Influence of Accountability on Health System Responsiveness: A Case of Pumwani Maternity Hospital, Kenya

Abstract

Availability of quality healthcare servicesis essential to functioning of a society. While the government of Kenya is constitutionally mandated to ensure highest level of healthcare for all of its citizens, a number of hurdles remain on the way to realization of such priorities. To improve health system performance, accountability has been considered key to reducing abuse as well as assuring compliance with procedures and standards. The objective of this study was to examine the influence of accountability mechanisms on health system responsiveness in Pumwani Maternity Hospital (PMH) Nairobi in Kenya. The study was guided by the Principal-Agent theory. This was a cross-sectional study design with mixed data collection methods. The target population was health workers and patients from PMH. The study sample of 111 health workers was determined using Yamane (1967) formula, 25 middle level managers were purposively selected as key informants, and patients were included in 5 Focused Group Discussions (FGDs). Quantitative data was collected among health workers using a structured questionnaire, key informant and focused group discussion guides were used to collect qualitative data from key informants and patients. Quantitative data was analyzedusing SPSS for descriptive and inferential statistics. Thematic content analysis was used to summarize qualitative data.The multivariate linear regressions results revealed that the two variables under investigation in this study, professional accountability (β1= 0.075, P< .001) and social accountability (β2 = 0.356, P< .002) had a positive and significant influence on health system responsiveness. Results reviewed that patients did not mention any issues on social accountability.The study recommends that the PMH management should i) strengthen clinical audits in order to ensure good clinical governance in the institution, ii) develop strategies to ensure adherence of use of clinical practice guideline among all health workers, and iii) the Nairobi County government should work with community health workers and civic organizations to empower the community on social accountability issues.