Doctor of Philosophy in Health Systems Management

Improving Health Systems Responsiveness Among Chronic Care Centers in Selected Tier Three Hospitals in Kenya: Predictors and Effect of Health Workers Training

Sun, 01 Sep 2024 00:00:00 GMT

Improving Health Systems Responsiveness Among Chronic Care Centers in Selected Tier Three Hospitals in Kenya: Predictors and Effect of Health Workers Training KIBIRITI, HILLARY MARAKARU This study assessed health system responsiveness, predictors (accountability mechanisms, access, structural, valuations, organizational culture, justice perceptions) and role of training among patients with diabetes mellitus and hypertension at three primary hospitals in Kenya: Kimilili (Bungoma county), Uasin Gishu (Uasin Gishu county) and Gatundu (Kiambu county). It used a quasi-experimental design with baseline survey, a training intervention on responsiveness and client interaction skills for health workers, and an end-line survey. A sample of 323 respondents was selected from a sampling frame of 853 using Fisher's formula. The end-line survey included 258 participants. Data were collected using an interviewer-assisted structured questionnaire, with responses rated on a five-point Likert scale and then dichotomized into favorable and unfavorable categories using a demarcation threshold formula. Responsiveness levels increased from 63.7% to 67.4%, while proportion of favorable responsiveness rose from 38.3% to 52.7%. The odds of favorable responsiveness nearly doubled from 0.620 to 1.114 between baseline and end line. Comparatively, Kimilili hospital exhibited higher levels and distribution of responsiveness. Communication scored highest with 72.7% at the end line, while Choice performed lowest with 53.3% at baseline. Dignity was most valued domain at 23.1%, while social support was least at 3.9%. A paired samples t-test indicated significant (P<0.05) positive deviations across all responsiveness domains and four predictors: valuations, accountability, structural factors, and organizational culture. Chi-square test indicated the socio -demographic factors: facility (p=0.001), medical condition (p=0.001), religion (p=0.033), marital status (p=0.001), and occupation (p=0.001) significantly impacted responsiveness at baseline, while marital status (p=0.012) and occupation (p=0.039) remained significant at end line. Following an iterative binary logistic regression, the final predictive model for responsiveness was based on end line survey findings and indicates structural (p=0.010, OR=2.171), accountability (p=0.001, OR=2.730), organizational culture (p=0.009, OR=2.267), and justice perceptions (p=0.001, OR=2.909) were significant predictors. After intervention, the model improved significantly; explained variation increased from 15.7% to 32.8%, the logit improved from 68.5% to 85.1%, and the correct classification of responsiveness categories rose from 66.9% to 70.5%. Including two significant sociodemographic factors: marital status and occupation; into the predictive model raised the explained variation to 40.4%, reflecting the context. The -2log likelihood ratio indicated justice perceptions significantly moderated the association between responsiveness and all other predictors. Qualitative analysis underscored the importance of respect for persons domains, with varied perceptions across contexts. Challenges included low client voice, insufficient managerial support, inadequate accountability mechanisms, corruption, and limited supplies. In conclusion, responsiveness, although generally low, improved with training. Lower socioeconomic groups received more responsive care, suggesting potential for lowered expectations. The study suggests hospital managers prioritize an integrated, patient-centered approach, conduct regular client-provider feedback sessions, and implement audits for continuous improvement. Training institutions and hospital management should integrate attitude and cultural competence training across all levels to enhance sensitivity to cultural differences in healthcare. Furthermore, the Ministry of Health and county health departments should enhance accountability, improve structural factors, foster positive organizational culture, and ensure fairness in justice perceptions to enhance patient experiences and health outcomes.

Effect of Training Bystanders On Responsiveness Of Pre-Hospital Emergency Health Care Delivery In Nairobi City County, Kenya

Wed, 01 Oct 2025 00:00:00 GMT

Effect of Training Bystanders On Responsiveness Of Pre-Hospital Emergency Health Care Delivery In Nairobi City County, Kenya Musyoka, Felistus Ndanu Emergency care systems are essential for delivering rapid critical care, and the bystander, as the initial system activator, is crucial to its responsiveness. This study investigated the impact of bystander training on the responsiveness of pre-hospital emergency health care delivery in Nairobi City County, Kenya. An unmatched case-control design using mixed methods was employed, drawing theoretical guidance from the Theory of Planned Behaviour, the Bystander Intervention Model, the Golden Hour Theory, and Queuing Theory. Data were collected from 752 households, the Emergency Operations Centre (EOC), and Accident & Emergency (A&E) departments using questionnaires, Focus Group Discussions (FGDs), Key Informant Interviews (KIIs), and checklists. Quantitative data were analysed with SPSS using descriptive statistics, a Difference-in-Differences (DiD) model to measure the intervention's causal effect, and correlation analysis. Qualitative data were thematically analysed using NVivo 12. The study demonstrated that bystander training had a positive impact on several emergency response metrics. The training increased participants' knowledge (adjusted p=0.022 DiD) and improved overall decision-making capabilities (adjusted p=0.003 model). Crucially, the intervention led to meaningful improvements in composite willingness-to-help scores (p<0.001), primarily by reducing psychological barriers such as fear of being judged (p=0.001), concerns about legal consequences (p<0.001), and bystander waiting tendencies (p<0.001). Operationally, the training significantly increased the number of emergency calls placed (p=0.048), the number of patients receiving care (p=0.001), and ambulance utilization rates (p<0.0001). Most importantly, training of bystanders significantly reduced emergency notification intervals (P<0.001) with a large unadjusted DiD effect of 38.4. The intervention group experienced a 76% reduction in delays exceeding 15 minutes (from 80.4% to 4.1%) and a notable increase in responses within 0−5 minutes, confirming the training’s effectiveness in accelerating early emergency recognition and response. However, despite these numerous positive outcomes, the training did not improve the responsiveness times of pre-hospital emergency healthcare delivery in measured intervals: response (p=0.136), transportation (p=0.354), activation (p=0.851), and handover (p=0.818). The findings underscore the training's effectiveness in accelerating early response actions. It was recommended that the study results be used by the MOH, policymakers, and implementers to develop strategies for improving pre-hospital emergency healthcare delivery and increasing survival rates, including the incorporation of a bystander training component in the WHO Emergency Care System Framework (ECSF), thus overcoming some of the challenges faced by the health care systems in responding to emergencies.

The Role of Health Services Integration in Healthcare System Performance: A Case of Hiv/Aids and Ncd Services in Nakuru County, Kenya.

Mon, 01 Jul 2024 00:00:00 GMT

The Role of Health Services Integration in Healthcare System Performance: A Case of Hiv/Aids and Ncd Services in Nakuru County, Kenya. NJUGUNA, DAVID KINYANJUI The intersection of Non-Communicable Diseases and Human Immuno deficiency Virus exacerbates morbidity and mortality, in low-and-middle-income countries. While progress has been made in raising awareness globally, challenges persist in effectively combating the rising burden of NCDs. This study aimed to develop an optimal approach for integrating HIV/NCD services to enhance population health by providing more equitable, sustainable, and cost-effective healthcare. The study objectives focused on assessing the impact of pooled resources, institutional support, health information processes, and collaborative guidelines on the integration of HIV/NCD services, while exploring the influence of organizational culture on the relationship between integrated services and healthcare system performance. Employing a mixed-method research design, the study targeted 212 healthcare workers in 146 public health facilities offering Comprehensive Care Clinic services in Nakuru County. Data collection utilized a structured questionnaire and Key Informant Interview guide with pretesting conducted to ensure tool reliability and validity. NVivo 12 software was used to analyse the qualitative data from the key informant interviews. Thematic analysis was employed for the qualitative data analysis. Statistical analyses included Chi-square tests to examine relationships between variables, and binary logistic regression to predict healthcare system performance outcomes, with rejection of null hypotheses for P values ≥ 0.05. The study outcomes highlight that in the setting of institutional support, the monitoring of HIV/NCD services emerged as a robust predictor of health system performance. The statistical examination unveiled notable associations: a Pearson’s chi-square statistic of χ2 = 3.578, n = 198, p = 0.044 for Health Information Process; χ2 = 9.955, n = 198, p = 0.001 for the accessibility of information systems; and χ2 = 12.285, n = 198, p = 0.001 for information sharing. Information security was also identified as a significant determinant of health system performance, with a chi-square value of χ2 = 6.486, n = 198, p = 0.001. These outcomes indicate that all facets of information processes play a critical role in forecasting health system performance. Concerning pooled resources, the analysis demonstrated that human resources significantly impacted health system performance, with a Pearson’s chi-square value of χ2 = 4.122, n = 198, p = 0.049. Similarly, financing models were recognized as a significant predictor, with a chi-square value of χ2 = 12.203, n = 198, p = 0.001. These results underscore the significance of resource distribution and administration in determining health system performance. Furthermore, a multivariate analysis illustrated that the five independent factors explained 36.9% of the variance in health system performance. The study results also proved that (20% or 30% or 50%) cost would be saved and patients waiting time would be reduced if HIV and NCD services are integrated. In conclusion, a multisector approach would ensure that the study findings can have a meaningful impact across different levels of healthcare delivery and policymaking. The study recommends a team oriented organisational culture, it would lead to full integration of HIV/NCD services that would ultimately improving the overall quality and sustainability of healthcare system.

Scaling Up Community Differentiated Service Delivery To Improve Access To Health Care Among People Living With Hiv in Kakamega County, Kenya

Sun, 01 Sep 2024 00:00:00 GMT

Scaling Up Community Differentiated Service Delivery To Improve Access To Health Care Among People Living With Hiv in Kakamega County, Kenya OWITI, WINNIE SARAH Access to health services encourages early treatment seeking leading to better health outcomes and significant social and economic benefits. Without adequate access, the impact of HIV treatment and care services is severely diminished. This study aimed to address the existing challenges in healthcare access by scaling up community differentiated service delivery and evaluating its effectiveness in improving health outcomes among people living with HIV in Kakamega County. Two public facilities (cluster) in two sub counties (Butere and Kakamega) were randomly assigned (1:1) to provide community differentiated service delivery model (intervention group) and standard care (control group) to people living with HIV who are established on antiretroviral therapy. Exclusion criteria included patients on transit, those with comorbidities, pregnant and breastfeeding and those unable to give informed consent. At intervention clinic patients were assigned a lay health worker, attended monthly group meetings, received health education, peer counseling, symptom screening and ART refill. The primary outcome was the proportion of patients who had two clinic visits in twelve months. Baseline data was collected through questionnaires, in-depth interviews, and end line data collected through document reviews. Ethical clearance was obtained from relevant authorities. This trial is registered with National Council of Science and Technology clinical trial registry, number Nascosti/P/21/12623.At enrollment, 402 participants (201 in each group) were included, with 295 aged below 35 years and 107 above 35 years. Males comprised 116, and females 286. Baseline assessment established low level of readiness (p=0.007, OR=1.362), low demand (p=0.032, OR=1.78), non-comprehensive package of services (p=0.009, OR=1.134) and poor support (p=0.009, OR=1.20) At end line scaling up community differentiated service delivery was successful in improving accessibility to health services among people living with HIV odds ratio 1.494 (p-value 0.001). Community differentiated service delivery can substantially improve and should be scaled up to improve health outcomes among people living with HIV. Future research should investigate enhancing visibility and accessibility of community differentiated service delivery for chronic diseases.

Towards a Digital Health Information Framework For Management of Essential Medicine Supply Chain in Public Healthcare Facilities in Kenya

Mon, 01 Jan 2024 00:00:00 GMT

Towards a Digital Health Information Framework For Management of Essential Medicine Supply Chain in Public Healthcare Facilities in Kenya NALEBE, ROBERT MUGUBI A digitized health information system for managing the “essential medicine supply chain” is an electronic information system capable of electronically gathering data, processing, and disseminating information for decision-making in the supply chain process. Globally, Wales Slovenia, Scotland, Estonia, the United Kingdom, the Netherlands, Finland, Denmark, Norway, and Sweden have successfully developed digital health information systems capable of collecting, processing, and disseminating information across other information systems; however, gaps in the early realization of scarcity of essential medicine persist. Vital medicine stockouts in public healthcare facilities in Kenya persist due to incomplete, inaccurate, unreliable, and untimely information flow, poor information processing, insufficient ICT infrastructure, a lack of digitally literate personnel, and the absence of an e-health policy. These issues lead to delays in information sharing, decision-making, access to medicine, and service delivery. The study aimed to develop a “digital health information framework for managing the essential medicine supply chain” in Kenya’s public healthcare facilities. The development of a digital health framework was driven by the need to enhance the use of “digital health information” in managing the vital medicine supply chain as a measure to prevent essential medicine stockouts. The study utilized both quantitative and qualitative research methods, including individual and key informant interviews, in the Counties of Mombasa, Makueni and Kajiado from August to October 2023. To gather information from personnel involved in health information and medical products and supply chain,150 Healthcare Workers and 14 key informants (Medical Superintendents of Health, Procurement Officers, Health Records and Information Officers and Medical Stores Officers) from a sample frame of 437 health workers in 14 public hospitals. Data was analyzed both descriptively and by inferential statistics. From the multiple linear regression: (i) quality of “digitised health information has a significant influence” on the management of “essential medicine supply chain”; (ii) there is a significant relationship between the digitised health information processing strategy factor and the management of “essential medicine supply chain”; (iii) a “significant relationship exists between ICT infrastructure factor support for health information and management of “essential medicine supply chain”; (iv) there is a significant relationship between workforce skills and management of vital medicine supply chain. The results also showed that the digital health policy affects the relationship between the quality of digitised health information, the strategy for processing digitized health information, ICT infrastructure support, workforce skills, and the management of “essential medicine supply chain” in public healthcare facilities in the three counties. Findings revealed that most of the information available for making decisions regarding managing “essential medicine supply chain” in level 4 and 5 hospitals in Mombasa, Makueni and Kajiado counties is often untimely, incomplete, incorrect, and unreliable. The findings led to the development of a digital health information framework for managing “essential medicine supply chain” in public healthcare facilities in Kenya. The goal is to improve the timely management of “essential medicine supply chain,” increase essential medicine stock availability, and enhance overall healthcare service delivery.

Improving Health Systems Responsiveness among Chronic Care Centers in Selected Tier Three Hospitals in Kenya: Predictors and Effect of Health Workers Training

Sun, 01 Sep 2024 00:00:00 GMT

Improving Health Systems Responsiveness among Chronic Care Centers in Selected Tier Three Hospitals in Kenya: Predictors and Effect of Health Workers Training KIBIRITI, HILLARY MARAKARU This study assessed health system responsiveness, predictors (accountability mechanisms, access, structural, valuations, organizational culture, justice perceptions) and role of training among patients with diabetes mellitus and hypertension at three primary hospitals in Kenya: Kimilili (Bungoma county), Uasin Gishu (Uasin Gishu county) and Gatundu (Kiambu county). It used a quasi-experimental design with baseline survey, a training intervention on responsiveness and client interaction skills for health workers, and an end-line survey. A sample of 323 respondents was selected from a sampling frame of 853 using Fisher's formula. The end-line survey included 258 participants. Data were collected using an interviewer-assisted structured questionnaire, with responses rated on a five-point Likert scale and then dichotomized into favorable and unfavorable categories using a demarcation threshold formula. Responsiveness levels increased from 63.7% to 67.4%, while proportion of favorable responsiveness rose from 38.3% to 52.7%. The odds of favorable responsiveness nearly doubled from 0.620 to 1.114 between baseline and end line. Comparatively, Kimilili hospital exhibited higher levels and distribution of responsiveness. Communication scored highest with 72.7% at the end line, while Choice performed lowest with 53.3% at baseline. Dignity was most valued domain at 23.1%, while social support was least at 3.9%. A paired samples t-test indicated significant (P<0.05) positive deviations across all responsiveness domains and four predictors: valuations, accountability, structural factors, and organizational culture. Chi-square test indicated the socio -demographic factors: facility (p=0.001), medical condition (p=0.001), religion (p=0.033), marital status (p=0.001), and occupation (p=0.001) significantly impacted responsiveness at baseline, while marital status (p=0.012) and occupation (p=0.039) remained significant at end line. Following an iterative binary logistic regression, the final predictive model for responsiveness was based on end line survey findings and indicates structural (p=0.010, OR=2.171), accountability (p=0.001, OR=2.730), organizational culture (p=0.009, OR=2.267), and justice perceptions (p=0.001, OR=2.909) were significant predictors. After intervention, the model improved significantly; explained variation increased from 15.7% to 32.8%, the logit improved from 68.5% to 85.1%, and the correct classification of responsiveness categories rose from 66.9% to 70.5%. Including two significant sociodemographic factors: marital status and occupation; into the predictive model raised the explained variation to 40.4%, reflecting the context. The -2log likelihood ratio indicated justice perceptions significantly moderated the association between responsiveness and all other predictors. Qualitative analysis underscored the importance of respect for persons domains, with varied perceptions across contexts. Challenges included low client voice, insufficient managerial support, inadequate accountability mechanisms, corruption, and limited supplies. In conclusion, responsiveness, although generally low, improved with training. Lower socioeconomic groups received more responsive care, suggesting potential for lowered expectations. The study suggests hospital managers prioritize an integrated, patient-centered approach, conduct regular client-provider feedback sessions, and implement audits for continuous improvement. Training institutions and hospital management should integrate attitude and cultural competence training across all levels to enhance sensitivity to cultural differences in healthcare. Furthermore, the Ministry of Health and county health departments should enhance accountability, improve structural factors, foster positive organizational culture, and ensure fairness in justice perceptions to enhance patient experiences and health outcomes.

Effect of Community Health Strategy in Advancing Social Accountability in the Health System in Nairobi County, Kenya

Sat, 01 Oct 2022 00:00:00 GMT

Effect of Community Health Strategy in Advancing Social Accountability in the Health System in Nairobi County, Kenya Abuga, Malkia Moraa The goal of community health strategy is to increase participation in improving the quality of health services in Kenya by incorporating health users' voices. The community's health workforce consists of community health assistants/officers and community health volunteers. Their position in the health system enables them to act as community mouthpieces, combating inequities and advocating for community rights and needs to government structures. However, knowledge asymmetry, inadequate supportive supervision, and provision of working tools affect how community health volunteers advocate for themselves and their communities. The study's overarching goal was to assess the effect of community health strategy on advancing social accountability in Kenya's health system. The specific objectives were to evaluate the influence of Community Health Volunteers' characteristics and practices, contextual factors, and community dialogue in advancing social accountability in the health systems. In addition, the effect of training community health volunteers on social accountability was evaluated. This was a quasiexperimental study design with a pre-test and post-test carried out in Embakasi North and Embakasi Central sub-counties in Nairobi County, Kenya. It took over 12 months to design and implement a training intervention that addressed key aspects of social accountability, such as how to report complaints and compliments. The study involved 180 Community Health Volunteers who consented to participate in the intervention and comparison groups. Stratified sampling was used to select the community health volunteers who participated in the study. To collect data and interpret findings, a convergent mixed methods approach was used. Quantitative data was analysed using SPSS version 28. The transcribed data from four focus group discussions, 15 KII, and minutes were analysed using a thematic framework indexed by Atlas.ti 22 software. After training, cumulative test scores improved significantly with at pre-test score (mean= 48.2, SD = 9.5) and post-test score (mean = 71.1, SD = 9.36; p< 0.001). Findings showed that the number of CHVs reporting complaints in the intervention group increased from 11 (12.2 %) to 57(63.3 %). In addition, the likelihood of CHVs recording complaints in the intervention was (b=.554, p=.011, OR=1.740) compared to the comparison group (b=.010, p=.506, OR=1.010) at the end of the study. In conclusion, community health volunteers social accountability practices were enhanced through training, supportive supervision and provision of working tools. The study recommended that the Ministry of Health's department of community health services adapt the social accountability-training guide. Further research should be conducted to determine the extent to which the CHV's intermediary role influences health system responsiveness.

Effects of Health System Approach Intervention on Adherence to Appointments in Antenatal and Postnatal Clinics in Public Hospitals in Selected Counties in Kenya

Wed, 01 Sep 2021 00:00:00 GMT

Effects of Health System Approach Intervention on Adherence to Appointments in Antenatal and Postnatal Clinics in Public Hospitals in Selected Counties in Kenya Opon, Shadrack African medical setting has about 42% missed appointment rate. With about 44% missed appointment rate in antenatal and postnatal clinics, Kenya wastes up to 22% of health resources caused by both facility and patient factors. According to UNICEF 2017 report, 502,860 children were not immunized in 2017, and 1.7 million children born between 2013 and 2017 did not receive all prescribed vaccines. Homabay and Kisumu Counties recorded 42% and 35% missed appointment rates in antenatal and postnatal clinics respectively in 2019 as per 2019 Hospital “Did Not Attend Reports”. This study assessed the effect of health system approach intervention on adherence to appointments in antenatal clinics in public hospitals in Kenya. Specifically, the study assessed: the influence of organization of maternal and child health services; contribution of health workers; influence of access; influence of patient characteristics; and effect of system-wide communication on adherence to appointments in antenatal clinics in public hospitals. The study adopted a case control with a quasi-experimental research design in which two hospitals were purposively sampled for inclusion (Homabay and Kisumu County Hospitals) because of the high under-five mortality, poverty rates, and high HIV prevalence rates. These facilities are also ranked on the same level by the Ministry of Health. The study targeted 4 hospital managers and 200 registered antenatal clients in their first trimester of pregnancy. Stratified sampling and proportionate sampling were used to sample clients, and purposive sampling for hospital managers. Yamane Formula was used to determine sample size. The study sample comprised of 133 antenatal clients (Homabay County Hospital 70, Kisumu County Hospital 63) and 2 hospital managers per hospital. A self-administered structured questionnaire and a key informant interview guide were used to collect data. Findings revealed that, in Homabay and Kisumu County hospitals, 55 (78.6%) and 33 (55%) of antenatal clients had missed their appointments because of the long waiting time; 50 (71.4%) and 37 (61.7%) due to poor consultation process; 50 (71.4%) and 27 (45%) due to inadequate responsiveness towards their needs; 50 (71.4%) and 34 (56.7%) due to poor staff attitude; 55 (78.6%) and 30 (50%) due to high opportunity cost of seeking services; and 55 (78.6%) and 25 (41.7%) due to the long distance to the facility. An intervention in form of system wide communication on the above factors in Homabay County reduced missed appointments to 6 (9.1%) due to short waiting time; 10(15%) due to enhanced consultation process; 9 (13.6%) due to better staff responsiveness; and 14 (21.2%) due to improved staff attitude. Single, separated and young antenatal clients miss more appointments than the married, cohabiting, and older clients. The Pearson chi-square test also showed p value of 0.000 revealing a strong association between the variables. The logistic regression models depicted high odds ratio (at 95% confidence interval) of appointment adherence with positive increase in independent variables. Also, the independent variables have a p<0.05 depicting high significance to dependent variable. Conclusively, there is a high missed appointment rate in ANC clinics in Homabay and Kisumu County hospitals because of long waiting time and poor consultation process; poor staff attitude and inadequate staff responsiveness; and high opportunity cost and facility location. The study recommends that the two counties reorganizes MCH services by increasing consultation points; train staff on public relations; devolve crucial ANC services to remote areas; adopt this study’s system approach intervention; and community health workers to educate mothers on the significance of ANC services to improve adherence to appointments in ANC clinics.

The Influence of Health Literacy on Patients' Rights Charter on Health Systems responsiveness at a Primary Health Care facility in Machakos County

Sun, 01 Nov 2020 00:00:00 GMT

The Influence of Health Literacy on Patients' Rights Charter on Health Systems responsiveness at a Primary Health Care facility in Machakos County Njuguna, Roseline Susan Health systems do not always respond to legitimate non-medical needs and expectations of the patients attending for services. Responsiveness to peoples’ legitimate expectations in health systems is one of the goals of health systems. Despite its importance, few studies have documented interventions aimed at improving responsiveness in primary health care facilities. The aim of the study was to establish whether integration of an intervention of health literacy of patients’ rights into ongoing service delivery practices influenced health systems responsiveness at primary health care facilities of Machakos County. The objectives of the study were to establish the health care providers’ knowledge of patients’ rights influence on responsiveness, to establish patient’s knowledge of responsiveness and to establish the influence of literacy on patients’ rights charter on health systems responsiveness at primary health care facilities in Machakos County. A descriptive cross-sectional study design was used for objectives one and two and a quasi-experimental study design used for objective three. Data was collected using semi structured questionnaires from the 62 health care providers, 91 patients at pre-intervention and 89 patients at post-intervention. Key informant interviews with 4 facility in charges were conducted. Intervention of health literacy on patients’ rights charter was carried out using multiple methods. Pre and post-intervention data were collected and analyzed using SPSS version 25 and findings were presented as descriptive and inferential statistics. Results obtained from the health care provider indicated that they were both knowledgeable and considered health systems to be responsive, this was positively significantly associated with health systems responsiveness at (r=.700**, p < .001). and with all the individual domains of responsiveness except for the domain of access of patients to social support (r=.096, p < .46). There was no documentation of the practice of patients’ rights by the health care provider despite their level of knowledge. Post-intervention findings indicated that All variables of patients’ rights charter contributed in the test of between subjects; patients’ knowledge of their rights r2 = 77.9% (U=267, p=0.001) with an effect size of 2.6 standard deviations; the health care providers role of communication of patients’ rights r2=59.4% (U=472.5, p=0.001).Patients practice of their responsibility contributed 18.1%, (U=3753.5, p=0.379) and the effect size was 0.045 while institutional factor of mechanism of handling complaints contributed r2= 24.6% (U=472.5, p=0.001) with an effect size of 2.3 standard deviations. Health literacy had a statistically significant positive effect on responsiveness ( U=123; p ˂ 0.001) effect size 2.6.standard deviations on post-intervention findings. The null hypothesis was rejected. Conclusion: Health literacy on patient rights charter has an influence on health systems responsiveness. Recommendations for further study is for an intervention study targeting community health units to establish the influence of patients’ rights charter and health systems responsiveness in this primary health care setting.

National Hospital Insurance Funds Purchasing Mechanism and Access to Primary Care Health Services in Kenya

Wed, 01 Jan 2020 00:00:00 GMT

National Hospital Insurance Funds Purchasing Mechanism and Access to Primary Care Health Services in Kenya Mwangi, Eunice Muthoni Health care financing (HCF) is one of the six building blocks of a health system. Kenya envisions having Universal Health Coverage (UHC) by 2022. In order to achieve this Kenya has identified and settled on National Hospital Insurance Fund (NHIF) as a vehicle towards the realization of UHC. UHC is one of the country’s “Big-four” agendas. NHIF is Kenya’s sole social insurer which collects revenue, pools and purchases health services for its members. Purchasing can be passive or strategic, for health systems to be responsive and financially fair, strategic purchasing is the way to go. NHIF is currently undertaking strategic purchasing of primary care health services (PCHS) through capitation. Strategic purchasing should guarantee access to quality, equity and financial risk protection. Despite strategic purchasing, access to PCHS still remains a challenge, with patients still lacking drugs and paying for services. Strategic purchasing requires the purchaser to engage actively in three main relationships: with Government, with healthcare providers, and with the citizens. The aim of this study was to assess the effect of NHIF purchasing mechanisms on access to PCHS for its members. To meet this aim the study focused on determining how citizens’ engagement, providers’ responsibility and County government’s role affect access to NHIF s’ PCHS. This was a descriptive cross sectional study. Data was collected from Nakuru and Nyandarua counties, using semi structured questionnaires, from 395 patients, from 66 NHIF accredited health facilities, and from 115 county health management team members. Results obtained from logistics regression analysis of citizen engagement factors and access, indicate that NHIF communication to citizens (p <0.05, OR=2.4, 95% CI [1.4-4.0]), purchaser accountability (p<0.05, OR=2.07, 95% CI [1.02-4.23] and provider choice (p<0.05, OR=2.99, 95% CI [1.82-4.92) had a significant association with access. Under providers responsibility, monitoring provider performance (p<0.05, OR=31.25, 95% CI [1.58-620.05] had a significant association with access, while analysis of the County government’s role indicate that only the constant was significant while other variables such as communication by NHIF, guidelines for National scheme implementation, adequacy of capitation funds and county health facility infrastructure had no significant association with access to PCHS. In conclusion, citizen are partially engaged by NHIF as this study demonstrates that the citizens received communication from NHIF, and knew how to select a provider, however citizens ‘views and values were not accounted for in NHIF decision making. The providers were undertaking their responsibility as long as the monitoring mechanisms by the NHIF and the county government are in place, however monitoring of performance by NHIF was inadequate. The County health department role was not felt in NHIF purchasing of PCHS, thus this may hinder access of citizens to PCHS. The effectiveness of strategic purchasing of the NHIF National scheme should be based on the successful implementation and effective collaboration of all stakeholders. There is need to raise awareness of the strategic purchasing function in order to promote a shared understanding which will enrich knowledge of the roles and responsibilities of all the players including the County and National governments, NHIF, Citizens and providers, thus improving on access to health services.