Browsing by Author "Mapesa, Job O."
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Item Citizen Engagement in Social Health Insurance Purchasing, in Selected Counties in Kenya(International Journal of Community Medicine and Public Health, 2019-09-05) Mwangi, Eunice Muthoni; Tenambergen, Mwaura Wanja; Mapesa, Job O.; Mutai, Isaac K.Background: National hospital insurance fund (NHIF) uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study sought information on citizen knowledge of PCHS benefit package, NHIF communication to citizens, determination of citizen views and values, NHIF accountability to citizens, citizen choice of PCHS provider and how these factors influence citizen access to NHIF, PCHS. Methods: This was a cross sectional research conducted between March 2017 to March 2018. 426 patients were sampled from Nyandarua and Nakuru Counties. Results: 366 (93%) patients knew the PCHS benefit package, 226 (57%) said NHIF communication to them was adequate, 280 (71%) said NHIF does not take into account their view and values, 272 (69%) said NHIF is not accountable to them, 269 (68%) knew how to select an outpatient facility, 111 (28%) said they did not receive NHIF, PCHS. Multivariate logistics regression analysis of citizen engagement factors and access to PCHS, indicate that NHIF communication to citizens (p<0.05, OR=2.358, 95% CI [1.399-3.975]), purchaser accountability (p<0.05, OR=2.073, 95% CI [1.017-4.226]) and provider choice (p<0.05, OR=2.990, 95% CI [1.817-4.920]) added significantly to the regression model. Conclusions: There is inadequate engagement of citizens in NHIF decision making which may hinder access to NHIF PCHS, therefore NHIF should establish citizens’ needs and preference through public forums, elicit citizens’ feedback, act on complains when raised, inform citizens on how the capitation system works and NHIF should visit health facilities regularly to establish if patients are accessing PCHS.Item Effect of Socio-demographic Characteristics on Health System Responsiveness in Diabetic and Hypertensive Clinics: A Cross-sectional Study in Tier Three Hospitals in Kenya(International Journal of Professional Practice (IJPP), 2024-04-19) Kibiriti, Hillary; Tenambergen, Mwaura Wanja; Mapesa, Job O.This study aimed to investigate the effect of socio-demographic characteristics on health system responsiveness within diabetic andhypertensive clinics in tier three hospitals in Kenya. Responsiveness, which refers to meeting non-health-improving expectations, is crucial for a well-functioning health system, and gaps in responsiveness can compromise the quality of healthcare. While both client and health system factors contribute to responsiveness, the specific influence of socio-demographic characteristics on health systems responsiveness remains unexplored in Kenyan chronic care centers.The cross-sectional descriptive survey involved 308 respondents from Kimilili, Uasin Gishu, and Gatundu hospitals. Data were collected using a structured questionnaire that assessed responsiveness domains such as promptness, respect, communication, involvement, confidentiality, choice, cleanliness, social support access, and overall trust, rated on a five-point Likert scale. Socio-demographic factors investigated included facility location, gender, age, medical condition, religion, marital status, education levels, income level, occupation, and insurance enrollment. The mean responsiveness score was 98.8 (63.7%), with only 38.3% of respondents reporting favorable outcomes. Chi-square analysis revealed significant associations (p<0.05) between responsiveness and facility location, religion, marital status, occupation, and medical condition. Age, gender, insurance enrollment, education, and income level showed no significant association (p>0.05) with responsiveness. The study concluded that favorable responsiveness was less likely than unfavorable outcomes, highlighting the significance of socio-demographic factors. It recommends that healthcare managers prioritize holistic, patient-centered interactions to improve responsiveness in chronic care clinics, taking into account the influence of socio-demographic characteristics on patients' experiences and expectations.Item Effects of Health Insurance Schemes on Utilization of Healthcare Services and Financial Risk Protection: A Systematic Review(Public Health Research, 2020) Njuguna, David K.; Tenambergen, Mwaura Wanja; Mapesa, Job O.Universal health coverage (UHC) assures healthcare utilization and financial risk protection. Health insurance schemes are highly variable in the scope of the benefits package, the magnitude of premiums, deductibles, copayments, and the range of providers and health facilities participating in the networks. The variability has different effects utilization and financial risk protection. This systematic review explores the effect of various models of health insurance on utilization of healthcare services, and financial risk protection. We included 22 studies conducted in 17 countries that implement different health insurance schemes. Overall, evidence on the impact of health insurance on financial protection varied across studies reviewed. Seven studies reported a reduction in out-of-pocket expenditure, two studies had no statistically significant effect; and one study reported an increase in out-of-pocket expenditure. While 14 studies found a positive effect on healthcare utilization, six studies had no statistically significant impact on utilization of healthcare. The findings of this review show that enrollment in various insurance schemes can protect households and individuals from catastrophic out-of-pocket spending and increase healthcare utilization. The consistent evidence of the positive effects of health insurance highlights the need to explore creative and responsive insurance schemes contextualized to meet the needs of different groups and achieve UHC.Item Factors Influencing Management of Pharmaceutical Supplies at Meru Teaching and Referral Hospital, Kenya(Health Systems Management Journal, 2018-09-14) Kaluai, Julius; Tenambergen, Mwaura Wanja; Mapesa, Job O.Introduction: Availability of medicine is vital especially in the reduction of mortality and morbidity associated with disease burden. However, lack of essential medicines is one of the most serious public health problems worldwide. Government hospitals in Kenya have for long time experienced frequent shortages of pharmaceutical products. The purpose of this study was to investigate management of pharmaceutical supplies in Meru Teaching and Referral Hospital in Kenya. Specific objectives were to examine procurement process, budgeting process, legal requirements, and health workers characteristics influence on the management of pharmaceutical supplies. Methods: This was a cross-sectional research design. The population of this study comprised of management staff of Meru Teaching and Referral Hospital in Kenya, procurement, pharmacy, and nursing staff. A total of 154 respondents were included in the study. Data was collected using a structured questionnaire. Results: The results showed that budgeting process (r= .433**, P < .001), legal requirements (r=.355**, P < .001), and human resource factors (r=0.460**, P < .001) were scientifically significant and influenced the management of pharmaceuticals supplies. The study found that legal requirements contribute significantly to management of pharmaceutical supplies. The study established that, there was no significant relationship between procurement process and management of pharmaceutical supplies. Conclusions: The study recommends the following to the hospital management board (i) to involve key and competence stakeholders in budgeting, assess disease burden and type of suppliers in order to enhance management of pharmaceuticals supplies, (ii) to adherence to pharmaceutical regulations including forming a procurement committee, and (iii) train staff on inventory management.Item Health Literacy on Patients’ Rights Charter Among Users of Primary Care Health Facilities in Kiambu and Machakos Counties in Kenya(International Journal of professional Practice (IJPP), 2020-10) Njuguna, Susan; Tenambergen, Mwaura Wanja; Mapesa, Job O.Health literacy of patients’ rights and responsibilities is a challenge for users of primary health care facilities in many parts of Kenya. Low health literacy hinders the practice of patients’ responsibilities as described in the patients’ rights charter thereby negatively impacting health outcomes. Health literacy is associated with improved utilisation of health services leading to better health outcomes. The aim of this study was to establish the extent to which users of primary health care facilities in Kiambu and Machakos counties in Kenya have embraced health literacy as envisaged in the Patients’ Rights Charter. Specifically, the study sought to establish patient’s awareness of their rights; to establish the extent to which patients practice their responsibilities and rights in primary health care facilities; and to relate literacy to the demographic characteristic of the respondents. Health literacy of patients’ rights in the context of this study refers to the patients’ awareness of their rights and their ability to make basic health decisions concerning their rights as their responsibility. This was a descriptive cross-section study that used semi-structured questionnaire to collect quantitative data. A random sample of 422 patients from the outpatient department of four primary care health facilities was drawn. Every fifth patient who met the inclusion criteria and was willing to participate in the study was enlisted. Of the respondents enlisted, 389 (92%) complete questionnaires were analysed using SPSS version 25. Overall, majority of the respondents agreed that they were aware of their rights and they practised their responsibilities as per the Patients’ Rights Charter. The respondents’ awareness of their rights was statistically significant with regard to age (r = 0.293**, P ˂ 0.001), level of education (r =0.293**, P ˂ 0.001) and duration of health care services (r = 0.294**, P ˂ 0.001). Respondents’ practice of their responsibilities was statistically significantly related to age (r = .244**, P ˂ 0.001) and duration of receiving health care services (r = 0.342**, P ˂ 0.001). The study concludes that patient demographic characteristics like age, level of education, and the duration they had visited the health facility for services, had an influence on their health literacy based on Patients’ Rights Charter. This therefore draws the recommendation that health facilities should have a structured approach to health literacy of patient’s rights charter that targets demographic characteristics along the patients’ developmental stages through specific components of primary care health services.Item Health Systems Interventions for Prevention of Maternal Peripartum Infection in Low and Middle Income Countries: A Systematic Review(BMC Women's Health, 2024-04-19) Abwao, Roseline; Mapesa, Job O.; Tenambergen, Mwaura Wanja; Odada, David; Gathoni, Nasra; Riunga, FelixBackground Maternal peripartum infection is still a widespread avoidable problem in Low and Middle Income countries (LMICs) despite developments in postnatal care. Lately systems approach, encompassing all the factors in the health system, is being recognized as ameliorate option for the improvement of maternal health and prevention of maternal mortality. Objective: The aim of this systematic review was to identify and evaluate interventions to prevent maternal peripartum infection in LMICs. Methods -The Cochrane Library, CINAHL, MEDLINE (via PubMed) and Scopus,World Health Organization (WHO) ,the National Institute for Health and Care Excellence (NICE) websites were searched to identify interventional studies to prevent maternal peripartum infection using the PRISMA model. The article searching was conducted for a period of 3 months (01/08/2022 to 30/10/2022). Search terms were “Peripartum”, “Infection”, “Genital tract”, and their MESH terms. The inclusion criteria were primary studies that reported interventions for the prevention of maternal peripartum infection, studies from LMICs and those written in English language. Cochrane Risk of Bias tools were used to appraise the quality of the studies. Results – From 1662 article results,29 articles were included covering 56,151 participants. The interventions were grouped into six domains: antibiotic prophylaxis 11(37.9% of studies), self-care training 6 (20.6%), skin preparation 6 (20.6%), systems approach 2 (6.9%), Traditional Birth Attendant training (6.9 %) and use of Clean Delivery Kit 2(6.9%).12 studies reported a significantly lower risk of infection. Six studies reported a significantly improved knowledge and practice of women regarding maternal peripartum infection. Two studies reported no change in the risk of infection. Conclusion- There is limited research from LMICs on interventions to prevent maternal peripartum infection, however the studies are of good quality. The study identified six domains of interventions which were mainly inpatient settings targeting maternal peripartum infection in isolation without consideration of other system components. This provides an opportunity for achieving optimum reduction in maternal peripartum infection though systems approach. Health systems interventional studies are therefore needed to further the gains in maternal peripartum infections prevention in LMICs.Item Influence of Bystander Activation on Pre-Hospital Emergency Care Response Time: Systematic Review(Emergency Care Journal, 2024-10-12) Musyoka, Felistus Ndanu; Tenambergen, Mwaura Wanja; Mapesa, Job O.; Ndolo, Abdushakur; Agot, George; China, Joy; Koyio, Lucina; Ngunu, Carol; Mulonzi, Martin; Njeri, VeronicaThis article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emergency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emergency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analysis included forty-six relevant studies meeting the inclusion criteria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the timely provision of these services is paramount. Bystanders play a central role in activating emergency medical services (EMS) and providing cardiopulmonary resuscitation. Prompt calls to EMS by bystanders resulted in reduced PEC response times, improved survival chances, and better neurological outcomes, particularly among out-of-hospital cardiac arrest patients. There is substantial evidence that prompt bystander activation of EMS significantly reduces PEC response times, thereby saving lives and strengthening existing PEC systems. However, further research is necessary to accurately assess the impact of different interventions aimed at enhancing bystander activation of EMS and reducing PEC response times.Item Influence of Patients’ Rights Charter on Health Systems Responsiveness in Selected Counties in Kenya: Health Care Provider Perspective(International Journal of Community Medicine and Public Health, 2019-10-14) Njuguna, Susan ; Tenambergen, Mwaura Wanja; Mapesa, Job O.Background: The role of health care providers in the implementation of responsiveness of health systems is unclear. Responsiveness of health systems is one of the goals set out by WHO in 2000. Effective leadership and governance of health systems incorporates all players involved in policy implementation. The objectives of the study were to establish how the health care provider’s awareness of patients’ rights charter influence health systems responsiveness and to establish how the health care provider practice of patients’ rights charter influence responsiveness of health systems in primary care settings. Methods: This was an exploratory cross section descriptive study design that used a psychometric semi- structured questionnaire to collect qualitative data that was analyzed quantitatively. Respondents were 62 purposively sampled health care providers from four, primary care health facilities. Key informant interviews from the four health facilities in-charges were carried out. Data was analyzed using SPSS vs 25 and themes. Results: Health care provider awareness of the content of patients’ rights charter (r=0.612*, p<0.001) and practice of patient’s right charter (r=0.610*, p<0.001) were statistically significant and influenced health systems responsiveness. Conclusions: Implementation of patients’ rights charter has an influence on responsiveness of health systems. Leadership and Governance of health systems requires a structured approach to implementation of policies that positively influence responsiveness of health systems. Supervision of health care providers for best practice can provide a basis for replication in other primary care facilities and lead to achieving responsiveness of health systems.Item ModelingPredictors of Health System Responsiveness amongChronic Care Centersin Tier Three Hospitals in Kenya(InternationalJournalof ProfessionalPractice (IJPP), 2024-05-03) Kibiriti, Hillary; Tenambergen, Mwaura Wanja; Mapesa, Job O.This study sought to model predictors of health system responsiveness among diabetic and hypertensive patients in Kenyan primary hospitals. Responsiveness in the health system hinges on service provision and system demands, but there are noted deficiencies in Kenya prompting this study.Thestudy exploredhow valuations, accountability, access, structural factors, organizational culture, and perceptions of justice impact responsiveness. This cross-sectional survey provided baseline data for an intervention study. Froma sampling frame of853patients,323 were sampled using the Fishers et al. formula. Of these, 308 questionnaires were completed: 130 from Gatundu, 98 from Uasin Gishu, and 80 from Kimilili Hospitals. Data was collected through structured questionnaires using a five-point Likert Scale, after which scores were summed up and divided into favourable and unfavorable using the demarcation threshold formula.Only38.3% of respondents reported favorable responsiveness. Three predictors; accountability, structural and organizational culture had majority in the unfavorable, while valuations, access, and justice had majority in the favorable category. Following conditional backward binomial logistic regression, the final model included four significant predictors of responsiveness; namely,structural, accountability, organizational culture, and justice perceptions. Using the Nagelkerke statistic, the model explained 15.7% variation in responsiveness. The model achieved a 79.5% success rate in predicting unfavorable responsiveness and a 46.6% success rate in predicting favorable responsiveness, with an overall correct prediction rate of 66.9%. The probability of experiencing favorable responsiveness given positive experiences in the predictors was 68.5%. In conclusion, responsiveness remains low. Critical predictors identified in this study serve as intervention targets for improving responsiveness. With 15.7% explained variation in responsiveness, there's room for further model enhancement. The study recommends managers to adopt a holistic, patient-cantered care approach, and suggests implementation studies to validate the model across diverse contexts and identify additional predictive factors for responsiveness improvement.Item Role of County Health Governance in Implementation of Social Insurance National Scheme in Selected Counties in Kenya(International Journal of Professional Practice (The IJPP), 2019-11-10) Mwangi, Eunice Muthoni; Tenambergen, Mwaura Wanja; Mapesa, Job O.; Wairia, Samuel K.Health care financing (HCF) is one of the building blocks of a health system. Kenya envisions to have Universal Health Coverage (UHC) by 2022. To achieve this, the National Hospital Insurance Fund (NHIF) was identified as a vehicle towards the realization of UHC. NHIF collects revenue, pools risks, and purchases health services for its members. NHIF uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study aimed to establish the role of County Health Governance in implementation of the NHIF national scheme. Specifically, the study sought information on NHIF’s communication with the County Health Management Team (CHMT), CHMT knowledge of NHIF national scheme guidelines, suitability of county health facility Infrastructure , adequacy of NHIF capitation funds, NHIF accountability and how they all influence provision of NHIF primary care health services. This was a cross sectional research. All 120 County and Sub-County Health Management Team members were purposively sampled from Nakuru and Nyandarua Counties, a 96% (115) response rate was achieved. Results showed that, 64(56%) of respondent said NHIF was accountable to the population, 73(63%) said the county health facility infrastructure was adequate and 67(58%) said there were guidelines directing implementation of NHIF PCHS. However, 66(57%) said patients were not accessing NHIF primary care health services, 70(61%) said capitation funds were not adequate and 59(51%) said communication from NHIF to them was inadequate. Chi square results indicated that all variables, NHIF communication χ² = 5.364, p < 0.05, availability of guidelines χ² = 10.447, p < 0.05, suitability of county health facility infrastructure χ² = 13.199, p < 0.001, adequacy of NHIF capitation funds χ² = 6.956, p < 0.05 and NHIF accountability χ² = 10.982, p < 0.05 were scientifically significant and influenced implementation of the national scheme outpatient services. The study concludes that there is minimal participation of the CHMT in NHIF decision making and this hinders successful implementation of the NHIF National scheme. The study recommends that 1) NHIF improves communication with the CHMT members, so as to involve them in the implementation of NHIF national scheme, 2) NHIF 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.