International Journal of Health Economics and Policy

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Efficiency and Organizational Arrangements in the Utilization of Resources at Primary Health Care (PHC) in Machakos County, Kenya

Received: 26 March 2017    Accepted: 07 April 2017    Published: 26 May 2017
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Abstract

Health care is costly and there is need for rational use of health care resources for the world to achieve universal health coverage (UHC). The preventive Primary Health Care (PHC) service is cheaper than the Secondary Health Care (SHC). PHC is strengthened through gatekeeper system, so the emphasis on the PHC for cost control is self-explanatory. This study aimed at determining the efficiency and organizational arrangements using human resources for health (HRH), laboratory services and supply of drugs as the performance indicators that determined rational use of resources in Machakos County, Kenya. This was a convergent parallel mixed methods cross-sectional study that employed qualitative and quantitative data collection techniques. The study targeted facility health managers in charges and policy implementers namely the Chief Officer of health, the Director of Prevention and PHC and the Medical Superintendents and patients seeking health care. A response rate of 83%was achieved (n=83), of whom 84.3% were nurses and 15.7% diploma medicine practitioners. Over (70%) of the health facilities had less than 3professional health workers. Exactly 75% of the community-based self-referrals cases would be treated at PHC level. Self referrals were largely due to patients’ perceived need for laboratory services (53.8%) and medicines (60%). On the contrary, 89.6% of the residents of Machakos County, Kenya were informed about PHC services, 91.7% were accessible to PHC and 93.7% had faith in health care providers at PHC level. The HRH, diagnostic equipment and essential drugs were not the main reasons for self-referrals, but perceived needs for drugs and laboratory services. The inverse and disproportionate attendances of patients at both PHC and SHC levels caused dissonance in service delivery and subsequent inefficiency in service delivery in Machakos County, Kenya. Proper supervision and implementation of referral policy available at county level should be emphasized.

DOI 10.11648/j.hep.20170203.18
Published in International Journal of Health Economics and Policy (Volume 2, Issue 3, September 2017)
Page(s) 138-144
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Efficiency, Primary Care, Organizational, Arrangements

References
[1] Schieber G, Baeza C, Kress D, et al. Financing Health Systems in the 21st Century. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries.2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006 [online] http://www.ncbi.nlm.nih.gov/books/NBK11772/.
[2] Kluge, E.-H. W. Resource Allocation in Healthcare: Implications of Models of Medicine as a Profession. Medscape General Medicine 2007, 9 (1), 57.
[3] Shi L. Impact of Primary Care. A focused review. Hindawi Publishing Corporation Scientifica, 2012. DOI: http://dx.doi.org/10.6064/2012/432892.
[4] Ardey, R., &Ardey, R. Patient Perceptions and Expectations From Primary Health-care Providers in India. Journal of Family Medicine and Primary Care 2015, 4 (1), 53–63.
[5] Dwyer, J. & Eagar, K. Options for reform of Commonwealth and State governance responsibilities for the Australian health system. Commissioned paper for the National Health and Hospitals Reform Commission 2008. [online] http://ro.uow.edu.au/ahsri/580/ on 12th July 2016.
[6] Simou, E, Karamagiol, i E and Rmeliotou, A. Reinventing primary health care in the Greece of austerity: the role of health-care workers. Primary Health Care Research and Development 2013[online] http://journals.cambridge.org retrieved on 17th November 2014.
[7] Mbilinyi et al. Health worker motivation in the context of HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study. BMC Health Services Research 2011: 11: 266.
[8] WHO. Everybody's business -- strengthening health systems to improve health outcomes WHO's framework for action. Geneva, World Health Organization 2007. [online] http://www.who.int/iris/handle/10665/43918.
[9] Kabene, M. S., Orchard, C., Howard, M J., Soriano, A. M. and Leduc, R. The importance of human resources management in health care: aglobal context. Human Resources for Health, Biomed Central 2006: 4(20). doi: 10.1186/1478-4491-4-20.
[10] Darkwa, E. K., Newman, M. S., Kawkab, M., &Chowdhury, M. E. A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC Health Services Research 2015, 15, 344.
[11] George, G., Gow, J., &Bachoo, S. Understanding the factors influencing health-worker employment decisions in South Africa. Human Resources for Health 2013: 11(15).
[12] Robyn, P. J., Shroff, Z., Zang, O. R., Kingue, S., Djienouassi, S., Kouontchou, C., & Sorgho, G. (2015). Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in Cameroon. International Journal of Health Policy and Management, 4(3), 169–180.
[13] Kumar, P. & Khan, A. M. Human resource management in primary health care system. Health and Population 201: 36, 66-76.
[14] Manzi et al. (2012): Human resources for health care delivery in Tanzania: a multifaceted problem. Human Resources for Health 2012: 10 (3).
[15] Leshabari, T. M, Muhondwa, P. Y. E, Mwangu AM. &Mbembati, A. N. (2008). Motivation of Health Care Workers in Tanzania: a case study of Muhimbili National Hospital. East African Journal of Public Health 2008: 5 (1).
[16] Chisholm, D. & Evans, B. D. Improving health system efficiency as a means of moving towards universal coverage. Health Systems Financing: The path to Universal Coverage. World Health Report 2010. Background Paper, No 28 [online] http://www.who.int/healthsystems/topics/financing/healthreport/28UCefficiency.pdf.
[17] Sambala, E. Z., Sapsed, S., &Mkandawire, M. L. Role of Primary Health Care in Ensuring Access to Medicines. Croatian Medical Journal 2010: 51(3), 181–190.
[18] Ahmed, S. M., & Islam, Q. S. Availability and Rational Use of Drugs in Primary Healthcare Facilities Following the National Drug Policy of 1982: Is Bangladesh on Right Track? Journal of Health, Population, and Nutrition 2012: 30 (1), 99–108.
[19] Kar, S. S., Pradhan, H. S., &Mohanta, G. P. Concept of Essential Medicines and Rational Use in Public Health. Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine 2010, 35 (1), 10–13.
[20] World Council of Churches. Essential Medicines in Health Care 2009. Nairobi, Kenya. http://www.mja.com.au/public/issues/178_ 01_060103/hal10723_fm.html.
[21] Miyakis, S., Karamanof, G., Liontos, M., &Mountokalakis, T. D. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgraduate Medical Journal 2006: 82(974), 823–829.
[22] Zunic, L. Economic Analysis of Requests for Laboratory Tests in Primary Health Care Centers. Acta Informatica Medica 2012: 20 (1), 21–24.
[23] Horvath, A. R. From Evidence to Best Practice in Laboratory Medicine. The Clinical Biochemist Reviews 2013: 34 (2), 47–60.
[24] Ferrante di Ruffano, L., Hyde, J. C., McCaffery, K. J., Bossuyt, MM P., Jonathan J Deeks, J. J. Assessing the value of diagnostic tests: a framework for designing and evaluating trials. BMJ 2012: 344.
[25] Brunetti, M., Pregno, S., Schunemann, H., Plebani, M & Trenti, T. Economic evidence in decision-making process in laboratory medicine. Clin Chem Lab2011: 49 (4): 617–621.
[26] Fryer A. A &Hanna W. F. Managing demand for pathology tests: financial imperative or duty of care? Annals of Clinical Biochemistry 2009: 46: 435–437. DOI: 10.1258/acb.2009.009186.
[27] Campbell KP, editor. Investing in Maternal and Child Health: An Employer’s Toolkit. Washington, DC: Center for Prevent on and Health Services, National Business Group on Health; 2007. [online] www.businessgrouphealth.org/healthtopics/maternal child/investing .
[28] Zunic, L. Economic Analysis of Requests for Laboratory Tests in Primary Health Care Centers. Acta Inform Med 2012: 20 (1): 21-4. doi: 10.5455/aim.2012.20.21-24.
[29] Bismark M. M & Studdert M D. Governance of quality of care: a qualitative study of health service boards in Victoria, Australia. BMJ 2014: 23: 474–482. doi: 10.1136/bmjqs-2013-002193.
[30] Johnson B. and Onwuegbuzie J. A. Mixed Methods Research: A Research Paradigm Whose Time Has Come. Educational researcher 2004: 33 (7), p14-26 [online] http://www.jstor.org/page/info/about/policies/terms.jsp.
[31] Yamane, Taro. Statistics, An Introductory Analysis, 1967: 2nd Ed., New York: Harper and Row.
[32] Kahabuka, C., Moland, M., K. Kvåle, G. and Hinderaker, G. S. Unfulfilled expectations to services offered at primary health care facilities: Experiences of caretakers of under five children in rural Tanzania. BMC Health Services Reasearch 2012 12: 158.
[33] Ojakaa, D., Olango, S., and Jarvis, J. Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya. Human Resources for Health 2014: 12, 33. http://doi.org/10.1186/1478-4491-12-33.
[34] George, G., Gow, J. &Bachoo, S. Understanding the factors influencing health-worker employment decisions in South Africa. Human ResourcesforHealth2013: 11 (15). doi: 10.1186/1478-4491-11-15.
[35] Kahabuka C, Kvåle G, Moland M. K. and Hinderaker G. S. Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania. BMC Health Services Research 2011: 11 (315).doi: 10.1186/1472-6963-11-315.
[36] World Health Organization. World Health Report 2015. WHO Library Cataloguing-in-Publication Data. Geneva, Switzerland.
Author Information
  • Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya

  • Department of Mental Health, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya

  • Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya

  • Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya

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    Desire Aime Nshimirimana, Donald Kokonya, Wanja Mwaura-Tenambergen, Maureen Adoyo. (2017). Efficiency and Organizational Arrangements in the Utilization of Resources at Primary Health Care (PHC) in Machakos County, Kenya. International Journal of Health Economics and Policy, 2(3), 138-144. https://doi.org/10.11648/j.hep.20170203.18

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    Desire Aime Nshimirimana; Donald Kokonya; Wanja Mwaura-Tenambergen; Maureen Adoyo. Efficiency and Organizational Arrangements in the Utilization of Resources at Primary Health Care (PHC) in Machakos County, Kenya. Int. J. Health Econ. Policy 2017, 2(3), 138-144. doi: 10.11648/j.hep.20170203.18

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    AMA Style

    Desire Aime Nshimirimana, Donald Kokonya, Wanja Mwaura-Tenambergen, Maureen Adoyo. Efficiency and Organizational Arrangements in the Utilization of Resources at Primary Health Care (PHC) in Machakos County, Kenya. Int J Health Econ Policy. 2017;2(3):138-144. doi: 10.11648/j.hep.20170203.18

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  • @article{10.11648/j.hep.20170203.18,
      author = {Desire Aime Nshimirimana and Donald Kokonya and Wanja Mwaura-Tenambergen and Maureen Adoyo},
      title = {Efficiency and Organizational Arrangements in the Utilization of Resources at Primary Health Care (PHC) in Machakos County, Kenya},
      journal = {International Journal of Health Economics and Policy},
      volume = {2},
      number = {3},
      pages = {138-144},
      doi = {10.11648/j.hep.20170203.18},
      url = {https://doi.org/10.11648/j.hep.20170203.18},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.hep.20170203.18},
      abstract = {Health care is costly and there is need for rational use of health care resources for the world to achieve universal health coverage (UHC). The preventive Primary Health Care (PHC) service is cheaper than the Secondary Health Care (SHC). PHC is strengthened through gatekeeper system, so the emphasis on the PHC for cost control is self-explanatory. This study aimed at determining the efficiency and organizational arrangements using human resources for health (HRH), laboratory services and supply of drugs as the performance indicators that determined rational use of resources in Machakos County, Kenya. This was a convergent parallel mixed methods cross-sectional study that employed qualitative and quantitative data collection techniques. The study targeted facility health managers in charges and policy implementers namely the Chief Officer of health, the Director of Prevention and PHC and the Medical Superintendents and patients seeking health care. A response rate of 83%was achieved (n=83), of whom 84.3% were nurses and 15.7% diploma medicine practitioners. Over (70%) of the health facilities had less than 3professional health workers. Exactly 75% of the community-based self-referrals cases would be treated at PHC level. Self referrals were largely due to patients’ perceived need for laboratory services (53.8%) and medicines (60%). On the contrary, 89.6% of the residents of Machakos County, Kenya were informed about PHC services, 91.7% were accessible to PHC and 93.7% had faith in health care providers at PHC level. The HRH, diagnostic equipment and essential drugs were not the main reasons for self-referrals, but perceived needs for drugs and laboratory services. The inverse and disproportionate attendances of patients at both PHC and SHC levels caused dissonance in service delivery and subsequent inefficiency in service delivery in Machakos County, Kenya. Proper supervision and implementation of referral policy available at county level should be emphasized.},
     year = {2017}
    }
    

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    AB  - Health care is costly and there is need for rational use of health care resources for the world to achieve universal health coverage (UHC). The preventive Primary Health Care (PHC) service is cheaper than the Secondary Health Care (SHC). PHC is strengthened through gatekeeper system, so the emphasis on the PHC for cost control is self-explanatory. This study aimed at determining the efficiency and organizational arrangements using human resources for health (HRH), laboratory services and supply of drugs as the performance indicators that determined rational use of resources in Machakos County, Kenya. This was a convergent parallel mixed methods cross-sectional study that employed qualitative and quantitative data collection techniques. The study targeted facility health managers in charges and policy implementers namely the Chief Officer of health, the Director of Prevention and PHC and the Medical Superintendents and patients seeking health care. A response rate of 83%was achieved (n=83), of whom 84.3% were nurses and 15.7% diploma medicine practitioners. Over (70%) of the health facilities had less than 3professional health workers. Exactly 75% of the community-based self-referrals cases would be treated at PHC level. Self referrals were largely due to patients’ perceived need for laboratory services (53.8%) and medicines (60%). On the contrary, 89.6% of the residents of Machakos County, Kenya were informed about PHC services, 91.7% were accessible to PHC and 93.7% had faith in health care providers at PHC level. The HRH, diagnostic equipment and essential drugs were not the main reasons for self-referrals, but perceived needs for drugs and laboratory services. The inverse and disproportionate attendances of patients at both PHC and SHC levels caused dissonance in service delivery and subsequent inefficiency in service delivery in Machakos County, Kenya. Proper supervision and implementation of referral policy available at county level should be emphasized.
    VL  - 2
    IS  - 3
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