Governance Accountability Mechanisms As A Determinant Of Delivery Of Quality Health Services In Kenyatta National Hospital, Kenya

ABSTRACT

Governance in essence is exercise of authority. It is about decision-making and implementation of decisions. It ensures strategic policy frameworks exist alongside effective oversight, coalition building, provision of appropriate regulations and accountability. The study set out to determine influence of governance accountability mechanisms in delivery of quality health services in Kenyatta National Hospital. Specific objectives of the study were to: i) establish the influence of professional health provider accountability mechanisms, ii) determine the influence of management accountability mechanisms, iii) determine the influence of Board of Directors accountability mechanisms, and iv) establish the influence of payer accountability mechanisms on the delivery of quality health services in Kenyatta National Hospital, Kenya. Mixed methods design involving both quantitative and qualitative methods was used. Target population comprised 4,715 employees in all Departments of the hospital. Stratified and purposive sampling was used to arrive at the sample of 369 respondents and four key informants. Structured questionnaire and key informant interview guide were used to collect data. Quantitative data was analysed using SPSS version 21. Qualitative data was analysed using thematic analysis and presented using the emerging themes. Logistic regression results indicated that professional health providers not registered with professional bodies were 0.216 times less likely to deliver quality health services as compared to those who are registered. There being consequences for breach of self-regulation was 2.086 times more likely to enhance delivery of quality health services as compared to having no consequences. Continuous professional training made application of clinical guidelines 2.157 times more likely in delivery of quality health services. The hospital not having a performance management policy was 0.340 times less likely to deliver quality services. It was 0.307 times less likely to deliver quality services if hospital did not have right people in the right job. The hospital is 0.334; 0.272; and 0.415 times less likely to deliver quality health services with a Board that has no functional finance committee, no monitored financial transactions or non-shared external audit reports with stakeholders respectively. Lack of multiplicity of payers and inability to choose payers in the hospital is 0.271 and 0.467 times less likely to enhance delivery of quality health services respectively. The study concluded that governance accountability mechanisms of various health actors is a determinant of delivery of quality health services in terms of timeliness in the hospital. The study recommended that the hospital should ensure that: i) professional health providers in the hospital are registered and licensed to practice by their professional bodies, ii) continuous professional education opportunities are made available to professional health providers and that value addition is monitored for actual improvements in professional and clinical governance accountability, iii) the hospital management reviews its service charter to ensure both internal and external customers get a clear picture of expected obligations and service standards, iv) the hospital management invest in modern technologies and infrastructure aimed at improving patients waiting time, and v) the Board makes the vision and core values of the organization understood and practised by all employees.