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

Abstract

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.