| dc.description.abstract | The Ministry of Health is fully committed to implementation
of Primary Health Care in the Country. However, since the
Alma-Ata declaration in 1978 of which Kenya was a
signatory, Primary Health care has only been carried out
in a small scale as 'Pilot Projects' by non-Governmental
Organizations,e.g. A.M.R.E.F., F.P.P.I., Aga Khan
Foundation; and the Missionary Health Services. The
Government and D.N.I.C.E.F. sponsored a National Pilot
Study on the Organ Lzat.Lon and Management of Community
Based Health Care in Kakamega District in 1977/1979 and
small Community Based Health Projects have been carried
out in various Districts.
Baringo, South Nyanza and Embu Districts have been earmarked
as the "Pilot" Districts for the implementation of Primary
Health Care and hence a study on the work and support of
the District Health Managers who are the "Core" of the
Health Delivery System in this Country was done in
Embu Districts.
The main aim of the project was to study how the District
Health Managers work in practice both as individuals
and as members of the District Health Managener.tTeam.
Since it was an action study, the researcher and the
co-ordinator of the project clarified and strengthened
the District Health Managers planning and management
knowledge and skills through discussions and'feedback
workshops. An emphasis on the roles and functions of
their support system was made.
The data was collected by the researcher over a period
of six months. The investigator spent five full-working
days with each Manager while on official duties e.g.
in office; in meetings, seminars/workshops, supervisory
visits, etc. During this period the researcher observed
(participant observation), discussed and interviewed the
the Manager about his/her, education background, roles and
responsibilites, resources management skills and techniques,
their priorities, internal and external relationship,
community development activities, constraints/frustrations
and their career development plans.
The researcher found that:-
1. The Managers have different basic professional training
and experience.
2. Seventy five per cent of the Managers had only a two weeks
Health planning and management training. Twenty five
per cent had more than three months training.
3. The Managers have attended many seminars and workshops
as part of their continuous education programme. However,
the knowledge and skills gained in these seminars is
hardly shared with other health workers and most of the
"Action Plans" formulated in these seminars/workshops
have not been implemented due to lack of finances and
support from the central level.
4. The Managers have not been fully exposed to the Primary
Health Care conc ep t, They showed biases towards their
professional training.
s. The Managers know their roles and responsibilities well
and except for the District Clinical Officer, they
have clear job description.
6. The Managers knowledge and skills in planning and management
is good but they have weak leaders~ip at the top and
transport is poorly managed. The Managers have no
programmed work schedule and spend over seventy five per cent
of their official time in their offices doing paperwork.
7. Communication is open and free and the internal relationship
is fair. However, staff motivation and supervision is
inadequate.
Intersectorial collaboration at District level is minimal.
8. Lack of transport, inadequate staff, inadequate physical
facilities, lack of drugs, medical supplies and
equipments and inadequate finance are some of the
commonest constraints/problems experienced by the Managers.
Low mora~e, indiscipline, lack of commitment, poor team
spirit and lack of knowledge and skills in some health
workers are common non-resource constraints.
9. All the Managers would like to go for further studies in
order to upgrade their management skills and knowledge and
probably get promotion.
The Investigator also joined the District Health Managers
in their meetings, during the Primary Health Care review
programme, the Growth Monitoring programme seminars,
supervision/monitoring and evaluation exercises.
He found that:
1. There are two main health management teams at the District
level, i.e.
The Rural Health Management Team and the
Provincial Hospital Management Team.
2. The Rural Health Management Team is responsible for the
delivery of health services in the Health Centres and
Dispensaries in the rural areas where more,than 85%
o~ the population live.
The Rural Health Management Team which is usually
equated to the District Health Mahagement Team (D.H.M.T)
roles and responsibilities are : .
To train, supervise and support staff in the Rural Health
Facilities.
To integrate specialist services at local levels.
c Consult and liase with a wide range of people in
the political, health and related development
fields.
- Initiate and maintain momentum for all health
projects.
3. Sub-Committees are formed to perform specific tasks
i.e.action-oriented task eroups e.g. Continuing
Education, Posting, Disciplinary, Housing Committees etc.
4. The Team meets quarterly but ad hoc meetings are held
whenever need arises. The meetings are well organised,
well attended and all Managers participate in decision
making and problem solving.
Communication is free and open and working relationship
is fair. Chronic absentism by some Managers occur.
5. The Team make supervisory visits quarterly. The safaris
are arranged at the begining of the year and are done
irregularly. Some members of the Team are left out
during visits.
6. The relationship of the team with its support system
is fair except for the strained relationship with
the provincial administrators.
There is however little intersectorial collaboration
at the district level.
7. The Team's constraints/frustr;tions are both resource
and non-resource nature and are similar to those
tabulated above.
Conclusion/Recommendation
Some of the critical factors which would affect the
implementation, success or otherwise of Primary Health Care
were analysed and recommendations made. These
includes: G .
1. Team Leadership and Organization
The team leadership at the top was found to be weak.
This Gould be attributed to the rapid turnover of
Medical Officers of Health and M.O.H. continuous
absence - when he is called upon to do other duties.
Recommendation:
(a) Staff transfers should be done only when necessary.
(b) Senior Medical Officers should be appointed by the
Provincial Officer to act as Medical Officers of
Health when need arises.
(c) A Primary Health Care Team should be formed at the
District level.
2. Manpower
Health Staff are the most important resources in
health delivery services. Most of the health workers
have not been exposed to Primary Health Care and
there are a few trained Health Managers.
Recommendation
Re-training and re-orientation of Health Staff to
Primary Health Care and development of planning and
management knowledge and skills in health managers
is a priority undertaking which should be done
before the programme is implemented.
Development of health manpower should be geared
towards expansion of the health infrastructure.
3. Finances
c·
.Lack of adequate finance is the major constraints experienced
by the District Health Managers. Even with the implementation
of the District Focus for Rural Development strategy and
central control of the district budgets and expenditure
is preventing the District Managers from implementing
the Health Programmes in their Districts.
Recommendation
(a). A specific allocation to Primary Health Care should
be made.
(b) A fund-raising (Harambee) meeting could supplement
the government funds.
4. Communication
Difficulties in communication leading to delay between
District Managers and Field Officers is common as most of
the rural areas are served by earth roads and marrumed
roads which are impassable during rainy seasons. Only
one third of the major health facilities are served by
telephone.
Recommendation
(a) Cheap solar powered telephones in the Rural Health
Facilities should be developed.
(b) A radio-link network in some remot~ areas could be useful.
5. Transport
Transport is a major problem to the District Health
Managers. Lack of vehicles designed for use in the
local roads, poor maintenance, lack of fuel and spare parts
and misuse of vehicles etc. are common.
Recommendation
(a) Small workshops for vehicle repair and maintenance should
1 be established at Provincial Headquarters.
(b) A scheme through which field officers may purchase
motorcycles should be started.
(c) Transport officers and drivers should be taught
simple mechanical engineering techniques.
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6. Drugs and Other Medical Supplies
Drugs, equipments and other medical supplies are
inadequate. The process of procuring drugs through
the District Tender Board is time consuming and
expensive.
Recommendation
Enough money should be allocated for procurement of
essential drugs, emergency drugs, sutures, gauze
and other medical supplies.
The process of procurement of drugs and other medical
supplies should be reviewed and the necessary
measures taken so that the chronic shortages of these
items is rectified.
7. Health Information System
Most of the epidemological and demographic data
collected at the District level is neither complete
nor adequate. The information gathered is also
rarely used for planning and management of health
services.
Recommendation
y The Health Information System should be strengthened
by training and orienting the health workers at
all levels in information collection, compilation,
analysis and use at all levels.
8. Intersectoral Co-operation
Primary Health Care require the co-operation of
other Ministries which have health related
activities e.g. Education, Agriculture, Social
Services, Transport and Communication, Information
and Broadcas_ting etc. Little intersectoral
co-operation occur at the District level in Embu.
Recommendation
(a) The Provincial Administration should ensure that
intersectoral co-operation is strengthened through
the formal forums like District Development Committee
meetings and other informal meetings.
(b) - The District Health Managers should champion in
encouraging intersectoral co-operation by forming
a District Primary Health Care Team with the District
Commissioner as the Chairman and the Medical Officer
of Health as the Secretary.
9. Community Development Activities
The health staff have the monopoly of promoting and
maintaining the health of the Community in Embu.
Time is ripe when the Community should be involved in
the planning, organization, monitoring and
evalution of the health programmes in their areas.
Recommendation
Primary Health Care should be implemented as soon as
possible. | en |
