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Item Utilization of Service Charters in Public Hospitals in Kenya: A Case of Thika Level 5 Hospital, Kiambu County(International Journal of Scientific and Research Publication, 2016-06) Masese, Charles Onyambu; Tenambergen, Wanja Mwaura; Muiruri, LillianService delivery in government health facilities in Kenya still faces multiple challenges. These challenges can still be identified ten years down the line since the introduction of Service Charter. The objective of the study was to assess how the service charter utilization would influence health service delivery in Thika Level 5 Hospital (TL5H) in Kiambu County. Cross sectional study design was employed. Quantitative data was collected using questionnaires. A sample size of 156 technical employees of TL5H and patients participated in this study. Collected data was edited, coded, and entered into the computer using the Statistical Package for Social Scientists (SPSS v 23). The respondents strongly agreed that the hospital charter content is not viewed annually creating unfriendly services (mean 1.73, SD 0.97), (mean 1.74, SD 0.997) indicated the respondents strongly agreed that the service charter is not clearly understood by the majority of patients informing them of their rights when seeking services. The respondents disagreed that the hospital management is always active in monitoring performance and playing the oversight duty according to the SC (mean 2.19, SD 1.20) on whether failure to utilize the service charter may lead to deterioration of quality and equity of healthcare, the respondents agreed (mean 2.05, SD 1.54). Most of the respondents strongly agreed there is availability of support for the service charter (Mean 1.72, SD 0.93), while the respondents also indicated that the waiting time has not improved despite the availability of service charter (Mean 2.98, SD 1.09). The study also established that there was uncertainty in the amount of waiting time in TL5H (Mean 1.775, SD 0.91). The channels used for communication were not clear (Mean 1.993, SD 1.12) while the communication at TL5H does not ensure clarity on issues (Mean 1.9, SD 1.07) while the respondent agreed on communication at TL5H was not always done to get commitment from staff (Mean 1.923, SD 1.047) and there was inadequate open communication of most issues at TL5H (Mean 1.846, SD 1.075). The study recommends that 1) TL5H should improve the contents of the service charter to make it clear, to ensure that the patients fully understand the contents, 2) there should be proper monitoring of the members of staff to ensure that the service charter is fully implemented to minimize the amount of complaints by patients, 3) the service charter contents should be embedded in the organization culture to ensure that is fully and properly implemented to the satisfaction of the service users.Item Assessing How the Packaging of Immunization Services Influence Uptake of the Immunization Services in Selected Health Facilities of Kajiado North Sub-County Kenya(International Journal of Scientific Research in Science, Engineering and Technology IJSRSET, 2016) Kipngetich, Toweett John; Tenambergen, Wanja Mwaura; Adoyo, Maureen AtienoBackground: Immunization as a preventive measure to diseases is vital to organizational performance. Among the six pillars of the health system, this research focused on service delivery. A desk review indicated that there was low immunization coverage in the County. The objectives of the study was to determine how the cultural values, packaging of immunization and health promotion supports the uptake of immunization services Methods: A cross-sectional study utilizing a guided questionnaire, targeting 280 mothers and an interview guide targeting 9 health workers were used. Data analysis was done using SPSS version 21 using descriptive statistics. Qualitative analysis was done by thematic content analysis and framework analysis. Results: Majority of the respondents (mothers) were young with a mean age of 26 years. 233 (83%) agreed that immunization program is well explained to them when they visit health facilities. More than half 183(65.4%) of mothers got the information about immunization through continuous health education routinely offered in health facilities, whereas a significantly low 39 (13.9%) mothers got the immunization information through community health promotion. The correlation of health education with awareness indicated a (P-value = 0.406**) A p-value of 0.209** indicates that frequent visits to the health facilities did not influence the awareness of mothers on the immunization services offered in health facilities. Conclusion: The researcher concluded that there is a relationship between immunization uptake and immunization health promotion activities and recommended that the County Government of Kajiado should introduce outreach services and intensify health promotion activitiesItem The Role Leadership Style Plays in the Integration of Health Management Information System(International Journal of Computer Applications, 2018-07) Kyalo, Caroline Kawila; Odhiambo-Otieno, G. W.; Otieno, George; Tenambergen, Wanja MwauraThis study aimed to establish the role played by leadership style in the integration of health management information systems (IHMIS). An integrated HMIS is a software solution that spans the range of business processes that enables organizations to gain a holistic view of the business enterprise (Alvarez, 2007). An IHMIS supports the different levels of healthcare in terms of information exchange and flow, and the integration of business functions as diverse as patient care, accounting, finance, human resources, operations, sales, marketing, patient information and even the supply chain. Three approaches of leadership styles were tested to see how they influence integration of HMIS; i) Lassiez-faire ii) Transactional and iii) Transformational. A mixed method research design was used. A sample size of 288 respondents stratified in three levels of healthcare (tier 1, 2, and 3) were purposively selected to participate in this study. The respondents included the in-charges, health records and information officers and sub-county and county health management teams members. A questionnaire and a key informant interview guide were used to collect primary data. The questionnaire was analyzed using SPSS and the Key Informant Interview using content analysis. The selection and appropriateness of leadership styles are significant factors for assuring organization success. Good execution of leadership transpires through the availability and access to information during decision making. The information system in an organization is dependent on the leadership behavior on decision making authority in groups. To a great extent Laissez-faire leadership style was found to dominate in the health sector in Kenya, with a few managers practicing Transactional Leadership Style. Laissez-faire leadership style was however found to have a negative and none significant effect in the integration of HMIS, (r=.121, P=.060), this type of leadership plays the role of fragmenting the information systems. Transactional leadership style was moderately significant (r=478**, P=.000), its role was in between fragmenting HMIS and Integrating them at the same time. Transformational leadership style was quite significant in the integration of HMIS (r=.765**, P=.000), this type of leadership style portrayed a positive and significant role in integrating HMIS. The study therefore recommends that healthcare managers should embrace the leadership style that fully encourages team work, because this kind of a leadership style automatically leads to integration of HMIS.Item Patient Perceptions on Primary Health Care (PHC) Nurses and Its Impact on Services Delivery at County Level, Machakos, Kenya(Central African Journal of Public Health, 2019-01) Nshimirimana, Desire Aime; Kokonya, Donald; Tenambergen, Wanja MwauraBackground: Patient perceptions on services delivered by nurses are crucial when assessing the quality of health services. These are most attributable to their knowledge, competent skills and other personal characteristics. These can be described in how effective they handle clients when performing their nursing duties and their effectiveness including their ability to utilize a variety of communication skills and their attitudes at their regular work place. Methodology: This is a crosssectional and qualitative study. Four public hospitals were randomly selected; Kathiani, Mwala sub-county hospital, Kangundo sub-district and Machakos county referral hospital. A systematic sampling was used for participant selection. A maximum of 12 and a minimum of 8 patients constituted a focus group for discussion (FGD) making a sample size of eighty (80) with eight (8) groups (four male and four female groups). The FGDs were conducted using standard guidelines by the researcher helped by a trained research assistant recording the proceedings with audio equipment. Participants aged 18-65 years and emancipated children were included. Data were analyzed using Atlas. ti 7 software. Results and Conclusion: (1) knowledge and competent skills of nurses, (2) personal characteristics, (3) other nurse’s behaviors are key when to effectively perform nursing duties. Participants acknowledged that nurses have the same knowledge because they can be transferred from health centers to at hospital level. Other participants added that patients need nurses who can perform their work with confidence. Personal characteristics like positive attitude, good mood, smile and willingness to provide medical information were also discussed by participants as very important when nurses have to deliver quality health care services. Lastly, other nurse behaviors like respect, honesty, confidentiality and compassion are as well other crucial characteristics on the top of knowledge which were emphasized by participants. All discussed characteristics should link together if nurses have to deliver quality health care. Nursing schools should review their curriculum to include the characteristics mentioned and introduce mentorship programs where the emphasis should be placed on the same.Item PATIENT SATISFACTION WITH EMERGENCY CARE SERVICES ACCESSED AT SELECTED HEALTH FACILITIES IN NAIROBI CITY COUNTY: PATIENTS’ PERSPECTIVE(JournalofHealth,Medicine andNursing, 2019) Edwin, Osiyel Daniel; Tenambergen, Wanja Mwaura; Muiruri, LillianPurpose:The main aim of the study was to study the factors influencing patient satisfaction with emergency care services accessed at selected health facilities in Nairobi City County.Methodology:In this study, descriptiveresearchdesign was adapted. The target population of thestudy included patients seeking emergency healthcarefrom five public health facilitiesin in Nairobi County. Stratified proportion and simple random sampling technique wereused to select 304respondentsamong patientsin emergency department.Data collection tool was used to obtain quantitative data. Nairobi City County referral facilities were purposely selected because of the high number of patient throughput. Systematic sampling was done to identify the respondents. Descriptive cross-sectional study design was used where quantitative approach was used for data collection.Findings:The results showed that there is a positive and significant influence of the physician servicefactors on accessand patient’s perspectiveto emergency healthcare services in public hospitals in Nairobi County (r = .596**, P= .001). On waiting timefactor, findings show that there is a positive and significant influence access and patients’ perspective to emergency healthcare services in public hospitals in Nairobi County(r=.407**, P= 0.001) onquality of care,findings show that there is a positive and significant influence access and patients’ perspective to emergency healthcare services in public hospitals in Nairobi County(r=.255**, P= 0.001). Lastly, results showed that there is a positive and significant influence of the health facility typefactor on access to emergency healthcare services in public hospitals in Nairobi County (r = .257**, P= .001). This implies that the fourfactors are important and significant determinants of accessand useofemergency healthcare services in public hospitals in Nairobi County. Unique contribution to theory, policy and practice: The researcher brings in a wealth of new knowledge to the field of emergency healthcare, where the health sector can adopt a strong pillar of health service delivery by introducing a physician specialty course on emergency healthcare and medicine, further, proper mechanisms can be put to reduce waiting times before a patient seeking emergency healthcare is attended to. This would rely on the quality of care the patient receives when in need.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 facilities