Drivers of a Functional Integrated HIV/NCDs Care Model for a Sustainable Healthcare System; Lessons from Nakuru County, Kenya

Abstract

Healthcare 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.