Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

Abstract

Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95 percent confidence intervals were used to interpret the strength of associations. Results: The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were 3.5 times higher for males than female-headed households (AOR 3.05 [95% CI 1.47-6.37]; p<.05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ $5.(AOR 0.36 [95% CI 0.18-0.74]; p<.05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to the public facilities (AOR 6.64 [95% CI 3.67-12.01]; p<.001). Conclusion: In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out of pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare

Calibrating Implementation of Strategic Plans Amongst Commercial Banks in Kenya: An Analysis of Leadership Role

“…From the findings of the study it can be seen that effective communication by the leaders influences implementation of strategies. These findings have been proved by other scholars (Otieno, 2013;Kibet, 2014;Wachira, 2014;Nyakeriga, 2015& Kibicho, 2015. The findings are in agreement with Mwinzi (2014) who posited that management creates an environment of open sharing of ideas through communication; this will enhance implementation of strategies.…”

“…Leadership style is about the role of leaders in terms of whether they are committed to their job and whether they effectively communicate to staff in regards to implementation of strategic plans. According to Otieno (2013) communication is also seen as a key aspect of good leadership and supportive leadership will consequently comprise of able communicators who are able to articulate the strategic initiatives and get staff buy in as to ensure their effective participation. Efficient communication should be able to give compressive explanation of new duties, responsibilities and obligations which are to be carried in a given organization.…”

“…The study also revealed that management style, organizational culture, stakeholders and organizational resources affected the effectiveness of strategic plan implementation. Guzamin (2013) and Otieno (2013) in their studies on strategy implementation in Community Based Organizations and Barclays bank in Kenya respectively underscored the importance of communication for implementation to be successful. Otieno's (2013) study targeted 10 managers out of whom only six responded.…”

“…Guzamin (2013) and Otieno (2013) in their studies on strategy implementation in Community Based Organizations and Barclays bank in Kenya respectively underscored the importance of communication for implementation to be successful. Otieno's (2013) study targeted 10 managers out of whom only six responded. The target population was too small and the results of the study could not be generalized to include all banks.…”

“…A leader needs to effectively communicate to employees so that they may be well informed about the strategy to be implemented and how they could contribute to successful implementation. Several studies have emphasized on the importance of communication in strategy implementation (Guzami, 2013;Otieno, 2013;Odero, 2016). According to Lynch (2012) and Wanjiku and Ombui (2013) the most crucial precondition for successful strategy execution is top level executive's commitment to follow the strategic direction.…”