The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.
| Published in | American Journal of Health Research (Volume 4, Issue 4) |
| DOI | 10.11648/j.ajhr.20160404.14 |
| Page(s) | 91-99 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2016. Published by Science Publishing Group |
PHC, Gatekeeper, Effectiveness, Policy, Rationalization
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APA Style
Desire Aime Nshimirimana, Wanja Mwaura-Tenambergen, Donald Kokonya, Maureen Adoyo. (2016). Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya. American Journal of Health Research, 4(4), 91-99. https://doi.org/10.11648/j.ajhr.20160404.14
ACS Style
Desire Aime Nshimirimana; Wanja Mwaura-Tenambergen; Donald Kokonya; Maureen Adoyo. Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya. Am. J. Health Res. 2016, 4(4), 91-99. doi: 10.11648/j.ajhr.20160404.14
AMA Style
Desire Aime Nshimirimana, Wanja Mwaura-Tenambergen, Donald Kokonya, Maureen Adoyo. Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya. Am J Health Res. 2016;4(4):91-99. doi: 10.11648/j.ajhr.20160404.14
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Download@article{10.11648/j.ajhr.20160404.14,
author = {Desire Aime Nshimirimana and Wanja Mwaura-Tenambergen and Donald Kokonya and Maureen Adoyo},
title = {Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya},
journal = {American Journal of Health Research},
volume = {4},
number = {4},
pages = {91-99},
doi = {10.11648/j.ajhr.20160404.14},
url = {https://doi.org/10.11648/j.ajhr.20160404.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20160404.14},
abstract = {The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.},
year = {2016}
}
TY - JOUR T1 - Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya AU - Desire Aime Nshimirimana AU - Wanja Mwaura-Tenambergen AU - Donald Kokonya AU - Maureen Adoyo Y1 - 2016/06/30 PY - 2016 N1 - https://doi.org/10.11648/j.ajhr.20160404.14 DO - 10.11648/j.ajhr.20160404.14 T2 - American Journal of Health Research JF - American Journal of Health Research JO - American Journal of Health Research SP - 91 EP - 99 PB - Science Publishing Group SN - 2330-8796 UR - https://doi.org/10.11648/j.ajhr.20160404.14 AB - The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care. VL - 4 IS - 4 ER -
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