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Item Aspect of Desire in Enhancing Electronic Resource Utilization among Postgraduate Students at Universities in Meru County(International Journal of Professional Practice, 2024) Shindemburi,Mercy; Gichohi, Paul; Gatimu, WinfredThe global shift to virtual libraries and e-learning has significantly increased the use of electronic resources in university libraries, particularly for postgraduate students. Customizing these services can enhance the "Desire" component of the AIDA model, promoting availability, regular updates, perceived value, and convenience. However, empirical investigations reveal that e-resources are underutilized. This paper presents some of the results of a large study that looked at how adoption of the AIDA model can enhance utilization of e-resources among postgraduate students in universities in Meru County. It assessed the desire of postgraduate students for e-resources. It employed a mixed method approach with a descriptive survey research design. The target population comprised of departmental heads and post-graduate students. Purposive sampling technique was employed to obtain librarians, while stratified random sampling and simple random sampling method was used to select students. A sample size of 260 postgraduate students and 13 departmental heads was obtained. Data was collected using questionnaires and interview guides, with quality ensured through construct, content, and face validity checks; while reliability was measured using Cronbach's alpha. Data was analyzed by computing mean, standard deviation, and correlation analysis to test relationship, while qualitative data was analyzed thematically. There was a positive correlation between postgraduate students' desire and e-resources utilization. However, in Meru County university libraries', desire is moderate. This can be enhanced by improving resource quality, staff communication, sensitization, user experiences, marketing strategies, and technological infrastructure. The study recommended university libraries to strengthen training programs, resource marketing, promoting e-resources' benefits, and integrating them into the curriculum to enhance postgraduate students desire for e-resources.Item How Public Library Information Resources Impact Maize Production in Laikipia East Sub-County, Kenya(Journal of Information and Technology, 2024) Maina, Susaide; Gichohi, Paul; Gatimu, WinfredPurpose: Kenya's economy is still based mostly on agriculture, with maize (Zea mays) being essential to rural populations' livelihoods and food security, especially in Laikipia East Sub-County. The problem was that maize farmers had a history of significant crop failure, as seen by the 12.8% drop in the total amount of maize harvested in 2023 over 2022. The goal of the current study is to ascertain how public libraries in Kenya's Laikipia East Sub County might improve maize production. The purpose of this study is to investigate how the Laikipia East Sub-County's public library information resources affect the methods used in maize growing. The research was guided by the Information-seeking Behavior Theory. Methodology: The survey method was utilized in this cross-sectional study. A population of 12,500 maize farmers from Laikipia East Sub-County was considered; where the simple random selection of 373 participants was taken as a sample for the study. A sample of 3 library staff was obtained from a population of 10 using a purposive sampling technique. Questionnaires and interview guides were used to collect the data. Mean and standard deviation were computed from data gathered through questionnaires, while, themes were identified from interview data. Results: The findings reveal that while public libraries in Laikipia East Sub-County provide resources for maize farming, many farmers view these resources as outdated or insufficient, pointing out need for updated agricultural information, better digital resources, targeted training programs, and increased awareness of available library services. Public libraries in Laikipia East Sub-County provide valuable resources for maize farming, but there's a gap between available information and farmers' needs. Conclusion: Libraries should update content, improve digital access, and tailor services to address farming challenges. The study recommends need for maize farmers to utilize digital resources from public libraries to enhance maize output and improve agricultural practicesItem Defect dependent memory switching in amorphous silicon alloys [a-Si xC1-x:H](Electronics Letters, 2002) Shannon, J.M; Gateru, Robert; Gerstner, EdIt is shown that memory switching in amorphous silicon alloys is affected by ion bombardment. In particular, ion damage lowers the voltage required to form devices and switch them into the on-state. This technique enables optimised non-volatile memory devices to be made with improved switching ratios.Item Polarity-dependent forming in ion bombarded amorphous silicon memory devices(Journal of Applied Physics, 2005) Gateru, Robert; Orwa, J.O; Shannon, J. M.Polarity-dependent forming in ion bombarded metal±semiconductor±metal (MSM) memory devices of hydrogenated amorphous silicon is reported. It is shown that prior to ion bombardment, current transport in the MSM devices is asymmetric and is controlled by the Schottky barriers at two MS junctions. Upon bombardment, however, there is a bulk component to the current and the I±V characteristics of the devices become symmetric at low bias voltages. The forming voltage in the bombarded devices shows polarity dependence. For positive bias applied on the top contact, we ®nd that devices form at the same electric ®eld independent of the thickness of the amorphous silicon while for negative voltage on the top contact, the electric ®eld needed for forming increases with the thickness. A model involving the difference in energy deposition and heat sinking for the two polarities is proposedItem Effects of Credit Card Incentives on Consumer Borrowing In Kenya: A Case of Commercial Banks in Kenya(International Journal of Academic Research in Economics and Management Sciences, 2017) Mwende, Joyce; Wachira, David Muturi; Amata, Evans OmbimaFinancial institutions have mainly relied on incentive programs as their main strategic driver to increase electronic payments, such as through use of credit cards. Credit cards have been globally acclaimed for their benefits that range from their ability to ensure tax-compliance, security, instant cash and their ability to facilitate settlement of cross-border transactions. However, there exists a great challenge of credit card usage, such as ease of accumulation of debts and high interest charges. The purpose of this study was to determine the effect of credit card incentives on consumer borrowing in Kenya. The study employed a descriptive study approach using a sample size of 18 commercial banks offering credit card services. Selfadministered questionnaires were used to collect information. Credit card incentives were found to be a major contributor to credit card uptake. The study also found that most banks used incentives such as rewards for repeated use, low interest rates, traveling awards and benefits to influence the spending behavior of their clients. The study found credit card also affected spending behavior. It is concluded that credit card incentives can be effectively used by banks to increase use of credit cards. It is recommended that financial institutions should educated their customers on how to use their credit cards so that they do not fall into a debt trap.Item Relationship Between Macro-economic Variable, Investor Herding Behavior and Stock Market Volatility in Kenya(International Journal of Economics, Commerce and Management, 2016) Amata, Evans Ombima; Muturi, Willy; Mbewa, MartinThis study sought to examine the relationship between interest rate, inflation, gross domestic product (GDP), foreign exchange, investor herding behaviour and stock market volatility. Published time series data from January 2001 to December 2014 was obtained from the Central Bank of Kenya, Kenya National Bureau of Statistics, Capital Market Authority and the Nairobi Securities Exchange. Granger causality test was used to determine the short run causality while the Vector Error Correction Model (VECM) was used to test the long run causality between predictor variables and stock market volatility. Result from the regression model show a positive and significant relationship between inflation and stock market volatility both in the short run and long run. The study finds that an increase in inflation by 1% leads to an increase in stock market volatility by approximately 24%. Results also revealed that there is a negative and significant relationship between interest rate and stock market volatility both in the short run and long run. GDP, Foreign exchange and herding behaviour had no significant relationship with stock market volatility in KenyaItem The impact of corporate diversification on firm value in Kenya(African Journal of Business Mangement, 2017) Manyuru, Anthony; Wachira, David Muturi; Amata, Evans OmbimaThis study investigates the impact of corporate diversification on the value of firms listed at the Nairobi Securities Exchange (NSE). Panel regression techniques were used as the estimation methods. The overall findings of the study where somewhat mixed. The study finds that industrial diversification reduces firm value, but geographical diversification does not have a significant impact on firm value. When examining each industry individually, the study established that industrial diversification enhanced firm value in the agricultural industry but did not significantly influence firm value in the other industries.Item Assessing How the Packaging of Immunization Services Influence Uptake of the Immunization Services in Selected Health Facilities of Kajiado North Sub-County Kenya(International Journal of Scientific Research in Science, Engineering and Technology (IJSRSET), 2016-06-26) Toweett John Kipngetich; Wanja Mwaura Tenambergen; Maureen Atieno AdoyoBackground: Immunization as a preventive measure to diseases is vital to organizational performance. Among the six pillars of the health system, this research focused on service delivery. A desk review indicated that there was low immunization coverage in the County. The objectives of the study was to determine how the cultural values, packaging of immunization and health promotion supports the uptake of immunization services Methods: A cross-sectional study utilizing a guided questionnaire, targeting 280 mothers and an interview guide targeting 9 health workers were used. Data analysis was done using SPSS version 21 using descriptive statistics. Qualitative analysis was done by thematic content analysis and framework analysis. Results: Majority of the respondents (mothers) were young with a mean age of 26 years. 233 (83%) agreed that immunization program is well explained to them when they visit health facilities. More than half 183(65.4%) of mothers got the information about immunization through continuous health education routinely offered in health facilities, whereas a significantly low 39 (13.9%) mothers got the immunization information through community health promotion. The correlation of health education with awareness indicated a (P-value = 0.406**) A p-value of 0.209** indicates that frequent visits to the health facilities did not influence the awareness of mothers on the immunization services offered in health facilities. Conclusion: The researcher concluded that there is a relationship between immunization uptake and immunization health promotion activities and recommended that the County Government of Kajiado should introduce outreach services and intensify health promotion activitiesItem Influence of Maternal Health Education Delivered Through Community Health Referral Project on Antenatal Care Attendance: A Focus on Mirihini and Midoina Communities of Kilifi County, Kenya(International Journal of Scientific and Research Publications, 2016-05) Janet Mukoshi Shibonje; Wanja Mwaura Tenambergen; Susan NjugunaTimely delivery of effective, safe, quality and personal services is a key pillar of health system strengthening. A Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project’s goal was to strengthen health systems at the facility and community levels, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. The objectives of the study were 1) to determine whether providing maternal health education to pregnant women had any influence on ANC attendance in the intervention and control communities and 2) to determine whether issuing referral advice forms to patients has any influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in Mirihini, the intervention community in Bamba and Midoina the control community. Primary data were sourced from 246 mothers of children aged below 2 years, parents of children aged 2 to 4 years, as well as Community Health Volunteers (CHVs). Quantitative analysis yielded descriptive statistics and cross-tabulations with Chi-square (χ2 ) tests. Qualitative data were transcribed, described and analyzed systematically to reveal themes and patterns. Maternal health education: In Mirihini, there was no significant association between providing maternal health education on the ideal number of ANC visits and women’s achievement of optimal ANC attendance (χ2 = 1.423, df=1 & a ρ-value = 0.233). In Midoina, a significant relationship between the two aspects was obtained (χ2 = 3.109, df = 1 & ρ-value = 0.078. Referral documentation: In Mirihini, issuing referral documents to pregnant women was significantly associated with women’s achievement of optimal ANC attendance (χ2 = 8.308, df =1 & ρ-value = 0.004). In Midoina, there was no significant association between two aspects (χ2 = 0.823, df = 1 & ρ-value = 0.185). The study recommends the need for: CHVs to deliver more information to support care-seeking behavior change; project officers to strengthen supervisory support to CHVs by engaging with MoH to provide reporting materials and ensure consistency of monthly review meetings.Item The Design Criteria in Implementation of a Health Management Information System: A Case of Kenyatta National Hospital(International Journal of Sciences: Basic and Applied Research (IJSBAR), 2016) Salim Matagi Omambiaa; G.W. Odhiambo-Otieno; Wanja Mwaura Tenambergen; Maureen AdoyoEmbracing modern technology is one among very many ways of improving efficiency and reducing costs within healthcare organizations. While the integration of information and health services potential benefits cannot be disputed, there are many challenges which affect its adoption, in fact, majority of organizations have abandoned their newly acquired systems only to go back to their old manual systems. The objective of this study was to determine the design phase of the implemented Health Management Information System at Kenyatta National Hospital. This study was a cross-sectional descriptive study, the targeted population of the study were 35 healthcare workers who were involved in the designing of the Health Management Information System at Kenyatta National Hospital, and the sample technique used was snowball sampling. The study utilized an in-depth interview schedule for 33 respondents in the design phase who were selected using snow-ball, the data collected from the field was analyzed through the use of univariete and bivariete statistics. Data presentation was in form of descriptive statistics such as frequency distribution, percentages, pie charts, bar graphs and tables. The data from the design phase were summarized in three main evaluation areas targeting the perception of the HMIS, purposes and processes From the findings, in the design stage although the respondents did not show systematic ordering there was evidence to the effect that the steps were followed during the design phase. From the findings majority of the key informants were able to define HMIS and distinguish the key features of the HMIS. Out of the 33 participants, 13 (33.4%) reported that they knew the persons who originated the idea of the electronic HMIS in KNH, a similar number were involved in the conceptualization of the system, while 4 (12.2%) indicated that they were involved in designing the HMIS and 18 (54.6%) were involved in implementation. Despite the general lack of knowledge on HMIS policy the informants demonstrated adequate understanding of the objectives of the electronic HMIS in KNH. Based on the responses obtained during interviews there were multiple problems related to the manual system that existed in KNH during the pre-implementation stage and these issues served as the basis for objective setting for the current HMIS in the hospital. Most key informants felt that the hypothesized benefits of the current HMIS were being realized including improved efficiency while four key informants felt that the benefits had been partially realized. An evaluation of the manual HMIS was done during which deficiencies of the HMIS were identified through consultations involving HMIS users and stakeholder. A HMIS needs assessment was conducted and formed the basis of the electronic system requirements with specific proposals for improvement of the deficiencies identified in the manual HMIS. An evaluation of the manual HMIS was done during which deficiencies of the HMIS were identified through consultations involving HMIS users and stakeholder. During the interviews the participants were able to highlight various aspects of the IS development cycle and there was evidence to the effect that the steps were followed during the design phase plus an evaluation of the manual system was done during which deficiencies of the system were identified through consultations involving HMIS users and stakeholders. Based on the results and discussions, among the main problems that key informants described during the design phase was major inefficiencies characterized by evident mismatching of resources input and output which spanned several areas including time, human resources and finances however, participants were able to highlight various aspects of the IS development cycle and there was evidence to the effect that the steps were followed during the design phase, planning plus an evaluation of the manual system was done during which deficiencies of the system were identified through consultations involving HMIS users and stakeholders. As a recommendation we can say that NH and the MOH needs to come up with an established standardized policy for implementing interventions.Item Factors Influencing Collecting of Blood Donor Test Results in Nairobi County – A Case Study of Nairobi Regional Blood Transfusion Centre(Journal of Health, Medicine and Nursing, 2018) George Gititu; Musa Oluoch; Wanja Mwaura TenambergenBackground: The Kenya National Blood Transfusion Services screens all donated blood for HIV, Hepatitis B&C and syphilis with each blood donor being informed of testing of his or her donated blood and availability of test results for collection at the Regional Blood Transfusion Centers. The study-assessed factors influencing collection of blood test results by blood donors as only less than 10% blood donor’s return to collect their test results. Method: The study utilized descriptive cross-sectional study approach employing a mix of both quantitative and qualitative approach. 385 blood donors and seven key informants interviewed using a pre-designed questionnaire and Key informant respectively. Quantitative data was analyzed using Epi info 6.04 while qualitative data was transcribed and analyzed using content thematic framework approach. Results: 95% of participants did not return to collect their test results with 90% not being aware that test results are available for collection. 50% of those who had not collected their test results would not have collected even after being adequately informed. 93% would not collect their test results in presence of friends fearing stigmatization and would not share the outcome of the test even with their families. Conclusion: The study concluded that the collection of donor test results is greatly influenced by knowledge, location of result collection sites, working hours of collection sites, stigma and cultural beliefs. The Study recommends mass sensitization on availability of test results, where to collect results and demystify social cultural beliefs.Item Motivational Factors That Influence Retention of Nursing Faculty in Kiambu Nurse Training Institutions(Journal of Health, Medicine and Nursing, 2018) Wanja Nyambura Susan; Wanja Mwaura Tenambergen; Musa OluochPurpose: The main purpose of this study was to establish the motivational factors that influence retention of nursing faculty in Kiambu County. Methodology: The study design was descriptive cross-sectional. The study population comprised nursing faculty currently working in Nursing Council of Kenya registered Institutions in Kiambu County. The total population of full time nurse educators in the 7 NCK registered schools in Kiambu County was approximately 50. Census sampling method was used where the entire nursing faculty in Kiambu County. The study used questionnaires to collect the required data. Descriptive statistics was used mainly to summarize the data. SPSS was used for analysing complex data. Data presentation was through the use of pie charts, and frequency tables. Results: The study findings revealed that there was a significant relationship between the effect of career development opportunity and the period of time the faculty had worked in the current organization. Availability of human resources was cited by 50% of the respondents as the work environment factor requiring improvement. Majority (66.7%) of the respondents said management of their respective institutions was not responsive to the faculty’s needs. There was no significant relationship (P=0.081) between the academic status of the respondent and the effect of institutional management factors on motivation. Policy recommendation: The study recommended that a research exploring the intrinsic factors that motivate faculty in Kiambu County Nursing Institutions needs to be carried out and the institutional management of Kiambu County nursing programs should institute a system of continually finding what the faculty needs are and responding to these needs.Item Improving Health Systems: Influence of Technical Capacities of Community Health Volunteers on Use of Community Health Information Systems in Kenya(International Journal of Computer Applications, 2018-07) Susan Njoki Mambo; George W. Odhiambo-Otieno; George Ochieng’-Otieno; Wanja Mwaura-TenermbergenWHO identified six key pillars of an effective health system namely: leadership and governance; service delivery; health workforce; health information systems; medical products, vaccines and technologies and healthcare financing. This study focused on Community-based Health Management Information System (CbHMIS) of health information pillar. A Community-based Health Management Information System (CbHMIS) is a type of health information system based in the rural community and informal settlements of urban areas. CbHMIS’s main objective among others is to produce relevant and quality information to support decision making on public health issues at the community level. The importance of effective information use is still a key impediment to achievement of goals at level one of health care delivery. According to a situation analysis on the state of Community Health Services in year 2014, the functionality of CbHMIS was said to be at 64% which came down considerably to 55% in year 2015 documented by USAID, and that access to quality data was not guaranteed through the current CbHMIS.Lack of technical capacities among the CHVs is a serious gap in achievement of information use in Kenya.This study aimed at establishing the factors influencing technical capacities of community health volunteers on use of CbHMIS in Kenya.Other objectives of this study were: To establish the influence of System Availability on CbHMIS use; to find out effects of availability of skills to CHVs on CbHMIS use, To assess the influence of personnel knowledge on CbHMIS use, To identify competencies of CHVs that influence CbHMIS use. The selected counties were Kiambu, Kajiado and Nairobi which gave a rural, urban and peri-urban representation respectively of the country. This was a crosssectional analytical study design, with both quantitative and qualitative data collection methods. The target population was 156 active Community Units (CUs) from the 3 counties where a total sample of 122CUs (50 in Kiambu; 26 from Kajiado and 46 from Nairobi CUs) was derived using Mugenda and Mugenda formula of populations less than 10,000. Multistage sampling was used to identify the CUs; Systematic random sampling was used to identify total of 366 respondents 3Community Health Volunteers (CHVs) were purposively sampled form each CU to make a total of 366 (150 in Kiambu; 78 from Kajiado and 138 from Nairobi. A total of 6 KIIs (two from each county) and 3 FGDs (one from each county) were conducted for qualitative data. Interviewer administered questionnaires were used to collect quantitative data, observation checklist was also used. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level. Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. Use of Cb-HMIS stood at 56.6%. Slightly above half 51% of respondents agreed to having technical skills on CbHMIS, However a KII noted that “….We have challenges in training all our CHVs and refresher trainings due to funding so you will find some have been partially trained….”.There was statistical significant differences between group means (F(2,363) = 32.47,p = .000). (X1) explains 28.6% of the total variations in the use of CbHMIS (R 2 =.286). This implies that the use of CBHMIS by Community Units (CU) improves significantly when the CU personnel have better technical capacities. URIItem Factors Influencing Management of Pharmaceutical Supplies at Meru Teaching and Referral Hospital, Kenya(Health Systems Management Journal, 2018-09-14) Julius Kaluai; Wanja Mwaura-Tenambergen; Job MapesaIntroduction: 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 The Influence of Healthcare Providers’ Attitude on Patients Satisfaction with Healthcare Services at Tier Three Hospitals of Mombasa County(Health Systems Management Journal, 2018-06-15) Maryan Duale Barrow; Wanja Mwaura-Tenambergen; Lillian Wambui KaburiIntroduction: Patient satisfaction with health care services is considered an important factor of quality health care. The provision of quality health care delivery especially in Kenya has often been attributed to inadequate knowledge and skills compounded by broader system failures and low staff numbers. The Mombasa County Referral Hospital has been rated below average on most of the service delivery attributes. The study assessed the influence of healthcare providers attitude on patient satisfaction with healthcare services received in Tier Three Hospitals in Mombasa County. Methods: This was a cross-sectional study design. Quantitative data was collected among 360 clients in the outpatient departments of three Tier Hospitals in Mombasa County. The sample population was determined using the Fishers formula and the sample was proportionally distributed. Face-to-face questionnaires were administered to the respondents and data was analyzed using SPSS version 23. Results: The study established that less than half 46.1% of the patients are generally satisfied with the healthcare service received in the Tier three hospitals in Mombasa County. Majority (70.8%) of respondents were satisfied with the way health providers explained and listened to them. Less than half (43.0%) of the respondents rated the level of healthcare providers’ attitude in the hospitals to be average, (57%) of the respondents said healthcare providers’ attitude affects the level of patient satisfaction with healthcare services to a large extent. Care and concern shown by healthcare providers affects the patients’ level of satisfaction and healthcare providers’ attitude towards the patients to great extents. The multiple regressions results indicate that all factors influencing patient satisfaction with health care services under investigation in this study that is healthcare workers technical skills (X1: β1 = .546, P < .001), care and concern of staff (X2: β2 = .442, P < .003) and dedication/commitment of staff (X3: β3 = .291, P < .009) are significant and positively influences patient satisfaction with healthcare services received in Tier Three Hospitals in Mombasa County. The constant (β0) is also positive and significant (β0 = .399, P < .001). Hence, this study found statistical and significant evidence that healthcare workers technical skills, care and concern and dedication and commitment factors, in a combined relationship, positively and significantly influence patient satisfaction with healthcare services received in Tier Three Hospital in Mombasa County. Recommendations: The hospital management should organize in-house staff training on positive customer care to change staff negative attitude in service delivery.Item 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) Amos Kipngetich Kandagor; Wan ja Mwaura Tenambergen; Eunice Muthoni MwangiBackground: 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.Item 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) Desire Aime Nshimirimana; Donald Kokonya; Wanja Mwaura-TenambergenBackground: 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.Item Patient Satisfaction with Emergency Care Services Accessed at Selected Health Facilities in Nairobi City County: Patients’ Perspective(Journal of Health, Medicine and Nursing, 2019) Osiyel Daniel Edwin; Wanja Mwaura-Tenambergen; Lillian MuiruriPurpose: The main aim of the study was to study the factors influencing patient satisfaction with emergency care services accessed at selected health facilities in Nairobi City County. Methodology: In this study, descriptive research design was adapted. The target population of the study included patients seeking emergency healthcare from five public health facilities in in Nairobi County. Stratified proportion and simple random sampling technique were used to select 304 respondents among patients in emergency department. Data collection tool was used to obtain quantitative data. Nairobi City County referral facilities were purposely selected because of the high number of patient throughput. Systematic sampling was done to identify the respondents. Descriptive cross-sectional study design was used where quantitative approach was used for data collection. Findings: The results showed that there is a positive and significant influence of the physician service factors on access and patient’s perspective to emergency healthcare services in public hospitals in Nairobi County (r = .596**, P = .001). On waiting time factor, findings show that there is a positive and significant influence access and patients’ perspective to emergency healthcare services in public hospitals in Nairobi County (r=.407**, P = 0.001) on quality of care, findings show that there is a positive and significant influence access and patients’ perspective to emergency healthcare services in public hospitals in Nairobi County (r=.255**, P = 0.001). Lastly, results showed that there is a positive and significant influence of the health facility type factor on access to emergency healthcare services in public hospitals in Nairobi County (r = .257**, P = .001). This implies that the four factors are important and significant determinants of access and use of emergency healthcare services in public hospitals in Nairobi County. Unique contribution to theory, policy and practice: The researcher brings in a wealth of new knowledge to the field of emergency healthcare, where the health sector can adopt a strong pillar of health service delivery by introducing a physician specialty course on emergency healthcare and medicine, further, proper mechanisms can be put to reduce waiting times before a patient seeking emergency healthcare is attended to. This would rely on the quality of care the patient receives when in need.Item Factors Influencing Reimbursement of Hospital Financial Claims by Private Health Insurance Companies in Kenya(Health Systems Management Journal, 2019-07-20) Richard Wachira Magondu; Wanja Tenambergen; Fredrick NdedeIntroduction: Despite the positive aspect of private health insurances, a number of challenges related to claims reimbursement for services offered to the insured have been raised. According to lean Six Sigma Improvement Project conducted in 2014 in a private hospital in Nairobi, Kenya, the top seven medical insurance companies that contributed to 40% of the corporate insurance business rejected over 4% of their total claims amounting to Kenya Shillings 214million over three years between 2011 and 2013. Even when claims are not disputed, the hospital usually experience delays in reimbursement sometimes up to 45 debtor days which is above the 30 days period stated on the contractual agreement. The broad objective of this study was to find out factors influencing payment of hospital claims by private insurance companies at a tertiary private hospital in Nairobi, Kenya. Specifically, this study sort to determine how hospital related factors, private health insurance related factors and insured related factors influence reimbursement of hospital claims by the private insurance firms. Methods: This was a cross-sectional research design using a semi-structured questionnaire to collect data. Data was collected from 94 staff members who were initially stratified by job category and thereafter randomly selected within each strata. Results: Hospital related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.548, P < .001); (β1 = .269, P < .001). Insurance related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.385, P < .001); (β2 = .226, P < .001). Insured related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.273, P = .008); (β3 = .245, P < .001). The value β0 was also significant meaning that even without the three variables of interest in this study a certain minimum reimbursement will always exist. Conclusion: A continuous feedback to the employees on factors that hinder timely and full reimbursement and regular training of the employees on adherence to insurance protocol and guidelines will improve reimbursement rates. This will be further enhanced by Tailor-making the billing system to meet end users’ needs and having strategies on effective dissemination of information to the health providers and the insured clients, automation of claim processes, Continuous policy education to the insured and Stakeholders relationship to be enhanced.Item Influence of Expanded Free Maternal Care Programme on Delivery of Quality Health Care i n Maternity Units in Kajiado County(Health Systems Management Journal, 2019-07-20) Richard Wachira Magondu; Wanja Tenambergen; Fredrick NdedeIntroduction: A well-functioning health system works in harmony among the building blocks: trained and motivated health workers, functional infrastructure, consistent supply of essential medicines and technologies, health information management, and sufficient funding. Africa is uniquely affected by maternal health challenges with a maternal mortality estimated at 686/100,000 live births. Kenya has high maternal mortality estimated at 360/100,000 live births. These deaths are avoidable with proper medical intervention. This study sought to assess quality of service delivery in maternity units of health facilities currently implementing expanded free maternal care programme in Kajiado County. It was guided by one general and four specific objectives: To establish how essential drugs, medical equipment, health workers and basic amenities influence quality of service delivery in maternity units of health facilities currently implementing expanded free maternal care programme in Kajiado County. Methods:The study adopted descriptive cross sectional design of survey, with midwives, clinical officers and medical officers being the target population. Since the target population was small a census was carried out. 44 self-administered questionnaires were used; the questionnaires were pre-tested for reliability using Cronbach’s-Alpha. Descriptive and inferential statistics were used to provide population details and make inferences based on data collected. Results:68% of the health facilities surveyed were dispensaries (Level 2), 23% were Health centres (Level 3), 7% were Sub County referral hospitals (Level 4) while 2% were County referral hospital (level 5). Oxytocin injectable was partly out of stock in 64% of health facilities while Magnesium sulphate was always available in only 5% 58% of assessed health facilities had a sterile delivery set. Only 18% of respondents agreed that their facilities had adequate skill mix of health workers. None of the independent variable had coefficient > 0.05 hence no problem of multi-collinearity, the probability value, p was <0.05 indicating the model used was entirely significant. Conclusion:Results show independent variables individually and combined significantly influenced provision of quality of health care in maternity units in Kajiado County Kenya