Background on Demographics, H/ Financing and Quality of Service Delivery

HEALTH CARE ORGANIZATION AND MANAGEMENT (PHS 801)

ASSIGNMENT

HEALTH FINANCING AS A SIGNIFICANT PROBLEM ASSOCIATED WITH QUALITY OF CARE (PATIENT/COMMUNITY SATSFACTION) IN HEALTH SERVICE DELIVERY IN NAKURU COUNTY

PRESENTED BY: RISPER .A. MURUNGA

SPH/PGH/1003/2014

LECTURER: DR. MABEL NANGAMI

NAKURU COUNTY

BACKGROUND ON DEMOGRAPHICS, H/ FINANCING AND QUALITY OF SERVICE DELIVERY.

Nakuru County lies along the major Nairobi-Uganda highway making it a major business and transit hub in the country. It is multi ethnic in nature but dominated mainly by the kikuyus and the kalenjins at 70%.It has 6 constituencies. Other demographics are as shown below.

Kenya County fact sheet by Commission on Revenue Allocation, 2009.Modified by Risper Murunga Jan 2015.

 The County derives its finances from government, donors and locally from its main economic activities which are subsistence farming, fish farming in Lake Naivasha, commercial farming (flowers and wheat). Others are energy generation at the Menengai and Olkaria stations, small scale trade and commercial businesses. Agriculture contributes 48% of its total income. In last FY budget 2014/2015 of 1.6 trillion, this county was  allocated Ksh 6.342B being in the sixth position behind Nairobi, Turkana, Mandera, Kakamega and Bungoma respectively (Commission on Revenue Allocation 2014).There is no level 4 hospital, level 3 are the county and 7 sub county hospitals. Tiers 2 are 21 H/ centers and 117 dispensaries and few tier one.

PROBLEM STATEMENT

Despite a clear vision of “An efficient and high quality h/ care system that is accessible, equitable and affordable to every citizen in the county and Kenyans in general” (Nakuru Integrated Development Plan 2013/17), the county has been bedeviled by a number of issues directly associated with h/ financing both arising from the national and county level. These have led to lack of patient satisfaction occasioning some of them travelling elsewhere to seek services that could be well available at their county. However ,h/ financing impediments arising from the national level are a few and tend to affect all counties .They are mainly delay in dispatch of allocated money to the county .After the Budget reading in second week of June every year, the money reaches respective areas in mid-October earliest. Less budget allocated to health (7%) despite the Abuja Declaration of 2000 that indicates that 15% of a country’s budget must go to health .In the last FY 2014/15 of 1.6 trillion, the government allocated only 34.7 B for health (National Budget 2014/15 at a Glance, Adili News later).Beauracracy on procurement by  PPDA of 2005  delays procurement and at times money meant to procure h/ products and improve h/infrastructure may be returned to the national government at the end of a FY (cedgg: Nakuru County integrated development plan 2013-2014 ) .Sessional paper number 10 of 2012 on Kenya Vision 2030 is the National Policy Blueprint that among other objectives, aims to ensure high quality of life to all. For quality of life to be high, citizens must be healthy. However, not much has been achieved in Nakuru County in the H/sector so far basing on the level of quality of health care. The majority of residents in this county rely on government h/facilities with only 19% covered by h/ insurance , 18% covered by NHIF compared to 56% in Ghana and 70% in Rwanda(National H/ Insurance Statistics). Too much politicking within counties is adversely affecting service delivery in counties and residents are not seeing the benefits of devolution(Daily Nation Oct 23rd  2014).This is true of this county and it is affecting service delivery. Corruption and misuse of public funds instead of putting it into proper use to provide quality and effective h/ care is present and affects service delivery(Transparency international kenyal:Kenya H/sector Integrity Study report 2011)

Quality of care is a major principle of service delivery since the aim of a health system is to restore, promote and maintain health through preventive, curative and rehabilitative means. Patient satisfaction is not synonymous to outcome since outcome is the measures of the system itself on what extend its planned objectives were met. However patient satisfaction/quality of care is the measure of to what degree a patients needs or expectations were met .It can only be assessed by asking the patients themselves of their experiences after they have received the services like after hospital admission or after services in radiology, laboratory departments and even the morgue which many at times tends to be neglected as part of a h/ facility. The assessment can be done verbally through exit interviews or feedback/checklist forms. It is a match of the quality of services offered and the patient’s expectations. It is important to note that patient expectations are subjective and are dependent on a number of factors such as socioeconomic status, gender or previous myths/stories/legends. Given same care, one patient may be satisfied and another totally disappointed. The level of quality of care is directly linked to the h/ financial management. Service provision in the county is as follows: