Factors influencing implementation of cost sharing program in public health facilities in Machakos county, Kenya.

Abstract

Provision of affordable and quality health care remains an issue of concern in Kenya just like in any other third world countries. Implementation of cost sharing program in Kenya then aimed at providing equitable and affordable healthcare at the highest possible standards for all citizens. Thus, the purpose of this study was to identify the factors influencing implementation of cost sharing program in public health facilities in Machakos County, Kenya. The study sought to establish how competence of employees, assess how internal controls, assess the extent to which attitude of employees and establish how public awareness influence the implementation of cost sharing program. The researcher used a descriptive survey research design to enable her capture attitudes of the respondents, which might otherwise be difficult to measure using observation method. Main instrument used for data collection was a questionnaire due to its practicability in reaching a large number of respondents. The study had a sample size of 263. This included managers, health care workers, clients and patients as program users and 2 key informants. Simple random sampling was used as a representation of the whole population. The data collected was analyzed using SPSS and was presented in tables and figures. The findings of the study showed that most of employees were not competent in issues related to cost sharing program. In fact a good number of the implementers did not know what the program entails as they had not been trained or updated. Their roles in the program were not clear. Internal control measures put in place-influenced implementation of the program in that most of them were ineffective, supervision was wanting and there capacity to detect fraud and corruption was quite low. Staff attitude, which was more of negative than positive was found to influence the implementation of the program. Most of the employees did not appreciate the importance of cost sharing and felt that collection and utilization of the funds was inappropriate. Public awareness about cost sharing was scarce, as the public knew little or nothing about the program thus influencing its implementation. The study recommended that the issues of staff incompetence need to be urgently addressed by ensuring proper training, communication and updates. Accountability and transparency are key issues that need to be checked through the financial control measures used. There is need for all concerned parties to address the need to change the negative attitude of the employees through communication and ensuring favorable working environment. Public awareness and involvement is key in implementation and sustainability of projects. There is urgent need for national and county governments to put in place measures that accommodate long-term awareness raising campaigns that become part and parcel of normal life of the public