Papers by Wanja Tenambergen
PAMJ - One Health, 2020
Maternal and child health is one of the most significant aspects of service delivery pillar. With... more Maternal and child health is one of the most significant aspects of service delivery pillar. With every country focusing on the achievement of sustainable development goal number three (SDG 3), provision and utilization of maternal and child health services continue to attract global attention. Many countries make significant investments to provide these services at no cost to expectant mothers. However, maternal and child health services have not obtained optimal utilization for various reasons. Improving adherence to antenatal care (ANC) is an integral strategy to reduce under-five mortality and to improve maternal and child health. In sub-Saharan Africa, women often initiate antenatal care visit in their first trimester, but do not follow through to the recommended four ANC visits. Failure to attend ANC visits increases fetal, maternal, and neonatal mortality. Therefore, there is need for comprehensive systems to attain SDG 3 by 2030. A systematic approach intervention that cuts across health system has been proven to increase adherence. Interventions such as patient reminders and public relation initiatives such as information sharing, effective communication and education among health workers could prove effective in this course. The aim of this review is to examine the impact of systematic approach intervention on adherence to ANC appointments. The methodology included PRISMA guidelines for systematic reviews. Google Scholar and PubMed databases were searched using the terms such as systems approach intervention, adherence to appointments, missed appointments, ANC visit attendance, Postnatal Care (PNC) visit attendance, ANC adherence, and PNC adherence. Biases were assessed based on geographical area and publication dates. The result of the review showed that all the studies included reported a positive effect of systems approach intervention in increasing appointment adherence, with an average of 42% appointment adherence and 35% reduction in missed appointments in antenatal and postnatal clinics across all the studies. Conclusively, systems approach intervention increases adherence to appointments in antenatal and postnatal clinics. Multiple interventions also produce better outcomes.
Public Health Research, 2021
International Journal Of Community Medicine And Public Health
Background: Social accountability encompasses a variety of strategies that enable citizens to exp... more Background: Social accountability encompasses a variety of strategies that enable citizens to express their concerns about the performance of health-care services. Community dialogues provide a forum for community engagement and participation in the health care system. However, there is little documentation on how it is used to improve social accountability within government community health structures. The purpose of this study was to determine the influence of community dialogues on social accountability in Nairobi County, Kenya.Methods: A qualitative study was conducted that included in-depth interviews with key stakeholders purposively selected. A total of three focus group discussions with 23 participants, eight key informant interviews and document review of minutes were conducted. Data analysis was done using thematic analysis.Results: Findings showed that community dialogues were held quarterly. The forums were mostly used for education purposes with little evidence on commu...
Public Health Research, 2020
The Journal of Global Health Care Systems, Mar 31, 2015
Background: Among the six pillars of the health system, this research focused on health workforce... more Background: Among the six pillars of the health system, this research focused on health workforce. Since the establishment of the Community Strategy in Kenya’s health sector in the year 2006, limited literature has proven that the capacity of Community Health Volunteers (CHVs) has been optimally built. This research therefore endeavored to determine how the selection of CHVs affects their capacity to deliver services in Tier One health care. Methods: The study was a cross-sectional design. Data were collected by administering questionnaires to 228 CHVs, focus group discussions with the Community Health Committee (CHC) and Community Health Extension Workers (CHEWs), interview the Sub-County Community Strategy Focal Person and observation of CHVs’ work. Descriptive and inferential statistics were used. Relationships were determined using chi square. Qualitative analysis was done by thematic content analysis and framework analysis. Results: The study showed a significant relationship between the volunteering spirit and role development (p=0.013). Permanence of residence was associated with positive contributions towards the community health (p=0.016). Higher performance on practical tasks was associated with being literate (p<0.001). More than half the CHVs 147 (64.47%) had acquired skills to perform their tasks as required; 149 (65.35%) of the CHVs were knowledgeable in health issues. Conclusion: Inadequate capacity building of CHVs results in sub-optimal delivery of services in Tier One health care. Secondly, sub-optimal selection of CHVs hampers their capacity to deliver services in Tier One health care. In recommendation, the County Government should secure a sustainable budget for Tier One health care to facilitate the capacity building of CHVs. As the health care managers in the Division of CHS review the implementation guidelines, more attention should be given to the education level of candidate CHVs.
The Journal of Global Health Care Systems, Mar 18, 2015
Introduction: The World Health Organization estimates that one third of the world population lack... more Introduction: The World Health Organization estimates that one third of the world population lacks regular access to essential medicines. Inadequate essential medicines relate to the way health systems are organized, financed and managed. A client exit survey conducted in Machakos County Referral Hospital (MCRH) in 2012 indicated that 58% of clients were dissatisfied with availability of EMs in the hospital. Previous studies in MCRH had not established how management influenced accessibility of drugs. Purpose : This study was conducted to determine how management influenced accessibility of essential medicines (EM) to clients. The objective of the study was to establish how EM support systems were organized in the hospital. Methodology: The study included 226 outpatient clients who accessed medicines at the pharmacy, 46 clinicians, the Medical Superintendent, the pharmacist in charge and the in charge of supply chain. Data was collected through structured questionnaires and analyzed through SPSS version 20. Results : The study revealed a significant relationship between organizations of management support systems with accessibility of essential medicines (p=0.037), an average staff shortage of 227 (50%) to mange EMs, out of which 225 (97%) had not been trained on management of EM. The average wait time in pharmacy was less than 10 minutes per client, 93(43%) of all clients were not issued with all the drugs prescribed to them due sock outs, only 7(3%) cited lack of enough money to pay for drugs. There was a financial deficit of (33%) to procure essential medicines quarterly and 130 (60%) of the clients were satisfied with services rendered in the pharmacy. Conclusion : The study revealed both strengths and weaknesses in the management of essential medicines in MCRH, the weaknesses outweighed the strengths and as such influenced negatively accessibility of EMs to clients. Recommendations made to the hospital management included to diversify on resource mobilization, ensure adequate staffing, train all staff on essential medicines management and upgrade the existing health management information system in the hospital. Key words: Management, Accessibility, Essential Medicine, Machakos County Referral Hospital.
Pan African Medical Journal, 2015
Introduction: Access to maternal and child health care services among the nomadic pastoralists co... more Introduction: Access to maternal and child health care services among the nomadic pastoralists community in Kenya and African continent in general is unacceptably low. In Turkana, only 18.1% of the women had seen a nurse or a midwife for antenatal care during pregnancy while only 1.3% of pregnant women reported delivery at health facilities in 2005. Ng'adakarin BAMOCHA model, based on migratory routes of the Turkana pastoralists and container clinics was adopted in 2007 to improve access to maternal and child health services by the nomads. Methods: A crosssectional study design was used to establish the effectiveness of Ng'adakarin BAMOCHA model on accessibility and uptake of antenatal care and delivery services. A total of 360 households and 400 households were interviewed for pre-intervention and post-intervention respectively. The study compared the pre-intervention and post-intervention findings. Structured questionnaires and focus group discussion were used for data collection. Results: There was no improvement in the fourth antenatal care visits between pre-intervention and post-intervention groups at 119(51.5%) and 111(41.9%) respectively (p<0.05). Knowledge of the community on the importance of ANC visits improved from 60%-72% with significance level of p<0.05. There was a significant increase 6%-17% of deliveries under a skilled health worker (p<0.05). TBA assisted deliveries increased from 7.5%-20.2% with a p<0.05.There was significant reduction in home deliveries from 89.5%-79.5% with a p<0.05. Conclusion: The Ng'adakarin Bamocha model had a positive effect on the improving maternal health care among the nomadic pastoralist community in Turkana.
International Journal Of Community Medicine And Public Health
Background: National hospital insurance fund (NHIF) uses capitation as a strategic purchasing mod... more Background: National hospital insurance fund (NHIF) uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study sought information on citizen knowledge of PCHS benefit package, NHIF communication to citizens, determination of citizen views and values, NHIF accountability to citizens, citizen choice of PCHS provider and how these factors influence citizen access to NHIF, PCHS.Methods: This was a cross sectional research conducted between March 2017 to March 2018. 426 patients were sampled from Nyandarua and Nakuru Counties.Results: 366 (93%) patients knew the PCHS benefit package, 226 (57%) said NHIF communication to them was adequate, 280 (71%) said NHIF does not take into account their view and values, 272 (69%) said NHIF is not accountable to them, 269 (68%) knew how to select an outpatient facility, 111 (28%) said they did not receive NHIF, PCHS. Multivariate logistics regression analysis of citizen engagement factors and access to P...
International journal of scientific and research publications, Apr 24, 2022
Background: Despite a growing body of literature on social accountability in health systems, many... more Background: Despite a growing body of literature on social accountability in health systems, many questions remain unanswered about how community actors interact with health workers and demand accountability. Social accountability is viewed as an empowerment process and a social practice in which communities actively participate in changing the conditions that affect their health. Local factors, such as the role of community actors, influence the effectiveness of social accountability. The purpose of this research was to assess empirical evidence on the role of community actors in social accountability. Methods: Electronic searches were conducted for eligible studies within each of the Pubmed, Medline, Google Scholar and SciELO databases from 2012 to January 2022. Peer-reviewed English language publications describing a social accountability mechanism with a focus on the role of community actors in Africa and South Asia were eligible for inclusion. There were no restrictions on the research design. Results: The review included eleven relevant studies. According to the findings, community actors include Community Health Workers, Health Facility Committees, Community Elected Leaders, and the media, among others. Their responsibilities include monitoring services and health worker's performance, gathering and sharing information, and resolving complaints. Some of the enablers to the role community health actors include diverse committee membership and the legitimacy of community leaders. On the other hand, knowledge and power asymmetry, the lack of a clear mandate, a lack of clarity on their roles and fear of reprisal are among the barriers to their role in Social Accountability. Conclusion: Community actors are part of the community health system, and understanding their role, strengths, and challenges has a practical impact on how they contribute to the overall health system's strength. The findings show that they can exert social pressure through their powerful coalitions, which is critical in Social Accountability activities. As a result, in order to maximize their potential, novel approaches to addressing the limitations identified in this review are required.
Effectiveness of Ng’adakarin Bamocha model in improving access to ante-natal and
Journal of Global Health Care Systems, 2015
Background: Among the six pillars of the health system, this research focused on health workforce... more Background: Among the six pillars of the health system, this research focused on health workforce. Since the establishment of the Community Strategy in Kenya’s health sector in the year 2006, limited literature has proven that the capacity of Community Health Volunteers (CHVs) has been optimally built. This research therefore endeavored to determine how the training offered to Community Health Volunteers affects their capacity to deliver services in Tier One health care in an urban setting of Nairobi County in Kenya. Methods: The study was a cross-sectional design. Data was collected by administering questionnaires to 228 CHVs, focus group discussions with the Community Health Committee and Community Health Extension Workers, interview the Sub-County Community Strategy Focal Person and observation of CHVs’ work. Relationships were determined using chi square. Qualitative analysis was done by thematic content analysis and framework analysis. Results: CHVs who scored higher in role de...
Effectiveness of Ng’adakarin Bamocha model in improving access to ante-natal and
Purpose: The purpose of this study was to establish influence of access determinants on selfrefer... more Purpose: The purpose of this study was to establish influence of access determinants on selfreferrals among pregnant women seeking delivery service in Coast General Referral and Teaching Hospital (CGTRH). Methodology: The study adopted a descriptive cross-sectional research. The study target population was all pregnant women seeking delivery services in coast general teaching and referral hospital at the maternity unit. Therefore, 6,420 formed the study population as it is from this sampling frame that a sample of mothers was obtained. A sample of 376 pregnant women was obtained. Systematic random sampling was used to select the pregnant women to be included in the sample. Data was collected using a structured questionnaire. The data collected were cleaned and coded, quantified and analyzed quantitatively. Quantitative data were analyzed using IBM SPSS where descriptive and inferential statistics were used to capture the data in order to understand the pattern and nature of relation...
Journal of Global Health Care Systems, 2015
Background: Among the six pillars of the health system, this research focused on health workforce... more Background: Among the six pillars of the health system, this research focused on health workforce. Since the establishment of the Community Strategy in Kenya’s health sector in the year 2006, limited literature has proven that the capacity of Community Health Volunteers (CHVs) has been optimally built. This research therefore endeavored to determine how the training offered to Community Health Volunteers affects their capacity to deliver services in Tier One health care in an urban setting of Nairobi County in Kenya. Methods: The study was a cross-sectional design. Data was collected by administering questionnaires to 228 CHVs, focus group discussions with the Community Health Committee and Community Health Extension Workers, interview the Sub-County Community Strategy Focal Person and observation of CHVs’ work. Relationships were determined using chi square. Qualitative analysis was done by thematic content analysis and framework analysis. Results: CHVs who scored higher in role de...
International journal of scientific and research publications, 2016
Timely delivery of effective, safe, quality and personal services is a key pillar of health syste... more Timely delivery of effective, safe, quality and personal services is a key pillar of health system strengthening. A Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project’s goal was to strengthen health systems at the facility and community levels, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. The objectives of the study were 1) to determine whether providing maternal health education to pregnant women had any influence on ANC attendance in the intervention and control communities and 2) to determine whether issuing referral advice forms to patients has any influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in Mirihini, the interv...
Purpose: The purpose of this study was to establish influence of access determinants on selfrefer... more Purpose: The purpose of this study was to establish influence of access determinants on selfreferrals among pregnant women seeking delivery service in Coast General Referral and Teaching Hospital (CGTRH). Methodology: The study adopted a descriptive cross-sectional research. The study target population was all pregnant women seeking delivery services in coast general teaching and referral hospital at the maternity unit. Therefore, 6,420 formed the study population as it is from this sampling frame that a sample of mothers was obtained. A sample of 376 pregnant women was obtained. Systematic random sampling was used to select the pregnant women to be included in the sample. Data was collected using a structured questionnaire. The data collected were cleaned and coded, quantified and analyzed quantitatively. Quantitative data were analyzed using IBM SPSS where descriptive and inferential statistics were used to capture the data in order to understand the pattern and nature of relation...
International journal of scientific and research publications, 2016
Service delivery in government health facilities in Kenya still faces multiple challenges. These ... more Service delivery in government health facilities in Kenya still faces multiple challenges. These challenges can still be identified ten years down the line since the introduction of Service Charter. The objective of the study was to assess how the service charter utilization would influence health service delivery in Thika Level 5 Hospital (TL5H) in Kiambu County. Cross sectional study design was employed. Quantitative data was collected using questionnaires. A sample size of 156 technical employees of TL5H and patients participated in this study. Collected data was edited, coded, and entered into the computer using the Statistical Package for Social Scientists (SPSS v 23). The respondents strongly agreed that the hospital charter content is not viewed annually creating unfriendly services (mean 1.73, SD 0.97), (mean 1.74, SD 0.997) indicated the respondents strongly agreed that the service charter is not clearly understood by the majority of patients informing them of their rights ...
International journal of scientific and research publications, 2016
Timely delivery of effective, safe, quality and personal services is a key pillar of health syste... more Timely delivery of effective, safe, quality and personal services is a key pillar of health system strengthening. A Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project’s goal was to strengthen health systems at the facility and community levels, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. The objectives of the study were 1) to determine whether providing maternal health education to pregnant women had any influence on ANC attendance in the intervention and control communities and 2) to determine whether issuing referral advice forms to patients has any influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in Mirihini, the interv...
The recent worldwide focus on healthcare quality improvement, cost containment and enhanced patie... more The recent worldwide focus on healthcare quality improvement, cost containment and enhanced patient experience has led to increased need for adoption of Electronic Medical Record systems (EMR) ( Waithera L, Muhia J, Songole R , 2017). This technology agitates for paperless transactions health care and would significantly reduce clinician workload and medical errors while saving the institution major expenses. Kenya is globally acclaimed as a leader for its Information Communication Telecommunications (ICT) innovations such as M-PESA (Graham, 2010). Many studies have been done in other countries to study the factors influencing adoption and usage of EMR technology, but a small number of studies exist in Kenyan situation (Ministry of Health, 2010). This study sought to examine why the application of EMR technology has not kept pace with its demand. This study therefore sought to answer two key research questions derived from the study objectives which include the influence of network ...
Uploads
Papers by Wanja Tenambergen