The effects of increased health facilities on quality of health care services in rural Kenya: A Case Study of MARANI Division, Kisii Central District.

Abstract

This study was designed to assess the effects of increased of health facilities on the quality of health care services. Specifically, the study sought to establish the relationship between increase in health care facilities and the quality of health care services being offered at these facilities. It was also important for this study to find out the perceptions of patients of out-patients category about quality health care services. Also to establish whether the number of new cases to the facilities has decrease as a result of improved health status of the people.

The study was guided by three sociological theories: Functionalism theory, the General Systems theory, and the Behaviour theory. The study is highly qualitative. Data was generated from both secondary and primary sources. Marani Division was purposely selected for the study. The study employed random sampling to conveniently select the Out-patients as respondents and purposively selected the health facilities and the Key Informants. Information in the field was collected by use of semi-structured interviews, interview guide, and observation guide. Exit interviews were conducted on the out­ patients who had just received services and were willing to participate. Interview guide was also used for the key informants. An observation checklist was used to observe the physical infrastructure and equipment 'in, use at the health facilities. The data obtained was analyzed using both Excel and SPSS computer programs and presented through descriptive statistics.

The study revealed that though the public health facilities in the area have increased over a period of time, from a single dispensary (Marani) to the current seven public health facilities, the health care services provided at these facilities lack quality due to many other factors. The study also revealed that though there has been improvements on these facilities in terms of status, (one of these facilities has been elevated to a Sub-district hospital and two others to Health Centre level), and the number of Out-patients visiting the facilities has remained relatively constant with an increase between June and September. Again, the study findings showed there is a felt information gap between what the patients

ought to know from the service providers at the facilities, and what they perceive as quality of health care services.

In the course of the study, several factors that negatively affect the quality of health care services emerged. Some of the constraints included; heavy workload on the part of service v providers due to under-staffing and congestions experienced particularly at the referral

centers, high staff tum-over, poor logistics management, inadequate and inconsistence in the supplies of essential drugs and equipment, and limited financial resources. As a result quality of health care services is highly compromised and people in the community tend to seek alternative health care services elsewhere. Without the deployment of adequate and qualified staff and other essential supplies and logistics, facilities alone, will not bring about the anticipated quality of health care services.

Based on its findings, the study recommended that:

In order to offer quality health care services, the government through its policy-makers and implementers need to recognize its critical coordinating role and the impact this has on the delivery of quality health care services. Therefore, there is need to evaluate the current service delivery process to ascertain its effectiveness and efficiency. Also, there is need to address and harmonize the standardization of service provision guidelines and 'possibly, overhaul the whole system of health c~.

In order to have integrated and patient-oriented health care services, there is need for the , government to make arrangements for Mobile Clinics and Sessional Doctors to visit the

divisional health facilities on particular days within a month. This will enable the community to get specialized services (e.g. dental and eye problems) and also to reduce the congestions experienced at the referral health facilities.

In order to empower the community and improve on the patients' perceptions and address the information-gap about disease rights and obligations of a patient, there is need to sensitize the community about their health issues. The sensitization programs should be carried through Local TV, Radio, Newspapers, chief barazas and fEe materials indicating the services being offered by targeting Schools, churches, community health support groups