Quality of health care services in Nyeri District, Kenya: patients perceptions and their effects on service utilization

Abstract

There is continued concern about unequal access to quality health care. In its policy framework, the Ministry of Health recognizes the challenges these emerging health issues entail. The 1994 Health Policy Framework, and the Nation Health Sector Strategic Plan (NHSSP, 1999-2004) provide the vision and the agenda for the Ministry of Health (MOH).The aim of the Kenya Government is to expand coverage of health services andtheir accessibility to vulnerable groups. The Ministry of Health also identified and committed to focus and allocate more resources on (a) preventive and promotive health care, (b) rural dispensaries and health centers, (c) primary health care, (d) family planning and Maternal and Child Health (MCH), (e) control of TB, HIV/AIDS, malaria; communicable and vector borne diseases; environmental health services, and (f) nutrition programs as core poverty programs. The Ministry of Health institutions form a pyramidal structure of facilities with the system being key component of overall health care system. Also there is emphasis on curative versus primary and preventive health care. The GOK through the ministry of health contributes about 42% of the total spending on health and individuals through the out of pocket expenditures contributes 40% towards health financing (Republic of Kenya, 1977). Inadequate staffing and inadequate health care quality are the main factors constraining health services utiliz-ition in Kenya. However, empirical information about this issue is lacking, for example, the demand for health care at some facilities is higher than others yet the technical quality of service at the same facilities is low. The main objective of this study was to determine how patients' perceptions about quality of services influence the use of the services. XVI The results from the study, and the literature review shows that unmeasured factors and their perception by patients are important determinants of health service demand. In particular, patients' perceptions about quality of health faciiities are important factors in utilization of health services. The study revealed that 31.9% of patients at the health facilities in Nyeri District are below the age of five years. Moreover, a significant number of patients lived between 1 and 5 km from the health facility (40.5%). The results further show that public hospitals were the preferred source of care (45.8%). Contrary to the current perception about the quality of health care in public facilities being poor, the results of this study indicate that demand is high at these facilities despite the unfavorable attitude of patients about medical personnel. This finding is due to the presence of doctors in hospitals and easy accessibility of patients to many government health facilities. The presence of doctors and drugs, combined with facility proximity lead to overcrowding at public health facilities, which typically would be associated with friction between patients and health personnel. Other factors influencing the utilization of health facilities include travel time, age of adult caregivers, household size, gender of the patient, education and user charges. However, while the effects of perceived quality under different model specifications persists, the effects of user charges become insignificant when social and demographic factors are added into the demand model. The concluding chapter of the thesis summarizes the policy implications of the study findings and recommendations for way forward. These recommendations include: • Staffing of a" health facilities with qualified staff, ..-( • Health policy revision on health financing, • Expansion of rural health care facilities, and • A more holistic approach to provision of healthcare. • Deployment or visits by doctors to rural health facilities