Approaches Used in Managing Students’ Healthcare in Public Secondary Schools in Meru County, Kenya

Abstract

There are different approaches for managing school healthcare, but there is noticeable lack of mechanisms, systems and structures for implementing them. The study aimed to analyze the different approaches used to manage students' healthcare in public secondary schools in Meru County. The objectives were to assess school-based health clinic, NHIF, and personal medical insurance as approaches for managing students' healthcare in public secondary schools in Meru County. The last objective was to compare the effectiveness of these approaches across categories of public secondary schools to inform on appropriate healthcare management model. Both the Andersen’s model of health service utilization and theory U informed this study. A descriptive survey research design was adopted where 375 public secondary schools were targeted. Schools were stratified according to categories, and then, proportionate systematic random sampling technique was used to sample 196 public secondary schools. The principals and the chairperson of students’ council from each sampled school filled self-administered questionnaires, while an interview guide was used to collected data from the County Director of Education, who was purposively selected. Cronbach’s coefficient alpha was used to check reliability, while the content and construct validity were ensured on instruments of collecting data. Data was analyzed using SPSS version 24. Frequencies, factor analysis, means and standard deviations were computed, while regression and ANOVA were used to test the hypothesis. Qualitative data were analyzed using the thematic technique. Findings were presented using tables, charts and narratives. Results show that management of student’s healthcare was significantly impacted by the three approaches. However, when integrated, the most effective approach was the school-based health clinics followed by personal medical health insurance, and NHIF respectively. Policy on school health did not moderate the three approaches. Except for NHIF, the study noted that school-based health clinics and personal medical health insurance were uncommon, and that there were different practices of handling them across categories of public schools. For effective management of students' healthcare in public secondary schools, principals ought to take up crucial roles as accounting officers and figurehead who are charged with the duty of directing, coordinating, allocating resources, advocating, and lobbying for a quality healthcare service provision model. The study recommended the Ministry of Education to develop mechanisms for establishing school-based health clinics and institute a policy framework for adopting personal medical health insurance in public secondary schools. Concerted collaborations and partnerships of stakeholders were recommended to aid funding, infrastructural development, buying of requisite healthcare facilities, employment of qualified health professionals, and awareness of a hybrid healthcare system. Results have implications on trainigs, budgetary allocations, and policy framework.