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Introduction: Essential Health Packages (EHP) delivery is likely to strengthen service delivery. Healthcare utilization rate is 77% for the sick. 44% and 18% who don’t seek care are hindered by cost and distance respectively. The overall child mortality rate in Kenya is 121/1000. In Homabay County, child mortality rate is 91/1000, and maternal mortality rate of 583/100000. The study looked into the provision of EHP in public hospitals in Homabay County. Methods: cross-sectional research design was used. Two hospitals were conveniently due to their municipality location. The study targeted 213 Health workers and 350 patients. Stratified sampling and proportionate sampling was used among different health workers. Sample size was determined by Yamane Formula. The study sampled 138 health workers and 186 patients. Questionnaire and key interview guide were used to collect data. Results: there are inadequate health workers based on 138 (100%) health workers. Insufficient drugs were reported by 138 (100%) health workers, and 120 (64.5%) patients. 115 (83.3%) health workers say ambulances are not operational. 26 (18.8%) health workers noted lack medical equipment, 138 (100%) are aware of patients referred elsewhere due to lack of medical equipment. 153 (82.3%) and 135 (72.6%) patients’ health access is hindered by cost and distance respectively. 159 (85.5%) patients don’t always find services needed. 159 (85.5%) patients affected by long waiting time. Conclusion: low service provision/utilization rate in Homabay County results from lack of health workers, inadequate drugs, poor health infrastructure, and lack of access in terms of affordability, availability and distance.
This was a cross-sectional research design with mixed method approach conducted in the two hospitals to answer the research questions. The study was conducted in public hospitals in Homabay County. The focus of the study was on the two major tiers 3 and tier 2 hospitals (Homabay County Hospital and Mbita Sub-County Hospital respectively) because of their location within the municipality. In addition, these two hospitals are the largest facilities serving the largest number of the county’s population, which is the reason the study focuses on them. The study targeted 213 health workers, out of which 138 (Pharmacists 5, clinicians 13, HMIS Officers 8, Nurses 104, and Hospital Managers 8) was sampled, and 350 patients out of which 186 was sampled. The 8 hospital managers were the key informants The study used Yamane’s Simplified Sample Formula for proportions which is suitable for small population and reducing the sample size slightly. n=N/ (1+N (e2)) Where: n is the sample size; N is the population size; e is the level of precision (margin of error) For Healthcare Workers: n1=213/ (1+213(0.05)2); n1=138.989. Thus, n1=138 Distribution of health workers by cadre is shown in Table 1 Distribution of healthcare workers sampled by cadres For the Patients: n2=350/ (1+350(0.05)2) n2=186.666. Thus, n2=186. Sampling of patients is shown inTable 2 Sampling of patients Stratified sampling method was used for the staff based on cadres in order to have a sample population that is representative of all the cadres. Proportionate sampling method was then be used to divide the sample size proportionately by percentage of the total population. That is, the total population per cadre over the general population multiplied by the determined sample size. This gave the sample size per cadre to be used in the study. Proportionate sampling method ensured that the cadres are represented proportionately in the final determined sample size as illustrated in Table 1 and Table 2. Both stratified sampling and proportionate sampling was used among the patients to reach a sample size for each facility. The study used daily attendance rate to ensure a manageable sample size because monthly or annual attendance rate would have given a huge sample that may not have been achieved during the study as data collection was carried out in a day. An exit interview was then conducted to gather information concerning service utilization. Sample population included only those who are directly concerned with the delivery of Essential Health Packages. These included all registered employees in the hospitals. Patients (both inpatients and outpatients) who were in the hospital at the time of the interview were sampled randomly at the exit point. Student staff and those who were absent at the time of the study were excluded. Patients in the surgical department were excluded from the study because of their delicate health condition. It would have not been easy for them to respond to the questionnaire appropriately. This study used a structured questionnaire and a key informant guide. There was a pretest of the research instruments conducted in Homabay County Hospital as a means to preview the likelihood of successful study. Based on the result of the pretest study, the questionnaire was redrafted to ensure the right data was collected in the actual study. The accuracy was tested during the pre-test among the respondents sampled randomly in the hospital to ensure validity. While some questions yielded the expected results, some questions were restructured, rewritten based on the way the respondents understood them, in order to get accurate responses during the actual study. The reliability of the questionnaires was measured by giving the same questionnaires to the same respondents on two separate occasions. A reliability coefficient of 0.8 was set to ensure good reliability. The responses on two separate occasions were correlated, and a reliability coefficient of 0.9 was obtained. The study employed both quantitative and qualitative methods of study during data collection, particularly structured questionnaire and interview guide. A structured questionnaire, self-administered was used among the target population (pharmacists, clinicians, HMIS officers, and nurses) to collect data. An exit interview was carried out among patients at the exit point of the facilities to gather information on satisfaction with service provision. Key Informant Interview (KII) was used among the hospital departmental heads to gather information on hospital infrastructure and staff competency levels. Quantitative data was coded and analysis done with the use of SPSS. Regression was used to analyze qualitative data. This involved both the descriptive and inferential statistics. Descriptive statistics was used to describe the status of both the independent (HRH, availability of drugs and supplies, health infrastructure, and organizational practices) and dependent variable (Patient satisfaction with the services). Inferential statistics was used to generate conclusions on the influence of independent variables on the dependent variable. Presentation of data was done with the use of tables. Prior to the commencement of the study, permission was obtained from respective authorities of the hospitals and Kenya Methodist University. Informed consent was also requested from all the respondents.
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