Effects of Accessibility on Health Service Delivery in Public Hospitals in Kilifi County, Kenya
DOI:
https://doi.org/10.53819/81018102t3078Abstract
Achieving UHC has remained a severe challenge globally, with countries experiencing severe gaps in the healthcare delivery system. Therefore, this research intends to bridge the gap by investigating UHC's effects on healthcare services in Kilifi County. The study aims to establish how accessibility affects health service delivery in public hospitals in Kilifi County. Institutional and new public management theories guided the study. The study adopted a descriptive research design and targeted a total of 2875 participants comprising both healthcare workers and patients attending the healthcare facilities and senior healthcare management team. The researcher adopted stratified random and convenience sampling to select 288 subjects for the study. A pilot study was undertaken to establish the validity and reliability of data collection instruments. The data were collected using a structured questionnaire for quantitative data and an interview guide for qualitative data, and the results were presented using percentages and frequency tables. Descriptive statistics and a regression model were used to analyze quantitative data, while qualitative data utilized thematic analysis. The results from the study showed that there was a significant association between accessibility factors for the patients where availability of services was associated with increased service delivery OR =1.25,95% CI=0.90-1.74, p=0.190) while staying further away from the facility is associated with decreased service delivery (OR) =0.76,95% CI=0.34-1.67, p=0.49). Similarly, easy accessibility was associated with improved service delivery on healthcare workers' factors OR =1.09,95% CI=0.21-5.68, p=0.9180). Thematic analysis revealed similar findings where increased accessibility was associated with increased service delivery. The results of the study were used to make recommendations for improving accessibility through integrating healthcare services within different departments and healthcare facilities using ICT. Finally, the study recommends further research on how technology in healthcare will increase accessibility.
Keywords: Universal Health Coverage, Accessibility, Affordability, Quality, Service Delivery
References
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Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gulmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014; 11:7.
Brinkerhoff, D. & Brinkerhoff, J. (2011) ‘Public-Private Partnerships; Perspectives on Purposes, Publicness and Good Governance’, Public Administration and Development 31: 2–14.
Camacho FAR. (2006) The relationship between the patient’s perceived waiting time and office-based practice satisfaction. N C Med J. 2006; 67:409–13.
Carillo, J. E., Carillo, V. A., Perez, H. R., Salas-Lopez, D., Natale-Pereira, A. & Byron, A. T. (2011). “Defining and targeting health care access barriers”. Journal of Health Care Poor Underserved, 22 (2), 562-575.
Carrillo JE (2005) An analytic framework defining barriers to health care access: healthcare access
D’Ambruoso, L. (2013). Global health post-2015: the case for universal health equity. Global Health Action, 6:19661.
Dalinjong, P.A., Welaga, P., Akazili, J., Kwarteng, A., Bangha, M., & Oduro, A. (2017). The associated between health insurance status and utilization of health services in Northern Ghana; evidence from the introduction of the National Health Insurance Scheme. J Health Population Nutr, 2(14), 123-127.
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Geleto A, Chojenta C, Musa A, Loxton D. Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature. Syst Rev. 2018; 7:183.
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Global health 2035: a world converging within a generation. Lancet, 382:1898–955.
Guagliardo, M. F. (2004). Spatial accessibility of primary care: concepts, methods and challenges. International journal of health geographics, 3(1), 1-13.
Hammonds, R., & Ooms, G. (2014). The emergence of a global right to health norm - the unresolved case of universal access to quality emergency obstetric care. BMC Int Health Hum Rights, 14:4.
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Jamison, D.T., Summers, L.H., Alleyne, G., Arrow, K.J., Berkley, S. & Binagwaho A. (2013).
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Kothari, C. R. (2004). Research methodology: Methods and techniques. New Age International.
Kutzin, J. (2013). Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ, 91;602–11.
Lim JN, Ojo AA. Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review. Eur J Cancer Care (Engl). 2017;26: e12444.
Mbangua, R. K., Kawila, C., & Mwangi, M. (2021). Factors Influencing Delivery of Quality Health Care in Kasarani Sub County. Journal of Medicine, Nursing & Public Health, 4(2), 46-64. Retrieved from: https://stratfordjournals.org/journals/index.php/Journal-of-Medicine-Nursing-P/article/view/868.
Meyer, J. W., & Rowan, B. (1977). Institutionalized organizations: Formal structure as myth and ceremony. American Journal of Sociology, 83(2), 340–363.).
Mills, A., Ally, M., Goudge, J., Gyapong, J., & Mtei, G. (2012). Progress towards universal coverage: the health systems of Ghana, South Africa, and Tanzania. Health Policy Plan, 27 suppl 1: i4–12.
Ministry of Health of Kenya, (2020), Refocusing on quality of care and increasing demand for services; Essential elements in attaining universal health coverage in Kenya.
Ministry of Health, (2014), Kenya Health Policy 2014-2030. Nairobi, Kenya.
Ministry of Health, (2016), Statistical review of progress towards the mid-term targets of the Kenya Health Sector Strategic Plan 2014–2018. http://www.who.int/healthinfo/ country_ monitoring evaluation/KHSSP_StatisticalReport_2016
Ministry of Health, (2017), Kenya: Kenya health policy 2014–2030. Accessed 1 Feb 2017.
Ministry of Health, (2018), “President Uhuru Launches Universal Health Coverage Pilot: Nairobi, Kenya.
Ministry of Health, (2018), Kenya harmonised health facility assessment: Nairobi, Kenya.
Ministry of Health, (2018b), “Roadmap towards Universal Health Coverage in Kenya 2018-2022.” Nairobi, Kenya.
Mohammed, A., Agwu, P., & Okoye, U. (2018). When primary healthcare facilities are available, but mothers look the other way. Social Work in Public Health, 35(1-2), 11-20.
Moreno-Serra, R., & Smith, P.C. (2012). Does progress towards universal health coverage improve population health? Lancet, 380:917–23.
Mugenda, O.M. and Mugenda, A.G. (2003) Research Methods, Quantitative and Qualitative Approaches. ACT, Nairobi
Muthui, R. (2018). Factors influencing the provision of quality services in health care facilities: A case of Kitui county referral hospital [Unpublished Master’s Thesis] University of Nairobi.
Mwaliko, E., Downing, R., O’Meara, W. et al. “Not too far to walk”: the influence of distance on place of delivery in a western Kenya health demographic surveillance system. BMC Health Serv Res 14, 212 (2014). https://doi.org/10.1186/1472-6963-14-212
Mwangi, D. (2018). President Uhuru Launches Universal Health Coverage Programme Kenyans.co.ke, 14 December 2018. Retrieved from: https://www.kenyans.co.ke/news/45270-residents-dangerously-siphon-fuel-after-tanker-overturns-video [accessed 05.11.2021]
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Noor, A. M., Amin, A. A., Gething, P. W., Atkinson, P. M., Hay, S. I., & Snow, R. W. (2006). Modelling distances travelled to government health services in Kenya. Tropical Medicine and International Health, 11, 188–196.
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Rifkin, S.B. (2018). Health for all and primary health care, 1978-2018: a historical perspective on policies and programs over 40 years. Available from: http://publichealth.oxfordre.com/view/10.1093/
Sanogo, N. A., Fantaye, A. W., & Yaya, S. (2019). Universal Health Coverage and Facilitation of Equitable Access to Care in Africa. Frontiers in public health, 7, 102. https://doi.org/10.3389/fpubh.2019.00102
Augustina, R. et al. (2019). Universal health coverage in Indonesia: concept, progress.
Scott, W. (2013). Institutions and Organizations: Ideas, Interests, Identities. Sage, Thousand Oaks
Simfukwe, K., Adebisi, Y., Oladunni, A., Mohammed Eltahir S.E, Don Eliseo & Lucero-Prisno III DE (2021). The role of health service delivery networks in Achieving universal health coverage in Africa (review article), SEEJPH 2021
Sun, J., Lin, Q., Zhao, P., Zhang, Q., Xu, K., Chen, H., Hu, C. J., Stuntz, M., Li, H., & Liu, Y. (2017). Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study. BMC Public Health, 17(1), 1-11.
The Government of Kenya (2010), The Constitution, Government Printers, Nairobi.
Wang, F. (2012). Measurement, optimization, and impact of health care accessibility: A methodological review. Annals of the American Association of Geographers, 102, 1104–1112.
Wanga, W., Temsah, G., & Mallick, L. (2017). The impact of health insurance on mater nal health care utilization: Evidence from Ghana, Indonesia and Rwanda. Health Policy and Planning, 32(3), 366–375.
Wanjiru, J. (2014). Challenges of provision of universal healthcare by the National hospital insurance firm. Unpublished thesis available at http://hdl.handle.net/11295/77862. Accessed on January 10, 2022.
World Health Organization (2019). Declaration of Alma Ata. Geneva: World Health Organization. Available: https://www.who.int/publications/almaata_declaration_en.pdf [Accessed: 16 January 2022]
World Health Organization. (2020), Health Systems: Universal Health Coverage.
Biya, M., Gezahagn, M., Birhanu, B. et al. (2022). Waiting time and its associated factors in patients presenting to outpatient departments at Public Hospitals of Jimma Zone, Southwest Ethiopia. BMC Health Serv Res 22, 107 (2022). https://doi.org/10.1186/s12913-022-07502-8.
Bloom, D. E., Khoury, A., & Subbaraman, R. (2018). The promise and peril of universal health care. Science (New York, N.Y.), 361(6404), eaat9644. https://doi.org/10.1126/science.aat9644.
Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gulmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014; 11:7.
Brinkerhoff, D. & Brinkerhoff, J. (2011) ‘Public-Private Partnerships; Perspectives on Purposes, Publicness and Good Governance’, Public Administration and Development 31: 2–14.
Camacho FAR. (2006) The relationship between the patient’s perceived waiting time and office-based practice satisfaction. N C Med J. 2006; 67:409–13.
Carillo, J. E., Carillo, V. A., Perez, H. R., Salas-Lopez, D., Natale-Pereira, A. & Byron, A. T. (2011). “Defining and targeting health care access barriers”. Journal of Health Care Poor Underserved, 22 (2), 562-575.
Carrillo JE (2005) An analytic framework defining barriers to health care access: healthcare access
D’Ambruoso, L. (2013). Global health post-2015: the case for universal health equity. Global Health Action, 6:19661.
Dalinjong, P.A., Welaga, P., Akazili, J., Kwarteng, A., Bangha, M., & Oduro, A. (2017). The associated between health insurance status and utilization of health services in Northern Ghana; evidence from the introduction of the National Health Insurance Scheme. J Health Population Nutr, 2(14), 123-127.
Evans, D.B., Marten, R., & Etienne, C. (2012). Universal health coverage is a development issue. Lancet, 380:864–5. doi: 10.1016/S0140-6736(12)61483-4.
Geleto A, Chojenta C, Musa A, Loxton D. Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature. Syst Rev. 2018; 7:183.
Gimoi, T.M. (2017). The impact of devolution on healthcare A research project report submitted to the Chandaria School of Business in partial fulfilment of the requirement for the degree of master’s in business Administration (MBA).
Global health 2035: a world converging within a generation. Lancet, 382:1898–955.
Guagliardo, M. F. (2004). Spatial accessibility of primary care: concepts, methods and challenges. International journal of health geographics, 3(1), 1-13.
Hammonds, R., & Ooms, G. (2014). The emergence of a global right to health norm - the unresolved case of universal access to quality emergency obstetric care. BMC Int Health Hum Rights, 14:4.
Hood C. (1995), Contemporary public management: a new global paradigm
Jamison, D.T., Summers, L.H., Alleyne, G., Arrow, K.J., Berkley, S. & Binagwaho A. (2013).
Jia, L., Meng, Q., Scott, A., Yuan, B., & Zhang, L. (2021). Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database of Systematic Reviews(1).
Jin, T., Cheng, L., Wang, K., Cao, J., Huang, H., Witlox, F., 2022b. Examining equity in accessibility to multi-tier healthcare services across different income households using estimated travel time. Transport Policy 121, 1–13.
Kahongeh, J. (2018). Universal Health Coverage: What you need to know. Daily Nation, 4th December 2018,https://www.nation.co.ke/news/Universal-Health-Coverage-explained/1056-4895006-vclblfz/index.html [accessed 06.11.2021].
Kazungu, J.S., Barasa, E.W. (2017). Examining levels, distribution, and correlates of health insurance coverage in Kenya. Trop Med Int Heal,22(9). doi:10.1111/tmi.12912. KCIDP. Report on annual performance review 2018-2022
Kothari, C. R. (2004). Research methodology: Methods and techniques. New Age International.
Kutzin, J. (2013). Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ, 91;602–11.
Lim JN, Ojo AA. Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review. Eur J Cancer Care (Engl). 2017;26: e12444.
Mbangua, R. K., Kawila, C., & Mwangi, M. (2021). Factors Influencing Delivery of Quality Health Care in Kasarani Sub County. Journal of Medicine, Nursing & Public Health, 4(2), 46-64. Retrieved from: https://stratfordjournals.org/journals/index.php/Journal-of-Medicine-Nursing-P/article/view/868.
Meyer, J. W., & Rowan, B. (1977). Institutionalized organizations: Formal structure as myth and ceremony. American Journal of Sociology, 83(2), 340–363.).
Mills, A., Ally, M., Goudge, J., Gyapong, J., & Mtei, G. (2012). Progress towards universal coverage: the health systems of Ghana, South Africa, and Tanzania. Health Policy Plan, 27 suppl 1: i4–12.
Ministry of Health of Kenya, (2020), Refocusing on quality of care and increasing demand for services; Essential elements in attaining universal health coverage in Kenya.
Ministry of Health, (2014), Kenya Health Policy 2014-2030. Nairobi, Kenya.
Ministry of Health, (2016), Statistical review of progress towards the mid-term targets of the Kenya Health Sector Strategic Plan 2014–2018. http://www.who.int/healthinfo/ country_ monitoring evaluation/KHSSP_StatisticalReport_2016
Ministry of Health, (2017), Kenya: Kenya health policy 2014–2030. Accessed 1 Feb 2017.
Ministry of Health, (2018), “President Uhuru Launches Universal Health Coverage Pilot: Nairobi, Kenya.
Ministry of Health, (2018), Kenya harmonised health facility assessment: Nairobi, Kenya.
Ministry of Health, (2018b), “Roadmap towards Universal Health Coverage in Kenya 2018-2022.” Nairobi, Kenya.
Mohammed, A., Agwu, P., & Okoye, U. (2018). When primary healthcare facilities are available, but mothers look the other way. Social Work in Public Health, 35(1-2), 11-20.
Moreno-Serra, R., & Smith, P.C. (2012). Does progress towards universal health coverage improve population health? Lancet, 380:917–23.
Mugenda, O.M. and Mugenda, A.G. (2003) Research Methods, Quantitative and Qualitative Approaches. ACT, Nairobi
Muthui, R. (2018). Factors influencing the provision of quality services in health care facilities: A case of Kitui county referral hospital [Unpublished Master’s Thesis] University of Nairobi.
Mwaliko, E., Downing, R., O’Meara, W. et al. “Not too far to walk”: the influence of distance on place of delivery in a western Kenya health demographic surveillance system. BMC Health Serv Res 14, 212 (2014). https://doi.org/10.1186/1472-6963-14-212
Mwangi, D. (2018). President Uhuru Launches Universal Health Coverage Programme Kenyans.co.ke, 14 December 2018. Retrieved from: https://www.kenyans.co.ke/news/45270-residents-dangerously-siphon-fuel-after-tanker-overturns-video [accessed 05.11.2021]
Njiru, L. W., Tenambergen, W. M. & Oluoch, M. (2019). Influence of devolved healthcare system on delivery of health services in Meru County, Kenya. International Academic Journal of Health, Medicine and Nursing, 1(2), 106-131).
Noor, A. M., Amin, A. A., Gething, P. W., Atkinson, P. M., Hay, S. I., & Snow, R. W. (2006). Modelling distances travelled to government health services in Kenya. Tropical Medicine and International Health, 11, 188–196.
North, D.C. (1991) Institutions. The Journal of Economic Perspectives, 5, 97-112. https://doi.org/10.1257/jep.5.1.97
Nyandekwe, M., Nzayirambaho, M., Baptiste, Kakoma, J. (2014). Universal health coverage in Rwanda: dream or reality. Pan Afr Med J, 17:232. doi: 10.11604/pamj.2014.17.232.3471
Nzwili, F. (2018). “Kenyan President Launches Benchmark Universal Health Coverage Pilot, To Become Nationwide in 18 Months”. Health” Policy Watch (blog). 2018. Retrieved from: https://www.healthpolicywatch.org/kenyan-president-launchesbenchmark-universal-health-coverage-pilot to-become-nationwide-in-18-months.
Odokonyero, O., Francis, M., Annet, A. (2017). “UHC in Uganda: critical health care infrastructure, health care coverage and equity”
Okech, C.T., & Lilegwe, L.S., (2016) Devolution and Universal health coverage in Kenya: situational analysis of health financing, infrastructure & personnel. International journal of Economics, Commerce and Management, Vol. IV, Issue 5.
Pollitt, C. 1993. Managerialism and the Public Services: Cuts or Cultural Change in the 1990s? 2nd ed. Oxford: Blackwell. [Google Scholar]
Ranabhat, C.L., Kim, C.B., Singh, A., Acharya, D., Pathak, K., Sharma, B., Mishra, S.R. (2019). Challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review. Arch Public Health, 4;77:5. doi: 10.1186/s13690-019-0331-7.
Rifkin, S.B. (2018). Health for all and primary health care, 1978-2018: a historical perspective on policies and programs over 40 years. Available from: http://publichealth.oxfordre.com/view/10.1093/
Sanogo, N. A., Fantaye, A. W., & Yaya, S. (2019). Universal Health Coverage and Facilitation of Equitable Access to Care in Africa. Frontiers in public health, 7, 102. https://doi.org/10.3389/fpubh.2019.00102
Augustina, R. et al. (2019). Universal health coverage in Indonesia: concept, progress.
Scott, W. (2013). Institutions and Organizations: Ideas, Interests, Identities. Sage, Thousand Oaks
Simfukwe, K., Adebisi, Y., Oladunni, A., Mohammed Eltahir S.E, Don Eliseo & Lucero-Prisno III DE (2021). The role of health service delivery networks in Achieving universal health coverage in Africa (review article), SEEJPH 2021
Sun, J., Lin, Q., Zhao, P., Zhang, Q., Xu, K., Chen, H., Hu, C. J., Stuntz, M., Li, H., & Liu, Y. (2017). Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study. BMC Public Health, 17(1), 1-11.
The Government of Kenya (2010), The Constitution, Government Printers, Nairobi.
Wang, F. (2012). Measurement, optimization, and impact of health care accessibility: A methodological review. Annals of the American Association of Geographers, 102, 1104–1112.
Wanga, W., Temsah, G., & Mallick, L. (2017). The impact of health insurance on mater nal health care utilization: Evidence from Ghana, Indonesia and Rwanda. Health Policy and Planning, 32(3), 366–375.
Wanjiru, J. (2014). Challenges of provision of universal healthcare by the National hospital insurance firm. Unpublished thesis available at http://hdl.handle.net/11295/77862. Accessed on January 10, 2022.
World Health Organization (2019). Declaration of Alma Ata. Geneva: World Health Organization. Available: https://www.who.int/publications/almaata_declaration_en.pdf [Accessed: 16 January 2022]
World Health Organization. (2020), Health Systems: Universal Health Coverage.
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Published
2023-05-14
How to Cite
Chesaro , C., & Kipchumba , H. (2023). Effects of Accessibility on Health Service Delivery in Public Hospitals in Kilifi County, Kenya. Journal of Public Policy & Governance, 7(1), 99–113. https://doi.org/10.53819/81018102t3078
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