Browsing by Author "Mwangi, Eunice Muthoni"

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    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.
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    Determinants of Efficient Health Commodity Management in Maternal Child Health: A Case of Meru County, Kenya
    (International Journal of Scientific and Research Publications, 2021-08) Mbatia, Elvis Mwandawiro; Mwangi, Eunice Muthoni; Tenambergen, Mwaura Wanja
    Emergency Obstetric and Neonatal Care (EmONC) has become a priority especially in developing countries like Kenya. However, access to obstetric and neonatal care has been hindered by lack of medical commodity, equipment’s and vaccines related to Maternal Child Health (MCH), resulting to high maternal and neonatal mortality rates. The study is anchored in the health products, vaccines and technologies pillar of a health system. The study seeks to establish the determinants of an efficient health commodity management in MCH in public health facilities in Meru County. Specific objectives were to establish the influence of i) logistic management information system, ii) medical staff competency, iii) inventory management, and iv) supply chain management practices on efficient health commodity management in maternal child health in Meru County. The study adopted a cross-sectional design with quantitative methods for data collection. The study sample was 116 health care workers from all public health facilities in Meru County. Results indicated that logistic management information system was positively and significantly associated with the efficient health commodity management in MCH (2 = 4.450, P=0.035). This implied that LMIS had a positive and significant association influence on the efficient management of health commodity in MCH services. Medical staff competency was positively and significantly associated with the efficient health commodity management of MCH (2= 7.0489, P=0.008).The study recommends the County Health Department of Meru should i) invest in health information systems for quantification, forecasting reporting and procurement of medical goods and equipment; ii) conduct continuous professional education among health workers to ensure efficient management of healthcare commodities in the health facilities. Child mortality rates which stands at 362/100,000 live births its major contributing factors lies to poorly managed commodities and health care delivery and little access to Reproductive maternal child health care services. Pastakia et al., (2018) stated that a reliable and efficient healthcare management system is dependent on having work force that has technical and administrative skills and experience and capacity to man it effectively. Workforce challenges stretch an already overworked health system and reduces the opportunities to improve interventions that are needed to develop efficient health care system including an efficient logistic management system. Desale et al., (2013) noted that, in spite of the existence of a well-designed laboratory management information system (LMIS), the quality of reports generated from Daily Activity Register and stock cards were very low. As a consequence of this there were regular stock outs of key commodities in many health facilities” A study by Bray and Awuah, (2019), showed that inventory management is important facet to commodity management, since systems of the inventory that are poorly maintained will lead to a negative impact that will severely affect the optimal delivery of service. The broad objective of the study was to explore the determinants of an efficient health commodity management in maternal child health in government health facilities in Meru County. The specific objectives were to establish the influence of i) logistic management information system, ii) medical staff competency, iii) inventory management, and iv) supply chain management practices on efficient health commodity management in maternal child health in Meru County.
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    Determinants of Uptake of National Hospital Insurance Fund Primary Care Health Services by Health Facilities in Nakuru Town, Kenya
    (Health Systems Management Journal, 2019-08-16) Wagura, Elizabeth Wanjiku; Tenambergen, Mwaura Wanja; Mwangi, Eunice Muthoni
    Introduction: There is a growing international consensus on the importance of providing social protection by governments and international bodies against extreme poverty, disease, inequality, and vulnerability that could be barriers to the achievement of the Sustainable Development Goals. Of great importance is financing of healthcare services, specifically the National Health Insurance Fund primary care. Despite the provision of accessible and adequate health services being the primary goal of financing healthcare, the uptake of the primary care services scheme among service providers is still low. This paper analysis the level of uptake of National Hospital Insurance Fund (NHIF) primary care scheme amongst service providers in Nakuru Town. Specifically: It explains the influence of knowledge of service providers about the scheme on the uptake of NHIF primary care scheme. Methods:The study adopted a cross-sectional research design targeting 120 service providers from 60 health facilities that are accredited by National Hospital Insurance Fund (NHIF) within the scope of NHIF Nakuru branch. A random sample of 96 service providers was drawn from 48 health facilities. Data was collected using a structured questionnaire and an in-depth guide. Quantitative data was analyzed using descriptive and inferential statistics with the aid of SPSS version 21.0. Results:The study findings indicated that there was a significant positive correlation between the knowledge of the service providers and uptake of the scheme. Conclusions:The study recommended need for the government and particularly the ministry of health to increase the level of knowledge and awareness among the general public about the membership and benefits of the scheme. Need for stakeholders to come up with mechanisms of addressing the various barriers affecting uptake of the scheme. A similar study be conducted in more health facilities in both rural and urban settings to relate the results of this study with all settings. Need for a study targeting the general public and other stakeholders to have a holistic understanding of the perception of all the critical stakeholders.
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    Effects of Perceived Image of NHIF Outpatient Facilities on Utilization of Primary Care Services by Private University Employees in Nairobi County
    (International Journal of professional Practice (IJPP), 2019-01) Kironji, Keziah M.; Tenambergen, Mwaura Wanja; Mwangi, Eunice Muthoni
    The NHIF is a mandatory health insurance fund covering public and private formal sector workers and their dependents as the main health insurer in Kenya. NHIF has embarked on an ambitious reform program intended to convert it to a Social Insurance Health Scheme with an aim of serving as workers’ first pillar of social insurance. The national formal scheme members are entitled to all primary health services after selecting their preferred facilities from a list of the NHIF outpatient ones. However, there are some members of National formal scheme whose contributions are remitted to NHIF by their employer every month but do not utilize primary care services. This study sought to determine the effects of perceived image of NHIF outpatient facilities on utilization of primary care services by the national formal scheme members in Nairobi with a focus on Private University employees. This study adopted a cross-sectional descriptive design with mixed methods approach. Multistage sampling with simple random sampling was used. Quantitative techniques were used for data collection. Descriptive statistics, F-Statistics, P-values, Pearson’s Rho ®, mean-scores, standard deviations, co-efficient of determination (R2) and the coefficient of multiple determinations (Adjusted R2) were analyzed using SPSS version 24. The rationale of this study was to inform top management of NHIF to undertake decisions in regards to utilization of primary health services by NHIF members by understanding effects of safety of healthcare services, waiting time at the health facilities, healthcare workers interpersonal skills and facilities amenities and physical outlook affect utilization of primary care services. The multiple regression results indicates that in a combined relationship only three factors on perceived image of NHIF facilities influence utilization of primary care services; safety of healthcare services (X1; β1 = .315, P ˂0.05), healthcare workers interpersonal skills (X3; β3 = .0.049, P ˂0.05), and healthcare facilities amenities and physical outlook (X4; β4 = .027, P ˂0.05). Waiting time is negative (X2; β2 = -.018, P ˂0.05) and thus does not influence utilization of primary care services. In a combined model, all four factors have no scientifically significant influence on utilization of primary health services by national formal scheme members in Nairobi County. The study recommends that NHIF should vet facilities they accredit to offer primary care services to ensure safety of healthcare services, train workers on effective interpersonal skills and improve facility amenities and physical outlook of NHIF outpatient facilities.
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    Factors Influencing Uptake of Health Insurance Schemes in Karatu District, Tanzania
    (International Journal of Professional Practice (IJPP), Apr 20,2022) Mhapa, William Elias; Tenambergen, Mwaura Wanja; Mwangi, Eunice Muthoni
    Strengthening health systems require a focus on six essential pillars of any health infrastructure system. This study focused on health financing pillar with an aim of promoting risk pooling. Tanzania subscribes to the global efforts of eradicating poverty. By 2016, only 20% of the Tanzanian total population were enrolled in health insurance systems. Little is known concerning the low registration of Tanzanians to health insurance systems despite the growing number of health insurance schemes over the past years. The objective of this study was to investigate factors influencing uptake of health insurance among the residents of Karatu District in Arusha, Tanzania. A cross sectional descriptive survey research design was used in this study. The study population consisted of 45,065 households from which 381 households were drawn using stratified systematic sampling. Data was collected from the heads of households using a structured questionnaire. Uptake of health insurance in Karatu District was low, with only 109 (32.7%) being enrolled into health insurance. Results show that there was a significant association between status of marriage, gender, age, education level, size of house unit, source of income, monthly income, affordable premiums of Tsh10,000 and uptake of health insurance at a p value<0.05. Results obtained from binary logistics regression analysis indicated that knowledge of benefits (p <0.05, OR=1.5, 95% CI [.417-2.37) had a significant association with uptake of health insurance. The conclusion is that a plethora of elements that motivate the decision of house units to take up health insurance schemes include; house unit size, education level, status of marriage and age, source of income, monthly income, affordable premiums of Tsh10,000. The study recommends enhanced health insurance awareness initiatives, specifically insurance benefits, registration processes, communication mechanisms, and how to access health services from health facilities who have contract with the health insurance service provider.
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    Factors Influencing Use of Linda Mama Boresha Jamii Health Insurance by Expectant Mothers In Trans Nzoia County, Kenya
    (International Journal of Professional Practice (IJPP), 2021-12-04) Nalwelisie, Michael; Mwangi, Eunice Muthoni; Tenambergen, Mwaura Wanja
    Generally, utilization of maternal and child health insurance around the globe is wanting, and African countries that lie South of the Sahara are the worst affected. Consequently, Kenyan government has established free maternity services (FMS) for all expectant mothers and children under one year. FMS insurance is offered under the brand name Linda Mama Boresha Jamii Insurance (LMBJI). However, access to maternal child health (MCH) services using LMBJI remains wanting in Trans Nzoia County. Based on population and housing census (2009), out of 45,472 estimated deliveries in 2017, only 6453(14%) utilized LBJI insurance service. The broad objective of this study was to establish factors that influence utilization of Linda Mama Boresha Jamii Insurance in Trans Nzoia County. The study adopted a cross-sectional design with mixed data collection methods. The target population was 45,472, and sample comprised 384 mothers and seven nursing services managers operating in the sampled facilities within Trans Nzoia County. Data collection tools were structured questionnaire for the 384 mothers; and a key informant tool for the seven nursing services managers. SPSS was used to analyze quantitative data, while qualitative data was analyzed thematically and presented in verbatim. The regression equation, in a combined relationship of all factors, namely; clients’ characteristics, NHIF scheme characteristics, health facility factors and health workers’ characteristics, indicated a positive effect, and were statistically significant in utilization of MCH services using LMBJI. The study recommended that Trans Nzoia County Government should ensure accessibility to rural health facilities, especially during rainy seasons, by repairing rural access roads; that it should empower women economically by providing enabling environment for them to do business; and that NHIF should adopt a mobile phone application which can allow as many expectant mothers as possible to register into LBJI without necessarily visiting preferred health facilities.
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    Healthcare Providers’ Engagement in Strategic Purchasing of Outpatient Services: A Cross-sectional Analysis of the National Health Scheme in Kenya
    (Pan-African Journal of Health and Environmental Science (AHJES), 2024-07-02) Mwangi, Eunice Muthoni; Tenambergen, Mwaura Wanja
    Background: National Health Insurance Fund (NHIF) outpatient services operate under capitation, and are strategically designed to enhance quality, equity, and affordability. However, despite this strategy, providers often demand out-of-pocket payments. This study investigates provider participation in strategic purchasing and its impact on NHIF’s outpatient service delivery. Methods: A cross-sectional analytical study was conducted among 66 healthcare managers from facilities accredited to provide NHIF outpatient services in two counties in Kenya. The data were collected using structured questionnaires. Logistic regression analysis was performed to assess the association between study variables. Results: Most respondents were male (36, 55%). The provision of NHIF outpatient services was significantly correlated with the monitoring provider performance by NHIF and the county department of health (Pmultivariate=0.024). There was a 31-fold increase in the likelihood of provision for monitored facilities. A significant difference (p=0.005**) was observed in monitoring health facilities. Monitoring was more common among private healthcare providers than public and faith-based health facilities. Conclusion: The involvement of healthcare providers in strategic purchasing has not yet been achieved. County and NHIF quality assurance departments should regularly monitor providers’ performance to ensure the delivery of equitable and high-quality healthcare.
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    Influence of Career Growth on Retention of Nurses In Public Primary Health Facilities in Lilongwe District, Malawi
    (Health Systems Management Journal, 2018-09-03) Tembo, Priscilla; Tenambergen, Mwaura Wanja; Mwangi, Eunice Muthoni
    Introduction: Retention of nurses is a very big challenge all over the world, especially in Africa. Malawi too is no exception, particularly Lilongwe District, despite the efforts of the government to provide good working condition for health workers. The broad objective of this study was to determine how career growth influences retention of nurses in public primary health facilities in Lilongwe District.The specific objectives were to establish the influence of training and promotion on the retention of nurses in public primary health facilities. Methods: A descriptive cross-sectional study design was used with quantitative and qualitative approaches to collect data. The study included 130 nurses and five principal nursing officers from five public primary health facilities in Lilongwe District in Malawi. Only the five public primary health facilities with the highest patient volume were included in the study sample. Census was used to determine the study sample. Data was collected using structured questionnaire and a key informant Interview guide. Quantitative data was analyzed using Statistical Package for Social Science software version 23. Results: The study established that training and promotion influences retention of nurses in primary public health facilities in Lilongwe District. The bivariate linear correlation analysis indicated a significant positive influence of training on nurses retention (r = .691, P < 0.001), and a significant positive influence of promotion on retention of nurses (r = .719, P < 0.001). Results from multiple regression analysis revealed a statistically significant relationship between career growth and nurses retention. Overall, promotion at work place had more influence on nurses’ retention in primary health facilities. Conclusion: The study recommends that managers in public primary health facilities enforce health quality management policy to promote training and upgrading of nurses. In addition, managers in primary public health facilities should provide career growth opportunities for nurses through on job training and promotions.
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    Influence of Routine Health Information on Decision-Making in Public District Hospitals in Kilimanjaro Region, Tanzania
    (InternationalJournalof ProfessionalPractice (IJPP), Jun 18,2024) Mdidi, Lisu; Tenambergen, Mwaura Wanja; Mwangi, Eunice Muthoni
    The study sought to assess the implication of regularly collected health information in public hospitals in Kilimanjaro region, Tanzania. The effect of information accuracy, completeness of reports, information reliability, and information timeliness on decision-making in public district hospitals was examined. Descriptive cross-sectional design was adopted for this study conducted in the Kilimanjaro region of Tanzania. A target population of 60 individuals comprising hospital administrators, procurement officers, pharmacists, doctors, and nurses from six public district hospitals was identified. The sample size was determined using convenient sampling techniques. Primary quantitative data was collected through structured survey questionnaires. Data was analysed using the Statistical Packages for Social Sciences (SPSS Version 26).The study underscores the importance of accurate and timely health information in guiding decision-making processes and improving healthcare delivery. It identifies challenges such as lack of standardized information procedures and inadequate electronic health information systems, and highlights the importance of streamlining data presentation and visualization as crucial in enhancing better comprehension among healthcare professionals, reducing delays, and improving efficiency in health information management. The study recommends implementation of standardized procedures and electronic health information systems, capacity building for health information analysis, and establishing accessible common health management information system to all hospitals. Further, the study advocates for policy suggestions, such as prioritization and adoption of standardized procedures and electronic systems, training healthcare professionals, and appointing health management information system focal persons within hospitals to facilitate information sharing and communication in bid to enhance accountability, and transparency, and ultimately improve health outcomes for the population served by public district hospitals
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    Promoting Delivery of Reproductive Health Services Through Legal Support and Capacity Development of Healthcare Providers in a Health Provider Network in Kenya
    (Journal of Obstetrics and Gynecology of East and Central Africa, 2021-09-28) Munyasia, Nelly L.; Mwangi, Eunice Muthoni; Tenambergen, Mwaura Wanja
    Background: Health provider networks (HPNs), an innovation in the private sector, is a service delivery model that has improved access to health services. However, there are no known studies or empirical evidence to support their effectiveness in Kenya. Objective: To determine the influence that legal support and provider capacity building have on providing quality reproductive health services in a healthcare provider network in Kenya. Methods: A cross-sectional study design was used. The study was carried out among Reproductive Health Network Kenya (RHNK) healthcare providers spread all over 42 counties in Kenya. The target population was 457 health care providers within RHNK and five board members. A sample of 252 health care providers was drawn using simple random sampling. A structured questionnaire was used to collect data from the 252 health care providers in the network. Quantitative data were analyzed using the IBM SPSS software, version 23, for descriptive and inferential statistics, and results were presented in tables. Results: A total of 252 respondents were included in this study; 52% (n=132) were male. Forty-six percent (n=117) of the respondents were between 41-50 years. Nurses were the majority at 73%(n=184), and 31% (n=78) of the respondents owned nursing homes. Fifty-one percent (n=127) of the respondents were diploma holders, and 28%(n=70) had 16-20 years of work experience. The bivariate analysis reported that legal support (r=.235**, p< .05) and capacity building (r= .213**, p< .05) had a positive and significant influence on the provision of quality reproductive health services in the provider network. Conclusion: Legal support and capacity building through training, mentorship, and coaching significantly impact reproductive health services quality in a provider network.
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    Relationship Between Structural Arrangement and Provision of Primary care Quality: A Case of Health Centers in Nakuru County, Kenya
    (Health Systems Management Journal, 2019-08-19) Kandagor, Amos Kipngetich; Tenambergen, Mwaura Wanja; Mwangi, Eunice Muthoni
    Background: Healthcare is a fundamental need, its availability and comprehensiveness helps in making people’s life better and productive. Delivery of quality care requires an efficient system with adequate capacity of well trained and motivated health workforce, good infrastructure, good leadership and governance and effective system for financing primary care. This study aimed at finding out the relationship between structural arrangement and provision of primary care quality in Kenya and majorly focused on the public health centers in Nakuru County. Methodology: The study used census research design. A total of 102 respondents comprising 17 Clinical Officers, 52 Nurses, 11 Laboratory Technologist,11 Pharmaceutical Technologist and 10 interns. Data was collected using closed and open ended questionnaire and analyzed using SPSS version 11. Findings: Adequate infrastructure led to an increase in provision of primary care quality in health centers (r=0.453, p<0.01), while increased employee capacity improved provision of primary care quality (r=0.365, p<0.0). Sufficient fund and effective financial management improved provision primary care quality (r=0.567, p<0.01) and effective governance improved provision of primary care quality (r=0.613, p<0.01). This implies that adequate infrastructure, sufficient funds, high employee capacity and effective governance improve provision of primary care quality. Conclusion: Provision of quality primary care requires good infrastructure, effective allocation and management of finance that will promote other functions that contribute to quality service, enhanced employee capacity and good governance through transparency and accountability. Policy Implication- Health policy addressing the plight of workers, Health resources for effective delivery of health service and Quality management.
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    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.
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    Uptake of Health Insurance Among Muslims in Nairobi county, Kenya
    (Pan African Medical Journa, 2018-02-23) Mohammed, Abdi Hassan; Tenambergen, Mwaura Wanja; Mwangi, Eunice Muthoni
    Introduction: In Kenya and the world across, health insurance has been reckoned as an important health policy that serves to protect households from the direct financial consequences of health care and meet the Sustainable Development Goal of Universal Health Coverage and Poverty Eradication. However, health insurance uptake has remained to be a major challenge for universal health care coverage especially among Kenyan Muslims who have conflicting religious faith towards conventional health insurance. This study had two main objectives: (1) to determine level of uptake of health insurance among Muslims and (2) to examine the role of religion in health insurance uptake among Muslims. Methods: The study adopted a cross-sectional study design. Post-stratified sampling was used to select 389 respondents who participated in the survey questionnaires. Descriptive statistics, cross-tabulation and Test of independence (Chi-square) were used to analyze quantitative data using SPSS Version 20. Results: Findings revealed that only 86(22%) of Muslims were enrolled in a health insurance scheme. Among the 86 Muslims who had an insurance cover, Majority were enrolled in National Health Insurance Fund (65,70.6%) while 21(29.4%) were enrolled in private health insurance schemes. Among the 303 Muslims who had no insurance cover, 285 (94.1%) preferred being enrolled in Takaful Health insurance which is Shariah Compliant. Religion played a significant role on choice and enrollment of Muslims to health insurance schemes. Religious beliefs and Shariah teachings had a statistically significant relationship with uptake of health insurance (p < 0.05). Conclusion: Uptake of health insurance among Muslims is low despite the growing population of Muslims in Kenya partly due to Muslims strong religious belief and Shariah laws, which prohibits them from enrolling into conventional insurance hence limiting freedom of individual decisions on the insurance schemes to enroll in. Despite high demand for health insurance products among Muslims, there lacks health insurances products aligned to the religious beliefs and needs of Muslim hence exposing them to hefty medical bills which deepens poverty and inaccessibility to basic health care.