Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals

Abstract

Background: Although considerable efforts are directed at developing international guidelines to improve clinical management in low-income settings they appear to influence practice rarely. This study aimed to explore barriers to guideline implementation in the early phase of an intervention study in four district hospitals in Kenya.

A descriptive study on health workforce performance after decentralisation of health services in Uganda

“…This finding contradicts what was found by a Kenyan study [17], which established that health workers working in hospital paediatric departments were not cooperating and communicating openly with each other and this was affecting their performance and the quality of care given to patients. Some researchers have established that behaviours that involve cooperation, creativity and self-development contribute to job performance [28].…”

“…This is contrary to what was found in Kenya where health workers were reported to have inadequacies in adapting or responding to new clinical practices or guidelines due to lack of perceived benefits linked to their uptake [17]. In that study, senior and older health workers were often reported to be stuck in the patterns of previous clinical practice although there were some exceptions [17]. This problem was attributed to the lack of experience in being compelled to change by emerging knowledge.…”

“…This study revealed that health workers were not providing timely services. This can be attributed to organisational constraints such as the low staffing levels, heavy workload, poor work flow structures and probably lack of some essential drugs and equipment necessary for performance [17]. It is essential that health workers are responsive to the demands of the communities they serve.…”

“…The reported high rate of disagreement among health workers regarding adequacy of staffing (Table 3) may probably explain high workload and long patients’ waiting-times [17]. It is however, important to note that availability of health workers on its own cannot directly improve the health outcomes unless there is effective drug supply, functioning facilities and good clinical practice [19].…”

Improving the use of evidence in health impact assessment

“…the professional groups involved in the local process that resulted in the document accept it and are committed to its use), all of which are important for the successful implementation of guidelines. 38,39 For example, an Australian version is being prepared with permission from the authors and funders of the original United Kingdom version. It includes minor changes to the text and alternative suggestions for information resources.…”