Browsing by Author "Nshimirimana, Desire Aime"

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    Attitudes of Primary Health Care (PHC) Gatekeepers Towards Patient Referral Policy, Machakos County, Kenya
    (Science Journal of Public Health, 2016-06-13) Nshimirimana, Desire Aime; Tenambergen, Mwaura Wanja; Kokonya, Donald; Adoyo, Maureen Atieno
    Primary Health Care (PHC) serves as the foundation for building a working healthcare system that provide good health outcomes. The quality of PHC delivery and the decision to refer patients depends on some behavioural factors (knowledge, skills and behaviour) of primary care providers. The study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for analysis. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). About 62% of the respondents reported to know about PHC gatekeeper system and 38% don’t know about PHC gatekeeper system. The gate keepers at a majority rate 86.7% reported to have participated in workshops of which at least 40.3% participated in at least one workshop per year, means that the majority of gatekeepers don’t fill the required continuing professional development (CPD) to renew their licenses. Bad behavior, poor communication, don’t care attitude, long waiting time and no courtesy were mentioned by patients by 60% of respondents as the main contributing factors to non-compliance of patients with the national patient referral policy. Attitudes (knowledge, skills and behaviour) are crucial in primary care gatekeeper policy implementation. It has been made clear that nurses acquire enough knowledge from college to take care of patients but still need more practical knowledge and experience to increase their performance. This study recommends an innovative plan using incentive driven model and performance rewards in the implementation process.
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    Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya
    (sciencepublishing group.com, 2016-06-30) Nshimirimana, Desire Aime; Tenambergen, Mwaura Wanja; Kokonya, Donald; Adoyo, Maureen Atieno
    The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resultingin inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.
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    Patient Perceptions on Primary Health Care (PHC) Nurses and Its Impact on Services Delivery at County Level, Machakos, Kenya
    (Central African Journal of Public Health, 2019-01-24) Nshimirimana, Desire Aime; Kokonya, Donald; Tenambergen, Mwaura Wanja
    Background: Patient perceptions on services delivered by nurses are crucial when assessing the quality of health services. These are most attributable to their knowledge, competent skills and other personal characteristics. These can be described in how effective they handle clients when performing their nursing duties and their effectiveness including their ability to utilize a variety of communication skills and their attitudes at their regular work place. Methodology: This is a crosssectional and qualitative study. Four public hospitals were randomly selected; Kathiani, Mwala sub-county hospital, Kangundo sub-district and Machakos county referral hospital. A systematic sampling was used for participant selection. A maximum of 12 and a minimum of 8 patients constituted a focus group for discussion (FGD) making a sample size of eighty (80) with eight (8) groups (four male and four female groups). The FGDs were conducted using standard guidelines by the researcher helped by a trained research assistant recording the proceedings with audio equipment. Participants aged 18-65 years and emancipated children were included. Data were analyzed using Atlas. ti 7 software. Results and Conclusion: (1) knowledge and competent skills of nurses, (2) personal characteristics, (3) other nurse’s behaviors are key when to effectively perform nursing duties. Participants acknowledged that nurses have the same knowledge because they can be transferred from health centers to at hospital level. Other participants added that patients need nurses who can perform their work with confidence. Personal characteristics like positive attitude, good mood, smile and willingness to provide medical information were also discussed by participants as very important when nurses have to deliver quality health care services. Lastly, other nurse behaviors like respect, honesty, confidentiality and compassion are as well other crucial characteristics on the top of knowledge which were emphasized by participants. All discussed characteristics should link together if nurses have to deliver quality health care. Nursing schools should review their curriculum to include the characteristics mentioned and introduce mentorship programs where the emphasis should be placed on the same.