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Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya
American Journal of Health Research
Volume 4, Issue 4, July 2016, Pages: 91-99
Received: Jun. 12, 2016; Accepted: Jun. 22, 2016; Published: Jun. 30, 2016
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Desire Aime Nshimirimana, Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
Wanja Mwaura-Tenambergen, Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
Donald Kokonya, Department of Mental Health, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya
Maureen Adoyo, Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
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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, resulting in 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.
PHC, Gatekeeper, Effectiveness, Policy, Rationalization
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Desire Aime Nshimirimana, Wanja Mwaura-Tenambergen, Donald Kokonya, Maureen Adoyo, Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya, American Journal of Health Research. Vol. 4, No. 4, 2016, pp. 91-99. doi: 10.11648/j.ajhr.20160404.14
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