a high level of agreement regarding the influence of infrastructure, with mean scores exceeding 3.0. Inferential analysis showed a significant positive relationship between hospital infrastructure and quality care (r=0.445, p<0.01). Furthermore, logistic regression identified infrastructure as the strongest predictor of quality healthcare service provision (β=0.593), with the model explaining 66.8% of the variance (Cox & Snell R²=0.668). The findings underscore the pivotal role of hospital infrastructure investment in enhancing service quality at KNH. The study recommends prioritizing infrastructure upgrades as a strategic pathway to improve patient care outcomes and operational efficiency.Item Drivers of a Functional Integrated HIV/NCDs Care Model for a Sustainable Healthcare System; Lessons from Nakuru County, Kenya(Public Health Research, 2023-09) Njuguna Kinyanjui David; Kyalo, Caroline Kawila; Mwangi, Eunice MuthoniHealthcare financing and resourcing have always been of great concern to low- and middle-income countries and households. Stakeholders must devise innovative ways to remain in operation amidst reducing financing and dynamic disease etiology to ensure that there is consistent access to quality healthcare services. The integration of Human Immunodeficiency Virus (HIV) and non-communicable disease (NCD) services has emerged as a crucial approach to optimize healthcare delivery and improve health outcomes. NCD and Human HIV programs are currently managed separately, despite frequent interconnections. The study aimed to conduct a regression analysis of an HIV/NCD integration model for healthcare providers to improve the performance of healthcare services in Nakuru County. Methods: This study explains the effect of the explanatory variables - institutional support, health information processes, pooled resources, and collaboration-on the explained variable- Healthcare System performance-, utilizing a multiple regression model. Organizational culture was also used to moderate the relationship between the explanatory variables and the explained variable. Data were collected from a representative sample of 123 healthcare workers drawn from 106 healthcare facilities providing both HIV/NCD services in Nakuru County, Kenya. The explanatory and moderating variables were selected based on their potential to influence healthcare system performance. The regression models were adjusted for potential confounding variables to ensure the robustness of the findings. Results: In the Multivariate analysis, organizational culture was significant in moderating the relationship between the integration of health services and the performance of the healthcare system, with a p-value of less than 0.05. Specifically, health facilities that embraced a team-oriented organization culture in delivering HIV/NCD service treatment and care were 2.142 times more likely to achieve sustainability of the services as compared to those that did not adopt a team-oriented organization culture. These results were statistically significant at a 95 percent confidence level. The findings of the study also revealed that institutional support in monitoring outcomes had a positive and significant influence on the performance of the healthcare system. Health information processes have a significant influence on healthcare system performance in Nakuru County. Health facilities that utilized functioning information systems during the provision of HIV/NCD services were 1.987 times more likely to achieve sustainability of the services compared to those without such systems. The findings also indicate that the performance of the healthcare system in Nakuru County was significantly influenced by human resources and funding models. Conversely, the findings suggest that there is no significant association between the collaboration guidelines and the performance of the healthcare system in Nakuru County. Conclusions: This study highlights the importance of cultivating a team-oriented organizational culture within healthcare facilities and a need for institutional support. Additionally, the availability and the ability to leverage on available resources contribute greatly to the sustainability of services, leading to a better-performing healthcare system. These findings can guide healthcare providers in developing strategies and interventions to enhance the integration of health services and improve overall healthcare outcomes.Item Integration of HIV and NCD Service Provision: Cost Savings and Implications in Nakuru County, Kenya(Public Health Research, 2023-09) Njuguna Kinyanjui David; Kyalo, Caroline Kawila; Mwangi, Eunice MuthoniDwindling donor funding has been on the rise. Therefore healthcare systems are forced to strategize on how to manage their service delivery with the available resources. There is need to sustain the healthcare services delivery. Integration of Human Immunodeficiency Virus (HIV) and (Non-Communicable Diseases) NCDs services has emerged as a potential solution to improve patient outcomes and optimize resource utilization. This study aimed to evaluate the cost savings associated with integrating HIV services with three common NCDs: Diabetes Mellitus (DM), hypertension (HTN), and the combination of diabetes and hypertension (DM/HTN) in Nakuru County. Methods: This study utilized a hybrid costing approach that combined both top-down and ingredients approaches. The costing analysis took a health system perspective and for acute conditions, the time horizon considered was a case management episode. To determine cost savings, integrated service costs were subtracted from the cumulative costs of individual services on a per-case basis. Results: Integration of HIV and diabetes services resulted in annual cost savings of KES 7,086 (21%) per case. Similarly, integrating HIV with hypertension services yielded cost savings of KES 6,166 (19%) per case. The greatest cost savings were observed when integrating HIV with both diabetes and hypertension services, with annual savings of KES 10,653 (29%) per case. Conclusion: The study results prove that integrating HIV/NCD services would save the healthcare system costs incurred while delivering the services in a parallel model. Hence recommends that healthcare service delivery be supported using an integrated care model to enhance sustainability of the services that have been heavily funded by donors in this country.Item Barriers of access to primary healthcare services by National Health Insurance Fund capitated members in Uasin Gishu county, Kenya(BMC Health Services Research, 2024) Were, Barbara Nawire; Mwangi, Eunice Muthoni; Muiruri, Lillian WambuiPurpose The study identifies provision of primary healthcare services using the capitated health model as a pre- requisite for promoting positive healthcare outcomes for a country’s population. However, capitated members have continued to face challenges in accessing primary healthcare services despite enrolment in the National Health Insur- ance Fund (NHIF). This study sought to determine if variables such as patient knowledge of the NHIF benefit package, NHIF Premium Payment processes, selecting NHIF capitated health facilities, and NHIF Communication to citizens’ influences access to primary healthcare services. Method A cross-sectional analytical research design was adopted. Data was collected from patients who were using NHIF cards, who were drawn from health facilities. Data was collected using a structured questionnaire where some of the questions were rated using the Likert scale to enable the generation of descriptive statistics. Data was analysed using descriptive and inferential statistics which was conducted with the aid of SPSS version 25. Bivariate analysis was conducted utilizing Chi-square to facilitate the comparison of the independent and the dependent variables. Data was presented in tabular formats where each of the specific objectives was used as parameters of interest to the study. Results The study found that four independent variables (Patient knowledge of NHIF Benefit Package, NHIF Premium Payment processes, Selecting NHIF capitated Health Facility, and NHIF Communication to citizens) were significant predictors of access to capitated healthcare services with significance values of .001, .001, .001 and .001 respectively at 95% significance level. Conclusions The study found that familiarity with the NHIF benefit package significantly influenced NHIF capitated members’ access to primary healthcare services in Uasin Gishu County. While most members were aware of their healthcare entitlements, there’s a need for increased awareness regarding access to surgical services and depend- ents’ inclusion. Facility selection also played a crucial role, influenced by factors like freedom of choice, NHIF facility selection rules, facility appearance, and proximity to members’ homes. NHIF communication positively impacted access, with effective communication channels aiding service accessibility. Premium payment processes also signifi- cantly linked with service access, influenced by factors such as payment procedures, premium awareness, payment schedules, registration waiting periods, and penalties for defaults. Overall, patient knowledge, NHIF communication, premium payment processes, and facility selection all contributed positively to NHIF capitated members’ access to pri-mary healthcare services in Uasin Gishu County.Item Drivers of a Functional Integrated HIV/NCDs Care Model for a Sustainable Healthcare System; Lessons from Nakuru County, Kenya(Public Health Research, 2023) Njuguna, David; Kyalo, Caroline Kawila; Mwangi, Eunice MuthoniHealthcare financing and resourcing have always been of great concern to low- and middle-income countries and households. Stakeholders must devise innovative ways to remain in operation amidst reducing financing and dynamic disease etiology to ensure that there is consistent access to quality healthcare services. The integration of Human Immunodeficiency Virus (HIV) and non-communicable disease (NCD) services has emerged as a crucial approach to optimize healthcare delivery and improve health outcomes. NCD and Human HIV programs are currently managed separately, despite frequent interconnections. The study aimed to conduct a regression analysis of an HIV/NCD integration model for healthcare providers to improve the performance of healthcare services in Nakuru County. Methods: This study explains the effect of the explanatory variables - institutional support, health information processes, pooled resources, and collaboration-on the explained variable- Healthcare System performance-, utilizing a multiple regression model. Organizational culture was also used to moderate the relationship between the explanatory variables and the explained variable. Data were collected from a representative sample of 123 healthcare workers drawn from 106 healthcare facilities providing both HIV/NCD services in Nakuru County, Kenya. The explanatory and moderating variables were selected based on their potential to influence healthcare system performance. The regression models were adjusted for potential confounding variables to ensure the robustness of the findings. Results: In the Multivariate analysis, organizational culture was significant in moderating the relationship between the integration of health services and the performance of the healthcare system, with a p-value of less than 0.05. Specifically, health facilities that embraced a team-oriented organization culture in delivering HIV/NCD service treatment and care were 2.142 times more likely to achieve sustainability of the services as compared to those that did not adopt a team-oriented organization culture. These results were statistically significant at a 95 percent confidence level. The findings of the study also revealed that institutional support in monitoring outcomes had a positive and significant influence on the performance of the healthcare system. Health information processes have a significant influence on healthcare system performance in Nakuru County. Health facilities that utilized functioning information systems during the provision of HIV/NCD services were 1.987 times more likely to achieve sustainability of the services compared to those without such systems. The findings also indicate that the performance of the healthcare system in Nakuru County was significantly influenced by human resources and funding models. Conversely, the findings suggest that there is no significant association between the collaboration guidelines and the performance of the healthcare system in Nakuru County. Conclusions: This study highlights the importance of cultivating a team-oriented organizational culture within healthcare facilities and a need for institutional support. Additionally, the availability and the ability to leverage on available resources contribute greatly to the sustainability of services, leading to a better-performing healthcare system. These findings can guide healthcare providers in developing strategies and interventions to enhance the integration of health services and improve overall healthcare outcomes.Item Integration of HIV and NCD Service Provision: Cost Savings and Implications in Nakuru County, Kenya(Public Health Research, 2023) Njuguna, K. David; Kyalo, Caroline Kawila; Mwangi, Eunice MuthoniDwindling donor funding has been on the rise. Therefore healthcare systems are forced to strategize on how to manage their service delivery with the available resources. There is need to sustain the healthcare services delivery. Integration of Human Immunodeficiency Virus (HIV) and (Non-Communicable Diseases) NCDs services has emerged as a potential solution to improve patient outcomes and optimize resource utilization. This study aimed to evaluate the cost savings associated with integrating HIV services with three common NCDs: Diabetes Mellitus (DM), hypertension (HTN), and the combination of diabetes and hypertension (DM/HTN) in Nakuru County. Methods: This study utilized a hybrid costing approach that combined both top-down and ingredients approaches. The costing analysis took a health system perspective and for acute conditions, the time horizon considered was a case management episode. To determine cost savings, integrated service costs were subtracted from the cumulative costs of individual services on a per-case basis. Results: Integration of HIV and diabetes services resulted in annual cost savings of KES 7,086 (21%) per case. Similarly, integrating HIV with hypertension services yielded cost savings of KES 6,166 (19%) per case. The greatest cost savings were observed when integrating HIV with both diabetes and hypertension services, with annual savings of KES 10,653 (29%) per case. Conclusion: The study results prove that integrating HIV/NCD services would save the healthcare system costs incurred while delivering the services in a parallel model. Hence recommends that healthcare service delivery be supported using an integrated care model to enhance sustainability of the services that have been heavily funded by donors in this country.Item Effects of Perceived Image of NHIF Outpatient Facilities on Utilization of Primary Care Services by Private University Employees in Nairobi County(International Journal of professional Practice (IJPP), 2019-01) Kironji, Keziah M.; Tenambergen, Wanja Mwaura; Mwangi, Eunice MuthoniThe 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 primary health services after selecting their preferred facilities from a list of the NHIF outpatient ones. However, there are some members of National formal scheme whose contributions are remitted to NHIF by their employer every month but do not utilize primary care services. This study sought to determine the effects of perceived image of NHIF outpatient facilities on utilization of primary care services by the national formal scheme members in Nairobi with a focus on Private University employees. This study adopted a cross-sectional descriptive design with mixed methods approach. Multistage sampling with simple random sampling was used. Quantitative techniques were used for data collection. Descriptive statistics, F-Statistics, P-values, Pearson’s Rho ®, mean-scores, standard deviations, co-efficient of determination (R2) and the coefficient of multiple determinations (Adjusted R2) were analyzed using SPSS version 24. The rationale of this study was to inform top management of NHIF to undertake decisions in regards to utilization of primary health services by NHIF members by understanding effects of safety of healthcare services, waiting time at the health facilities, healthcare workers interpersonal skills and facilities amenities and physical outlook affect utilization of primary care services. The multiple regression results indicates that in a combined relationship only three factors on perceived image of NHIF facilities influence utilization of primary care services; safety of healthcare services (X1; β1 = .315, P ˂0.05), healthcare workers interpersonal skills (X3; β3 = .0.049, P ˂0.05), and healthcare facilities amenities and physical outlook (X4; β4 = .027, P ˂0.05). Waiting time is negative (X2; β2 = -.018, P ˂0.05) and thus does not influence utilization of primary care services. In a combined model, all four factors have no scientifically significant influence on utilization of primary health services by national formal scheme members in Nairobi County. The study recommends that NHIF should vet facilities they accredit to offer primary care services to ensure safety of healthcare services, train workers on effective interpersonal skills and improve facility amenities and physical outlook of NHIF outpatient facilitiesItem Influence of Awareness of Daily Payment on Uptake of Social Health Insurance among Bodaboda Operators In Eldoret Town, Kenya(IOSR Journal of Nursing and Health Science (IOSR-JNHS), 2021-07) Mutai, Reuben Kipruto; Njoroge, Kezia; Mwangi, Eunice MuthoniHealth financing is an important component of healthcare delivery. In Kenya, the universal health cover scheme has officially been adopted by the government and it is delivered through the National Health Insurance Fund (NHIF). The health insurer has since unbundled its subscription to include small daily subscription packages targeting low income workers in the country among them the motorcycle taxi operators (also known in Kenya as BodaBoda) aiming to reduce the costly out-of-pocket health financing. However, it is not known why low subscription of the daily package was still being reported among Bodaboda operators in Eldoret town in Uasin Gishu County, Kenya. The study, therefore, sought to find out how awareness of daily payment influenced uptake of social health insurance among Bodaboda operators in the town. The study adopted a cross-sectional descriptive design and used purposive sampling to select 263 respondents from 5000 Bodaboda operators including 26 officials affiliated to 26 registered cooperative organizations in the town. Data was collected from the respondents using both questionnaire and focus group discussions. Quantitative data from questionnaires was analyzed using descriptive and inferential statistics using Statistical Package for Social Sciences (SPSS) version 25.0 software. Qualitative data from focus group discussions was analyzed using conceptual content analysis. The study confirmed that majority (69.8%) of the Bodaboda operators were uninsured by NHIF. It also revealed that awareness plays a significant (OR.1.394, 95% CI = 0.559 – 3.478) role in the uptake of the daily health insurance package among Bodaboda operators. Further, the odds of uptake increased with the level of education of the Bodaboda operators. The study recommends that NHIF come up with targeted awareness strategies that reach out directly to the members of the bodaboda operators Saccos with current information about the products they have on offer and the subscriptions options.Item Determinants of Efficient Health Commodity Management in Maternal Child Health: A Case of Meru County, Kenya(International Journal of Scientific and Research Publications,, 2021-08) Mbatia, Elvis Mwandawiro; Mwangi, Eunice Muthoni; Tenambergen, Wanja MwauraEmergency Obstetric and Neonatal Care (EmONC) has become a priority especially in developing countries like Kenya. However, access to obstetric and neonatal care has been hindered by lack of medical commodity, equipment’s and vaccines related to Maternal Child Health (MCH), resulting to high maternal and neonatal mortality rates. The study is anchored in the health products, vaccines and technologies pillar of a health system. The study seeks to establish the determinants of an efficient health commodity management in MCH in public health facilities in Meru County. Specific objectives were to establish the influence of i) logistic management information system, ii) medical staff competency, iii) inventory management, and iv) supply chain management practices on efficient health commodity management in maternal child health in Meru County. The study adopted a cross-sectional design with quantitative methods for data collection. The study sample was 116 health care workers from all public health facilities in Meru County. Results indicated that logistic management information system was positively and significantly associated with the efficient health commodity management in MCH ( 2 = 4.450, P=0.035). This implied that LMIS had a positive and significant association influence on the efficient management of health commodity in MCH services. Medical staff competency was positively and significantly associated with the efficient health commodity management of MCH ( 2= 7.0489, P=0.008).The study recommends the County Health Department of Meru should i) invest in health information systems for quantification, forecasting reporting and procurement of medical goods and equipment; ii) conduct continuous professional education among health workers to ensure efficient management of healthcare commodities in the health facilities.Item Factors Influencing Uptake of Oncology Specialized Health Care Services in Uasin Gishu County, Kenya(International Research Journal of Oncology, 2020-10) Linner, Chepngetich Soy; Mwangi, Eunice Muthoni; Musa, OluochIn Kenya, absence or poor access for oncology services has escalated the total national mortality rate in Kenya. Despite numerous studies on the increased prevalence and incidence of cancers, there is insufficient empirical literature explaining the factors influencing the increased absence or poor of access to oncology tertiary healthcare services in Uasin Gishu County, a research gap filled by this study. This study determined factors influencing access to oncology specialized healthcare services among patients in Uasin Gishu. Using descriptive research design, the study employed a census survey on population of 142 screened oncology patients in the 18 level 3 and 4 facilities in Uasin Gishu County. Data was collected using structured questionnaires. Data was analysed using descriptive statistics and then inferential analysis with results presented in form of tables and figures. The data was analysed with assistance of Statistical Package for Social Sciences (SPSS) software version 22.0. The study reveals that at 0.05 (5%) level of significance, there exists a significant relationship between each of; affordability of oncology services, location of oncology services, acceptability of oncology services, and availability of oncology specialized healthcare services and uptake of oncology specialized healthcare services in Uasin Gishu County. The study recommends that since health is a devolved function, the county government of Uasin Gishu should seek to provide affordable oncology services through establishment of a strategy for low income oncology patients and stakeholder participation