Influence of Multiple-Months-Scripting on Health Care Workers’ Performance at HIV Outpatient Clinics in Public Health Facilities in Nairobi County

Abstract

Health care workers shortage is a challenge facing health systems managers worldwide. World Health Organization estimates a projected shortfall of 10 million health workers by 2030. The shortage results in high workload, poor performance, and undesirable

patient outcomes. Implementation of World Health Organisation's Multiple-Months- Scripting guidelines was aimed at reducing the number of times a stable HIV patient

comes to the clinic for review from monthly to between 3 and 6 months. The broad study objective was to establish the influence of Multiple- Months-Scripting on healthcare worker performance in HIV outpatient clinics. The study's independent variables were health care workers' Multiple Months Scripting guidelines awareness and adaptation, healthcare workers capacity development on Multiple Months Scripting, persons living with HIV' Compliance with Multiple Months Scripting

regulations and Multiple Months Scripting Commodities flow. This was a cross- sectional study conducted in 20 public facilities in Nairobi County, Kenya. A key

informant tool and a self-administered questionnaire were applied to health facility leadership and technical healthcare worker including doctors, nurses, pharmacists and laboratory technologists. Collected data was entered in the SPSS, for descriptive, bivariate, and ordinal logistic regression analysis. Results showed that out of 128 respondents, 56% were females, 92% were aged between 30-49 years, 89% had served as healthcare workers for 6-15 years, and 53% had served in HIV outpatient clinics for 6-10 years. About 99% of the respondents were aware of and adopted Multiple Months Scripting guidelines; however, only 94% had applied Body Mass Index as a criterion for identifying stable persons living with HIV. About 98% of respondents indicated they were knowledgeable of Multiple Months Scripting guidelines, but 95% agreed they had received supportive supervision, and only 86% had received the Multiple Months Scripting training. About 98 % of respondents said they sensitized persons living with HIV on Multiple Months Scripting; 98% said clients on Multiple Months Scripting adhered to non-medical and medical requirements and maintained a stable state; however, only 93% indicated clients complied with their return dates. A total of 98% of healthcare worker agreed they informed clients on the clinic return dates; however, 48% agreed facilities had commodities stock out within six months prior to the study. Majority of healthcare workers' 98% agreed their performance had improved, agreed there was a reduction in client load and reduced waiting time, and 93% agreed they had more time with clients. Bivariate analysis revealed a significant correlation (0.334) between Multiple Months Scripting guidelines awareness and adaptation and healthcare worker performance and a significant and strong correlation (0.225) between client compliance against and healthcare workers performance. However, healthcare workers' performance had a weak correlation (-0.599) with capacity development on Multiple Months Scripting. There was no significant correlation (0.041) with Multiple Months Scripting commodities flow. Based on ordinal logistic regression, client compliance to Multiple Months Scripting was the most significant influencer of healthcare workers performance, followed by Multiple Months Scripting guidelines awareness and adaptation and finally healthcare workers capacity development on Multiple Months Scripting (Sig. 0.002, .011 and .014 respectively). The conclusion is that implementation of Multiple Months Scripting guidelines resulted in improved healthcare workers performance. It is recommended that the policymakers and HSMs should support Multiple Months Scripting and roll it out to all outpatient clinics for improved patient outcomes.