Employees' perception of equity in medical provision among staff: the case of the University of Nairobi
Most institutions are faced with medical provision challenges including unequal distribution of this product among their members. However, the perceptions of equity among the different employees vary. This study set out to assess the perception of University of Nairobi employees regarding equity in the provision of their medical care. The research used a sample survey design to document the perceptions of the University of Nairobi staff on the equity of provision of medical care. It determined the extent to which the employees utilize the University Health Services (UHS) and the perceived areas of inequity in the provision of health care to the members of staff. The study was guided by three theories a) The Marxist principle of 'distribution according to need' which proposes that we should strive for an equal outcome in which all members receive medical care according to need. b) The libertarian view or the theory of entitlement which rationalises private health care according to ability to pay. c) The theory of Egality which accentuates the equal distribution of both benefits and burdens among the parties. It means equalizing individual net health benefits. The study adopted a systematic sampling technique to select respondents from 8 out of the 9 administrative colleges of the University of Nairobi. Six key informants (who were all DoN employees) were also purposively selected and interviewed. Data was collected from 72 (90%) out of the targeted 80 members of the DoN staff. The data obtained was analysed using SPSS and presented through descriptive statistics. Data results indicate that there is fair distribution in gender among the respondents and a rich academic and professional background. Most members of staff are over 40 years and a majority of them have worked for the University for more than 10 years. All the respondents had been treated at the UHS indicating high utilization by members of staff. The members of staff believe that there is better medical service provision at the Senior Staff Clinic (SSC) compared to the Junior Staff Clinic (JSC) and campus clinics. Seventy percent (70%) of the respondents believe that the UoN Medical Scheme is not fair to all although most of them (37%) do not know if all members are treated according to the established policies. Seventy five percent (75%) of the respondents indicated that they do not participate in the UoN Medical Scheme policy formulation although 3 key informants indicated that this is done through their respective trade unions. The perception ofthe respondents was that the UoN Medical Scheme does not take into consideration the lowly paid members of staff and their dependants nor do the different cadres of staff and their dependants get treated equally for same diseases. The study also reveals that although 79% of the members of staff believe that the UoN Medical Scheme is not fairly applied to all staff, they still rate it as a fair scheme and that they are satisfied by the services offered at the clinics. The study recommends that: a) the junior and the senior staff be merged to form one main clinic to avoid inequity in health care provision at the University of Nairobi (b) a full fledged and well equipped hospital be established to avoid external consultancies so as to cater for the other health care components that are outsourced by the UoN the researcher recommends that further research be carried out to establish if gender and level of education playa role in the employees' perception on equity in health provision at the UoN; compare the cost incurred on outsourced medical services with the cost of running own hospital; and establish the impact of inequity on the health of the members of the UoN Medical Scheme.
University of Nairobi, Kenya