Counties In Kenya Research Articles

Healthcare Providers’ Engagement in Strategic Purchasing of Outpatient Services: A Cross-sectional Analysis of the National Health Scheme in Kenya

Abstract Background: National Health Insurance Fund (NHIF) outpatient services operate under capitation, and are strategically designed to enhance quality, equity, and affordability. However, despite this strategy, providers often demand out-of-pocket payments. This study investigates provider participation in strategic purchasing and its impact on NHIF’s outpatient service delivery. Methods: A cross-sectional analytical study was conducted among 66 healthcare managers from facilities accredited to provide NHIF outpatient services in two counties in Kenya. The data were collected using structured questionnaires. Logistic regression analysis was performed to assess the association between study variables. Results: Most respondents were male (36, 55%). The provision of NHIF outpatient services was significantly correlated with the monitoring provider performance by NHIF and the county department of health (Pmultivariate=0.024). There was a 31-fold increase in the likelihood of provision for monitored facilities. A significant difference (p=0.005**) was observed in monitoring health facilities. Monitoring was more common among private healthcare providers than public and faith-based health facilities. Conclusion: The involvement of healthcare providers in strategic purchasing has not yet been achieved. County and NHIF quality assurance departments should regularly monitor providers’ performance to ensure the delivery of equitable and high-quality healthcare.

Baseline assessment of cervical cancer screening and treatment capacity in 25 counties in Kenya, 2022.

Cervical cancer is the leading cause of cancer deaths among women in Kenya. In the context of the Global strategy to accelerate the elimination of cervical cancer as a public health problem, Kenya is currently implementing screening and treatment scale-up. For effectively tracking the scale-up, a baseline assessment of cervical cancer screening and treatment service availability and readiness was conducted in 25 priority counties. We describe the findings of this assessment in the context of elimination efforts in Kenya. The survey was conducted from February 2021 to January 2022. All public hospitals in the target counties were included. We utilized healthcare workers trained in preparation for the scale-up as data collectors in each sub-county. Two electronic survey questionnaires (screening and treatment; and laboratory components) were used for data collection. All the health system building blocks were assessed. We used descriptive statistics to summarize the main service readiness indicators. Of 3,150 hospitals surveyed, 47.6% (1,499) offered cervical cancer screening only, while 5.3% (166) offered both screening and treatment for precancer lesions. Visual inspection with acetic acid (VIA) was used in 96.0% (1,599/1,665) of the hospitals as primary screening modality and HPV testing was available in 31 (1.0%) hospitals. Among the 166 hospitals offering treatment for precancerous lesions, 79.5% (132/166) used cryotherapy, 18.7% (31/166) performed thermal ablation and 25.3% (42/166) performed large loop excision of the transformation zone (LLETZ). Pathology services were offered in only 7.1% (17/238) of the hospitals expected to have the service (level 4 and above). Only 10.8% (2,955/27,363) of healthcare workers were trained in cervical cancer screening and treatment; of these, 71.0% (2,097/2,955) were offering the services. Less than half of the hospitals had cervical cancer screening and treatment commodities at time of survey. The main health system strength was presence of multiple screening points at hospitals, but frequent commodity stock-outs was a key weakness. Training, commodities, and diagnostic services are major gaps in the cervical cancer program in Kenya. To meet the 2030 elimination targets, the national and county governments should ensure adequate financing, training, and service integration, especially at primary care level.

Understanding Kenyan policymakers' perspectives about the introduction of new maternal vaccines.

New vaccine policy adoption is a complex process, especially in low-and-middle-income countries (LMICs), requiring country policymakers to navigate challenges such as competing priorities, human and financial resource constraints, and limited logistical capacity. Since the Expanded Programme on Immunization's (EPI) beginning, most new vaccine introductions under this structure have not been aimed at adult populations. The majority of adult vaccines offered under the EPI are not typically tested among and tailored for pregnant persons, except those that are specifically recommended for pregnancy. Given that new maternal vaccines, including RSV and GBS vaccines, are on the horizon, it is important to understand what barriers may arise during the policy development and vaccine introduction process. In this study, we sought to understand information needs among maternal immunization policymakers and decision-makers in Kenya for new vaccine maternal policy adoption through in-depth interviews with 20 participants in Nakuru and Mombasa counties in Kenya. Results were mapped to an adapted version of an established framework by Levine et al., (2010) focused on new vaccine introduction in LMICs. Participants reported that the policy process for new maternal vaccine introduction requires substantial evidence as well as coordination among diverse stakeholders. Importantly, our findings suggest that the process for new maternal vaccines does not end with the adoption of a new policy, as intended recipients and various actors can determine the success of a vaccine program. Previous shortcomings, in Kenya, and globally during HPV vaccine introduction show the need to allocate adequate resources in education of communities given the sensitive target group. With maternal vaccines targeting a sensitive group - pregnant persons- in the pipeline, we are at an opportune time to understand how to ensure successful vaccine introduction with optimal acceptance and uptake, while also addressing vaccine hesitancy to increase population benefit.

Assessment of Relationship Between Human Resource Planning Strategies and Job Satisfaction in the Lake Region Economic Bloc County Governments in Kenya

Human resource planning encompasses predicting quantity, quality and category of human resources requirements in organizations to ensure that they are suitably redeployed and utilized optimally by organizations. Accurate predictions ease the rationalization of staff to improve its performance and create a conducive working environment. In that regard, organizations in the public and private sectors are formulating and deploying several strategies to enhance employee job satisfaction and gain a competitive edge. Despite the emphasis on job satisfaction, a review of available literature indicated limited focus on the relationship between human resource planning strategies and job satisfaction. This paper assessed the relationship between human resource planning strategies and job satisfaction in Kenya's Lake Region Economic Bloc County Governments. The study used the equity theory and the target population was all employees engaged by the 14 counties in Kenya's Lake Region Economic Bloc County Governments. Three counties: Kisumu, Bomet and Kakamega, which had employed 14,361 workers were sampled. The study sample consisted of 374 respondents, who arrived at the study using the Morgan and Krejcie sampling formula. A questionnaire was used to collect data analysed using SPSS for descriptive and inferential statistics and presented using tables. Regression analysis indicated that human resource planning strategies are positively and significantly related to job satisfaction (B = 0.939, p = .000). Thus, the study concluded that a significant relationship exists between human resource planning strategies and job satisfaction in Kenya's Lake Region Economic Bloc County Governments. The study recommends that county governments in the Lake Region Economic Bloc in Kenya emphasize implementing forecasting and restructuring strategies objectively and rationally to enhance employees' job satisfaction

Effect of Legislative Budgetary Control on Financial Accountability in Nairobi County Kenya

Effect of Legislative Budgetary Control on Financial Accountability in Nairobi County Kenya

Effect of Resource Orientation on Service Delivery of Public Level Four Hospitals in Kakamega County Kenya

Purpose: The study established the effect of resource orientation on service delivery of Level Four Public Hospitals in Kakamega County, Kenya Methodology/Approach: Mixed research design comprising of a descriptive and causal were applied. Targeted 304 comprising of 162 nurses, 135 Hospitals office staff and 7 Hospital Administrators. The study sample size was 173 using Yamane formulae. The study applied stratified and simple random sampling technique. Structured questionnaires aided in data collection. Pilot study was done at Sabatia District hospital in Vihiga County. Reliability was tested using Cronbach Alpha while validity was tested using content validity. SPPs versio 23 was used for effective descriptive as well as inferential statistics. Findings: The study found out that customer orientation had a significant influence on service delivery (t-statistic=7.489. Implications: Important to medical practitioners, government Authorities, and management of hospitals in managing strategic orientation plans for service delivery. The study recommends that customers orientation should be prioritized since it enhances service delivery.

Hair Dye and Relaxer Use among Cisgender Women in Embu and Nakuru Counties, Kenya: Associations with Perceived Risk of Breast Cancer and Other Health Effects.

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15-50 years to complete a questionnaire that ascertained hair product use in the last 7-14 days, ever using hair dyes and chemical relaxers, and participants' perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants' sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02-1.06 and OR 2.05, 95% CI: 1.38-3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01-1.06 and OR 1.93, 95% CI: 1.30-2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients-which may be hormone disruptors or carcinogens-and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products.

Childhood Cancer Awareness Program in Bungoma County, Kenya.

Awareness could play a key role in reducing underdiagnosis and accelerating referral of childhood cancer in low- and middle-income countries and ultimately improve outcomes. This study describes the implementation of a childhood cancer awareness program in Bungoma County in Kenya, containing five components: (1) baseline data collection of primary healthcare facilities; (2) live training session for healthcare providers (HCP); (3) early warning signs posters; (4) online SMS course for HCP; and (5) radio campaign. This study was conducted between January and June 2023. All 144 primary healthcare facilities (level 2 and 3 health facilities) within Bungoma County were visited by the field team. All 125 level 2 (87%) and 19 level 3 (13%) facilities participated in the study. National Health Insurance Fund (NHIF) failed to cover services in 37 (26%) facilities. HCP were more often reported absent at level 3 (89%) than level 2 (64%) facilities (P = 0.034). The 144 live training sessions were attended by over 2000 HCP. Distribution of 144 early warning signs posters resulted in 50 phone calls about suspected childhood cancer cases. Sixteen children were later confirmed with childhood cancer and treated. Online SMS learning was completed by 890 HCP. Knowledge mean scores improved between pre-test (7.1) and post-test (8.1; P < 0.001). Finally, 540 radio messages about childhood cancer and a live question-and-answer session were broadcasted. This study described the implementation of a childhood cancer awareness program in Kenya involving both HCP and the general public. The program improved HCP's knowledge and increased the number of referrals for children with cancer.

Integrating support persons into maternity care and associations with quality of care: a postpartum survey of mothers and support persons in Kenya

BackgroundDespite research that has shown that the presence of support persons during maternity care is associated with more respectful care, support persons are frequently excluded due to facility practices or negative attitudes of providers. Little quantitative research has examined how integrating support persons in maternity care has implications for the quality of care received by women, a potential pathway for improving maternal and neonatal health outcomes. This study aimed to investigate how integrating support persons in maternity care is associated with multiple dimensions of the quality of maternity care.MethodsWe used facility-based cross-sectional survey data from women (n = 1,138) who gave birth at six high-volume facilities in Nairobi and Kiambu counties in Kenya and their support persons (n = 606) present during the immediate postpartum period. Integration was measured by the Person-Centered Integration of Support Persons (PC-ISP) items. We investigated quality of care outcomes including person-centered care outcomes (i.e., Person-Centered Maternity Care (PCMC) and Satisfaction with care) and clinical outcomes (i.e., Implementation of WHO-recommended clinical practices). We used fractional regression with robust standard errors to estimate associations between PC-ISP and care outcomes.ResultsCompared to low integration, high integration (≥four woman-reported PC-ISP experiences vs. <4) was associated with multiple dimensions of quality care: 3.71%-point (95% CI: 2.95%, 4.46%) higher PCMC scores, 2.76%-point higher (95% CI: 1.86%, 3.65%) satisfaction with care scores, and 4.43%-point (95% CI: 3.52%, 5.34%) higher key clinical practices, controlling for covariates. PC-ISP indicators related to communication with providers showed stronger associations with quality of care compared to other PC-ISP sub-constructs. Some support person-reported PC-ISP experiences were positively associated with women’s satisfaction and key practices.ConclusionsIntegrating support persons, as key advocates for women, is important for respectful maternity care. Practices to better integrate support persons, especially improving communication between support persons with providers, can potentially improve the person-centered and clinical quality of maternity care in Kenya and other low-resource settings.

Teacher’s Perception of Child-friendly School Environment in Public ECDE Centres in Uasin-Gishu County

Education is an important factor in improving children's social and economic development all around the world. Despite the number of developing nations providing universal primary education, the quality of such education remains a concern that must be addressed. Therefore, the purpose of this study was to evaluate the influence of teachers’ perception of child-friendly school environment in public ECDE Centres in Uasin-Gishu County. The study was underpinned by the Reggio Emilia philosophy of early childhood education. The study adopted a pragmatic paradigm utilising both qualitative and quantitative methods. The study used simple random sampling to select ECDE teachers. A purposive sampling technique was used to select head-teachers and QASO officers. The tools that were used in this study were questionnaires and an interview guide. Qualitative data from interviews were analyzed thematically. Data from questionnaires were analyzed using both descriptive and inferential statistical methods. The findings showed teachers' perceptions were positively and significantly associated with a child-friendly learning environment (r =.459, n = 271, p 0.00), indicating that teachers' perceptions influenced the child-friendly school environment by 45.9%. The study concluded that teachers had a positive attitude towards teaching and pupils while some teachers had negative attitudes towards their learners. Teacher’s attitude affects the learning environment of pre-school children. A teacher's classroom activities influence their children's learning, and a motivated teacher is one who feels satisfied with his or her job. The study recommends teachers be provided with resources to support their implementation of child-friendly practices. This could include materials such as books, games, and activities that are appropriate for young children. Also provide teachers with professional development opportunities such as workshops or seminars on cognitive-behavioral strategies to help them recognize and address negative perceptions among learners. The study suggests research analyzing the effect of teacher operational dynamics on service delivery in ECDE Centres to be pursued to determine options in all the counties in Kenya.

Understanding performance of public hospitals: operational strategies approach in Kajiado County, Kenya

The performance of the healthcare sector is crucial for delivering optimal patients care and creating efficient healthcare systems. However, Kajiado County in Kenya faces various challenges that obstruct effective performance. This paper aims to assess the impact of operational strategies on performances of public hospitals in Kajiado County, Kenya. Specifically, it aimed to investigate the effect of information management strategy, continuous quality improvement strategy, innovation strategy, and resources management strategy on hospital performance. This study was anchored on balanced scorecard model, resource-based theory, quality improvement theory, and technology acceptance model, and employed a descriptive research design. Primary data was gathered through questionnaires distributed to full-time healthcare workers, following a successful pilot study in Narok County. Data collection utilized the drop-and-pick later method. Statistical Package for the Social Sciences software was used to analyze the data, involving descriptive statistics such as percentages, frequencies, means, and standard deviations while multiple regression model was used to test the relationship between independent variables and the dependent variable. Main findings of the study revealed that there exists a statistically significant relation between information management strategy and hospital performance, as well as continuous quality improvement strategy, innovation strategy, and resource management strategy, respectively. Consequently, the study recommended that the County Health Department should initiate a comprehensive training program for healthcare professionals, collaborate with hospital management to adopt innovative technologies, and identify and address skill gaps while promoting a positive work environment within public hospitals in Kajiado County. These actions aim to enhance hospital performance and ultimately improve patient care in the region.

Evaluating cropping intensity in registered and unregistered farms: Evidence from Kenya

Sustainable agricultural intensification strategies are crucial in increasing Africa's agricultural productivity. Globally, literature shows strong linkages between land tenure security and sustainable agriculture. However, in Sub-Saharan Africa (SSA), findings remain inconsistent. Studies attribute this inconsistency to the use of cost-benefit and yield methodologies that are limited in capturing the nuance of subsistence farming and spatial and temporal distribution. Thus, this study seeks to fill this gap using Tharaka Nithi County in Kenya by employing remote-sensing and spatial econometrics to evaluate this relationship. The study uses the Normalised Difference Vegetation Index (NDVI) as the dependent variable and a proxy for cropping intensity, which similar studies have not used. NDVI datasets covered seven years (2014–2020) acquired from Copernicus Global Land Service. Explanatory factors include land registration status, topography and climatic characteristics. The study utilises a three-step analysis, which includes exploratory regression for model selection, global regression using Ordinary Least Squares (OLS), and localised regression using Geographically Weighted Regression (GWR). Spatial autocorrelation tests on OLS residuals using Moran's Index indicated spatial heterogeneity; hence, the study ran GWR. GWR performed better with an adjusted R2 value of 0.941, compared to OLS with an R2 value of 0.807. Mapping the GWR model illustrated that NDVI is lowest in unregistered land in the semi-arid zone of the County (0.012608) and highest in registered areas (0.883172). A hot-spot analysis using the Gettis-Ord Gi* Statistic validated the findings. The test showed cold spots in unregistered land in the semi-arid zone and hot spots in registered land, which was significant at 99 % confidence. The findings shows that the relationship between land registration and cropping intensity is highly significant, particularly in arid and semi-arid lands (ASALs), an indicator that land tenure security promotes sustainable agriculture in Kenya. The results enrich policy discussions aimed at land reforms and sustainable agriculture. The study recommends fast-tracking land registration prioritising ASALs, implementing the national land information system, and modernisation of land registries in Kenya to improve public access to land information. The study also recommends similar studies on various agroecological zones to supplement the findings, mainly where subsistence farming is dominant. The findings will add a critical layer of information in decision-making for sustainable agriculture and land reform policies.

From conflict to coexistence: Reaffirming belonging and property rights through the ‘sons of village’ discourse in post-conflict Kenya

This article explores the puzzle of victims of political violence in Kenya committing to return to contested spaces of their prior victimhood and displacement. It considers how political violence has been brought to bear on understandings of property rights and belonging among Kikuyu victims of political violence in the Burnt Forest area of Uasin Gishu County in Kenya. It is reported that the iteration between the collapse of the multiparty Kenyan state commitment to protect Kikuyu land rights in their state settled areas and the partisan character of neo-customary tenure that restricts the admission of co-ethnic outsiders, induced Kikuyu spontaneous resistance to their spatial political confinement motivating their formulation of an organic discourse of belonging. The article introduces the ‘sons of village’ concept as a bottom-up framework for understanding the informal mechanisms for claiming property rights and belonging in contested spaces in Africa. By challenging notions of belonging rooted in contested histories and emphasizing credible links to land and space, this concept embodies inclusive citizenship with the potential to foster conciliatory relations between previously hostile groups in post-conflict scenarios. The 'sons of village' identification, therefore, offers a promising avenue for fostering positive peace in regions afflicted by chronic violence in Africa and beyond.

Physico-chemical characterization of feldspars for application as fluxing agents: Experimental and ab initio computational approaches

Feldspars are tectosilicates with unique composition and structural features employed to help develop the glassy phase while firing ceramic raw materials. This promotes vitrification by lowering sintering temperatures thereby making it more energy efficient and sustainable. This study examined the physico-chemical parameters of feldspars found in Marimanti, Tharaka Nithi county in Kenya with the aim of determining their fluxing capabilities. This was achieved through the use of ab-initio theoretical computations and experimental investigation into phases, morphology and thermal stability. Experimental results showed albite and anorthite mineral phases with dominant alumina and silica content, classifying it as a plagioclase type. Further experimental results revealed four predominant phases viz: Ca-feldspar, K-feldspar, Na-feldspar and quartz with mesoporous morphology and average particle sizes of 5 μm. Thermal stability studies showed a significant derived weight loss per °C in the 400–700 °C range with a peak at 497.67 °C. Three-dimensional atomistic simulations conducted on albite, anorthite and feldspar mineral phases were computed using the Cambridge Serial Total Energy Package (CASTEP) module of Material Studio software, using generalized gradient approximation (GGA) with Perde-Burke-Ernzerhof (-PBE) correction function. Accordingly, ab initio studies showed the minerals had a 3D triclinic lattice structure with predicted bulk moduli of 45.91 GPa and 88.86 GPa for albite and anorthite, respectively. In furtherance, the computed band gap energies were 2.644 eV for albite and 2.661 eV for anorthite, indicating high insulation capacity for both mineral phases. Overall, the experimental and computational results obtained were in agreement with literature on fluxing properties. Further, the outstanding properties reported indicated high quality feldspars which can be exploited sustainably for application as fluxing agents.

Exploring biochar and Moringa oleifera seed proteins for greywater remediation on small farms

This study investigated the potential of using biochar and Moringa oleifera seed proteins for sustainable greywater treatment in rural Kenya. Greywater samples from washing clothes were collected from households in the Kenyan counties of Kwale and Siaya. Two treatment methods, batch stirring and filtration, were used to assess the effectiveness of using biochar and Moringa oleifera seed protein extract together to treat greywater at a household level. Both methods achieved a significant reduction in contaminants: colour was reduced by up to 43% in Kwale and 67% in Siaya, turbidity decreased by 91–98%, and surfactant levels were lowered by 89–93%. There were increases in total organic carbon and total dissolved solids post-treatment, but both methods effectively reduced levels of phosphates, nitrates and iron. This research highlights the potential of using locally available materials for greywater treatment and provides insights into sustainable water management nature-based solutions in the Global South.

Social Capital and Environmental Performance: An Investigation in the Kenyan Meat Supply Chain

Abstract This paper aims to investigate the effect of social capital on environmental performance in the Kenyan informal meat supply chain. Social capital is categorized into three categories: structural capital, relational capital, and cognitive capital. The authors seek to understand which of the three dimensions of social capital influences environmental performance within the meat supply chain. The study was based on data collected using surveys from 85 abattoirs and 164 traders from four counties in Kenya: Nairobi, Kiambu, Machakos, and Kajiado. Statistical analysis was conducted using partial least squares structural equation modelling (PLS-SEM). The results also indicated a positive and significant relationship between structural social capital and environmental performance, while relational and cognitive capital had positive but insignificant relationships. The findings highlighted the disparities in the effect of social capital on environmental performance between formal and informal agri-food supply chains. To our knowledge, this finding presents a distinct contribution to social capital and environmental performance studies in informal buyer-supplier relationships in agri-foods. The study is one of the first to examine social capital and environmental performance in an informal agri-food supply chain with a focus on trader-abattoir relationships. The informal supply chain is an important context in which to examine the effects of social capital.

Climate Change and Gender Differential Impacts among Farmers in Tharaka-Nithi County in Kenya

Climate Change and Gender Differential Impacts among Farmers in Tharaka-Nithi County in Kenya

The Impact of Covid-19 Pandemic on Reproductive Health in Kenya: Challenges, Lessons and Opportunities

Health systems and healthcare delivery around the world have been greatly affected by the COVID-19 pandemic. In Kenya, the attainment of universal health coverage (UHC) has been hampered by the pandemic, particularly in the areas of reproductive, maternal, newborn, and child health (RMNCH). This paper examines the effect of COVID-19 on RMNCH in Kisumu, Isiolo, Machakos, and Nyeri counties in Kenya. The objective of the study was to determine if there was a significant change in service delivery under reproductive, maternal, newborn, and child health in hospitals under the Universal Health Coverage Program. The target population was the patients seeking RMNCH services in these hospitals. The study arrived at a sample of 78 respondents achieving a response rate of 84%. The study used a mixed-methods approach, comprising both quantitative and qualitative data collection methods. The quantitative data were collected through a retrospective analysis of RMNCH indicators from January 2019 to June 2021, while the qualitative data were collected through in-depth interviews with healthcare workers and community members. The key finding of the study was that there was a significant decrease in the quality of RMNCH services during the COVID-19 period compared to before the pandemic. This conclusion is based on the results of a Wilcoxon Signed Ranks Test, which produced a test statistic Z of -4.321 and an Asymp. Sig. (2-tailed) value of 0. The challenges identified as hindering access to and provision of RMNCH services during the pandemic include inadequate personal protective equipment, inadequate supply of essential medicine, and reduced funding for RMNCH services. The study concluded that COVID-19 pandemic had a significant negative impact on RMNCH in the four counties. The pandemic led to disruptions in health service delivery, resulting in reduced access to essential RMNCH services. Consequently, there was an increase in maternal and child deaths. Recommendations include strengthening health systems, improving access to essential RMNCH services, and providing necessary resources and support to healthcare workers for delivering high-quality care.

A qualitative assessment of influenza vaccine uptake among children in Kenya

BackgroundInfluenza is a significant contributor to acute respiratory infections (ARI), and children < 5 years are at increased risk of severe influenza disease. In Kenya the influenza vaccine is not included in the Kenya Expanded Programme on Immunization (KEPI). To inform roll-out of a national influenza vaccination program, we implemented an influenza vaccine demonstration project in Nakuru and Mombasa counties in Kenya from 2019 to 2021 and set out to establish factors driving influenza vaccine acceptance and hesitancy among caregivers of children aged 6–23 months. MethodsUsing semi-structured questionnaires, we conducted eight focus group discussions among community members and twelve key informant interviews among healthcare workers to elicit both lay and expert opinions. Thematic analysis of the interviews was conducted using the World Health Organization’s “3 Cs” model of vaccine hesitancy to determine reasons for acceptance or hesitancy of the influenza vaccine. ResultsThe influenza vaccine was well received among community members and healthcare workers though concerns were raised. Vaccine hesitancy was fuelled by misconceptions about reasons for introducing the vaccine (confidence), perceptions that influenza was not a serious disease (complacency) and administrative fees required at some facilities (convenience). Despite the use of various advocacy, communication and social mobilisation strategies targeted at educating the community on the influenza disease and importance of vaccination, there remained a perception of inadequate reach of the sensitization among some community members. Contextual factors such as the COVID-19 pandemic affected uptake, and parents expressed concern over the growing number of vaccines recommended for children. ConclusionDespite lingering concerns, caregivers had their children vaccinated indicating that vaccine hesitancy exists, even among those who accepted the vaccine for their children. Efforts targeted at increasing confidence in and reducing misconceptions towards vaccines through effective communication strategies, are likely to lead to increased vaccine uptake.

Strategic Sourcing and Performance of Lake Region Economic Bloc, Kenya

The devolved governments in Kenya undertake projects that make up over 50% of government spending and are important to the economy. To improve the performance of projects and efficiency in service delivery, Kenyan county governments commonly award bids using strategic sourcing. However, despite the adoption of strategic sourcing, the performance of devolved systems of government remains poor. The general objective of this study was to determine the effect of strategic sourcing on performance of devolved systems of government in the Lake Region Economic Bloc, Kenya. The specific objectives were to establish the effect of supplier relationship management, market research, analytics, and multiple sourcing on the performance of devolved systems of government in the Lake Region Economic Bloc, Kenya. The study is significant to the administration of County governments in the Lake Region Economic Bloc, the policy makers as well as other researchers and academicians. The study adopted a cross sectional research design. The target population of the study was all the 47 county governments in Kenya, which are categorized into 6 regional blocs. The target population of the study was all the 47 county governments in Kenya, which are categorized into 6 regional blocs. The respondents included heads of departments in finance, procurement, public relations and information and communication technology as well as their assistants in 14 Counties in the Lake Region Economic Bloc (LREB). A semi-structure questionnaire was used in the collection of data. Data was analyzed using qualitative data and quantitative methods. Qualitative data was analyzed using content analysis and the results were presented in a narrative form. Descriptive and inferential statistics were used in analyzing quantitative data with the help of the Statistical Package for Social Sciences (SPSS version 25) statistical software. Quantitative results were presented in the form of tables and figures. The study found that supplier relationship management has a positive and significant effect on performance in devolved systems of government in the Lake Region Economic Bloc, Kenya. The study also established that market research has positive and significant effect on performance in devolved systems of government in the Lake Region Economic Bloc, Kenya. The study further revealed that analytics has positive and significant effect on performance in devolved systems of government in the Lake Region Economic Bloc, Kenya. Also, the study found that multiple sourcing has positive and significant effect on performance in devolved systems of government in the Lake Region Economic Bloc, Kenya. The study recommends that County government should develop training programs and workshops for government procurement officers and suppliers to enhance their understanding of procurement processes, compliance requirements, and best practices. County governments should regularly update market information related to various goods and services required by the government. In addition, County governments should create a dedicated analytics department or unit within the government structure to focus on data collection, analysis, and interpretation. In addition, County governments should monitor supplier performance regularly and use data-driven insights to make decisions about contract renewals or terminations