| dc.description.abstract | There is continued concern about unequal access to quality health care. In its policy
framework, the Ministry of Health recognizes the challenges these emerging health
issues entail.
The 1994 Health Policy Framework, and the Nation Health Sector Strategic Plan
(NHSSP, 1999-2004) provide the vision and the agenda for the Ministry of Health
(MOH).The aim of the Kenya Government is to expand coverage of health services
andtheir accessibility to vulnerable groups.
The Ministry of Health also identified and committed to focus and allocate more
resources on (a) preventive and promotive health care, (b) rural dispensaries and
health centers, (c) primary health care, (d) family planning and Maternal and Child
Health (MCH), (e) control of TB, HIV/AIDS, malaria; communicable and vector borne
diseases; environmental health services, and (f) nutrition programs as core poverty
programs.
The Ministry of Health institutions form a pyramidal structure of facilities with the
system being key component of overall health care system. Also there is emphasis
on curative versus primary and preventive health care. The GOK through the ministry
of health contributes about 42% of the total spending on health and individuals
through the out of pocket expenditures contributes 40% towards health financing
(Republic of Kenya, 1977).
Inadequate staffing and inadequate health care quality are the main factors
constraining health services utiliz-ition in Kenya. However, empirical information
about this issue is lacking, for example, the demand for health care at some facilities
is higher than others yet the technical quality of service at the same facilities is low.
The main objective of this study was to determine how patients' perceptions about
quality of services influence the use of the services.
XVI
The results from the study, and the literature review shows that unmeasured factors
and their perception by patients are important determinants of health service
demand. In particular, patients' perceptions about quality of health faciiities are
important factors in utilization of health services.
The study revealed that 31.9% of patients at the health facilities in Nyeri District are
below the age of five years. Moreover, a significant number of patients lived between
1 and 5 km from the health facility (40.5%). The results further show that public
hospitals were the preferred source of care (45.8%). Contrary to the current
perception about the quality of health care in public facilities being poor, the results of
this study indicate that demand is high at these facilities despite the unfavorable
attitude of patients about medical personnel. This finding is due to the presence of
doctors in hospitals and easy accessibility of patients to many government health
facilities. The presence of doctors and drugs, combined with facility proximity lead to
overcrowding at public health facilities, which typically would be associated with
friction between patients and health personnel.
Other factors influencing the utilization of health facilities include travel time, age of
adult caregivers, household size, gender of the patient, education and user charges.
However, while the effects of perceived quality under different model specifications
persists, the effects of user charges become insignificant when social and
demographic factors are added into the demand model.
The concluding chapter of the thesis summarizes the policy implications of the study
findings and recommendations for way forward. These recommendations include:
• Staffing of a" health facilities with qualified staff,
..-(
• Health policy revision on health financing,
• Expansion of rural health care facilities, and
• A more holistic approach to provision of healthcare.
• Deployment or visits by doctors to rural health facilities | en |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
