THE INFLUENCE OF INSTITUTIONAL FACTORS IN ACCESS TO HEALTHCARE IN KENYA: A CASE OF NAIROBI COUNTY, KENYA.

Davies N. Chelogoi, H. Amadi
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Abstract

This study examines the influence of institutional factors on access to public healthcare in Kenya, a case for Nairobi County. It addresses the influences of health policies, leadership and governance, health infrastructure, health facilities, health workers, health finances and health insurance.  The objective of the study is to evaluate the influence of institutional variables in access of public healthcare. The study used data from a sample of 1066 households purposively selected from Nairobi County. All households were aged 15 years and above. The households were subjected to interviews that covered a wide range of topics.  Descriptive design was chosen for the study. The study adopted multiple sampling methods for the study. These included purposive sampling, systematic sampling, snowball sampling and multi stage cluster sampling frame.  The data was collected using various techniques or instruments which included observation, key informant interviews, questionnaires, in-depth interviews, and focus-group discussions. The data was processed using descriptive statistics. Correlation and regression analyses were used to correlate and interpret the data of the study.  The findings show access to healthcare is inadequate and unevenly distributed among the households in Nairobi County. The factors attributed to these inequalities were inadequate and poorly implemented health policies, inadequate health facilities, and inadequate health workers, shortage of essential drugs, low level funding and poorly managed health insurance. This study argues that these institutional factors should be made adequate, accessible and quality improved. The focus should be on the lower social classes, who are deprived, and denied capabilities to access healthcare. This is despite the interventions made to access healthcare to the entire population in the County.  
体制因素对肯尼亚获得保健服务的影响:以肯尼亚内罗毕县为例。
本研究考察了肯尼亚体制因素对获得公共医疗保健的影响,以内罗毕县为例。它涉及卫生政策、领导和治理、卫生基础设施、卫生设施、卫生工作者、卫生财政和健康保险的影响。本研究的目的是评估制度变量对公共医疗服务可及性的影响。该研究使用了从内罗毕县有意挑选的1066个家庭样本的数据。所有住户年龄均在15岁及以上。这些家庭接受了涵盖广泛主题的采访。本研究采用描述性设计。本研究采用多重抽样方法进行研究。包括有目的抽样、系统抽样、滚雪球抽样和多阶段聚类抽样框架。数据收集采用各种技术或工具,包括观察,关键线人访谈,问卷调查,深度访谈和焦点小组讨论。数据采用描述性统计进行处理。相关分析和回归分析用于关联和解释研究数据。调查结果显示,内罗毕县家庭获得医疗保健的机会不足,而且分布不均。造成这些不平等的因素是卫生政策不充分和执行不力、卫生设施不足、卫生工作者不足、基本药物短缺、资金水平低和健康保险管理不善。本研究认为,应使这些体制因素充分、可及并提高质量。重点应放在社会下层,他们被剥夺了获得医疗保健的能力。尽管采取了干预措施,使全县人口都能获得医疗保健服务,但情况仍然如此。
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