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ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.4
, Dece
m
b
er
2
014
,
p
p
.
2
1
3
~
223
I
S
SN
: 225
2-8
8
0
6
2
13
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
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r
na
l.com/
o
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lin
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e
x.ph
p
/
IJPHS
Factors Influencing Utilization of
Health S
e
rvi
ces
i
n
Ken
y
a: The
Case of Hom
a
Bay County
O
t
ieno
St
ep
h
e
n
O
d
iwuo
r
1
, M
a
cha
r
i
a
D
avid
2
1
Agenc
y
for
Co
operat
i
on and
R
e
s
earch
in
Development (ACORD),
Nairob
i,
Ken
y
a
2
Department of Distance
Studies
, U
n
ivers
i
t
y
of
N
a
irobi
, K
e
n
y
a
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
Se
pt 8, 2014
Rev
i
sed
O
c
t 20
, 20
14
Accepted Nov 15, 2014
In order to
im
prove eff
i
ci
enc
y
in he
alth
servi
ce d
e
liv
er
y in
Ken
y
a,
th
e
Ministr
y
of
Health h
a
s develope
d stru
ctu
r
es through inter-sectoral
collaboration at
various
levels.
Despite effor
t
s b
y
th
e government and k
e
y
stakehold
e
rs to
improve health sector
,
ut
il
iz
at
i
on of he
a
l
t
h
se
rvi
c
e
s
st
il
l
rem
a
ins
a m
a
jor chall
e
nge. Th
e purpos
e
of the stud
y
was to investigat
e
factors
that inf
l
uence utilizatio
n of
health
serv
ices
in Homa B
a
y
County
,
Ken
y
a. The stud
y
emplo
y
ed
survey
desig
n
and focused on health
benefi
ciar
ies
,
D
i
s
t
rict He
alth
M
a
na
gement Team and
other
key
health
s
t
akehold
e
rs
, an
d us
ed both quantit
ativ
e and q
u
alit
ativ
e dat
a
.
Quantit
ativ
e
data was co
llected through hou
sehold
interviews of 384 respondents and
qualitativ
e data was generated
thr
ough Key
I
n
formant Interv
iews of 16
respondents. Th
e stud
y
r
e
veals that he
alth f
i
nancing
,
service deliv
er
y
,
qualit
y,
acc
essibilit
y and equit
y
influen
ce
u
til
iz
ation
of
hea
lth services i
n
Hom
a
Ba
y
Coun
t
y
. It
is for th
ese
reasons tha
t
th
e
stud
y
r
ecom
m
e
nds that th
e
government should allocate adequate budg
et to
wards health ser
v
ices, avail
adequate trained health workers, a
nd improve infrastructure in health
faci
lit
ies as well
as drugs
and ot
her supplies. Th
ere is also need
for further
res
earch
on
cul
t
u
ral f
a
c
t
ors
influ
e
ncin
g
utilizatio
n of
he
al
th s
e
rv
i
ces
.
Keyword:
Accessib
ility
Equ
ity
Health
fin
a
n
c
in
g
Qu
ality
Serv
ice d
e
liv
ery
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
St
ephe
n Ot
i
e
n
o
,
Age
n
cy
fo
r C
o
ope
rat
i
o
n a
n
d
R
e
search
i
n
De
vel
o
pm
ent
(A
C
O
R
D
)
,
P.O
.
B
o
x 1
3
9
8
8
– 00
4
0
0
Nai
r
obi
– Ke
ny
a.
Em
a
il: S
m
ak
o
tien
o
@yaho
o
.co
m
1.
INTRODUCTION
In
19
9
4
, t
h
e G
ove
r
n
m
e
nt
of Keny
a (
G
OK
) app
r
ove
d t
h
e
Keny
a Heal
t
h
Pol
i
c
y
Fram
ewo
r
k
(K
HP
F
)
as a b
l
ueprin
t
for d
e
v
e
l
o
p
i
n
g
an
d m
a
n
a
g
i
n
g
h
ealth
serv
ices. It sp
ells ou
t
th
e lon
g
-term
strateg
i
c im
p
e
rativ
es
and the a
g
enda for
Kenya’s health sector. To operatio
nal
i
se the Fram
e
w
ork, the
M
i
ni
st
ry
of Heal
t
h
(M
O
H
)
devel
ope
d t
h
e
Keny
a Heal
t
h
Pol
i
c
y
Fram
ewo
r
k Im
pl
em
ent
a
t
i
on
Act
i
o
n Pl
an a
nd es
t
a
bl
i
s
hed t
h
e
Heal
t
h
Secto
r
Reform Secretariat (HSRS)
in
1
996
und
er a Mi
n
i
sterial Reform Co
mmittee
(MRC) in
19
97
to
spearhea
d
and
ove
rsee the implem
enta
tio
n
p
r
o
cess. A ration
a
lizatio
n
programme with
in
th
e MOH
was also
in
itiated
.
Th
e
ab
ov
e
p
o
licy in
itiativ
es ai
m
e
d
at respon
d
i
ng
to
th
e fo
llowing
con
s
trai
nts: d
eclin
e in
h
ealth
secto
r
exp
e
nd
it
u
r
e, in
efficien
t
u
tilizatio
n
o
f
resou
r
ces
, cen
t
ralized
d
ecision m
a
k
i
n
g
,
in
equitab
l
e m
a
n
a
g
e
men
t
in
fo
rm
atio
n
syste
m
s, o
u
t
d
a
ted
h
ealth
laws, in
ad
eq
u
a
te
man
a
g
e
m
e
n
t
sk
ills at th
e d
i
strict lev
e
l, wo
rsen
ing
po
ve
rt
y
l
e
vel
s
, i
n
creasi
n
g b
u
r
d
en
o
f
di
sease,
an
d rapi
d po
p
u
l
a
t
i
on g
r
o
w
t
h
[1]
.
The c
h
allenge
facing t
h
e
governm
ent is to re
vers
e
these
constrai
nts. T
h
e
National Health Sector
St
rat
e
gi
c Pl
an II (
2
0
0
5
-
2
01
0)
pro
p
o
ses t
o
i
m
prove ser
v
i
ce del
i
v
ery
by
u
s
i
ng si
x l
e
vel
s
of care del
i
ver
y
:
Level
1, t
h
e com
m
uni
t
y
l
e
vel
;
Level
s
2
an
d
3 (
d
i
s
pe
nsa
r
i
e
s,
health
cen
tres, an
d
m
a
tern
ity/
n
ursing
ho
m
e
s
)
;
and
Lev
e
ls
4
-
6 (p
ri
m
a
ry, secon
d
ary and tertiary ho
sp
itals).
In
t
h
is way,
the
ex
isting
v
e
rtical p
r
o
g
rammes will
com
e
together to provide s
e
rvices
to t
h
e
age groups at
these va
rious
levels. T
h
e plan adopts a
broa
der
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS
Vol. 3, No. 4, D
ecem
ber 2014
:
213 – 223
21
4
app
r
oach
- a
m
ove from
t
h
e em
phasi
s o
n
di
sease b
u
r
de
n
t
o
t
h
e p
r
om
ot
i
on
of i
ndi
vi
d
u
a
l
heal
t
h
base
d
on t
h
e
v
a
r
i
o
u
s
stag
es
o
f
t
h
e hu
m
a
n
cycle: p
r
egn
a
ncy an
d
th
e
n
e
w
b
o
r
n
(
u
p
to
t
w
o
w
e
ek
s of
ag
e)
; ear
ly ch
ild
hood
(two
week
s to
fiv
e
years); late ch
ild
ho
od
(6-12
year
s); youth and adoles
cence (13-
24
year
s)
; adu
ltho
o
d
(
25-
59
);
a
n
d
t
h
e el
derl
y
(
6
0+ y
e
a
r
s).
Th
e h
ealth
sect
o
r
co
m
p
rises th
e pub
lic syste
m
,
with
m
a
jor
players
includi
ng
t
h
e MOH a
nd
para
statal
o
r
g
a
n
i
zatio
n
s
, an
d
t
h
e priv
ate secto
r
,
wh
ich
in
clu
d
e
s pr
iv
at
e for-p
r
ofit, NGO, and
FB
O
facilities. Accord
i
n
g
to
th
e m
o
st recen
t
h
ealt
h
m
a
n
a
g
e
m
e
n
t
in
formatio
n
syst
em
(HMIS) d
a
ta, th
ere are ov
er 5,00
0 h
ealth facilit
ies
acro
s
s th
e co
un
try op
erated
by th
ree own
e
r
syste
m
s, w
ith
th
e gov
ern
m
en
t runn
ing
41
%
o
f
t
h
e facilities, no
n-
go
ve
rnm
e
nt
al
or
ga
ni
zat
i
ons (
N
G
O
s
)
1
5
%,
a
nd pri
v
at
e
b
u
si
nesses 43
%
(
M
OH, 2
0
0
7
)
. The go
ver
n
m
e
nt
o
w
ns
m
o
st o
f
th
e h
o
sp
itals, h
ealth
cen
ters, and
d
i
sp
en
saries,
while clin
ics an
d n
u
rsing
ho
m
e
s are en
tirely in
th
e
hands of
the private
sector.
According to Mi
nistry of Medi
cal Services
(MOMS) records,
t
h
ere
a
r
e 165
healt
h
facilities sp
read
acro
s
s th
e t
h
ree
d
i
stricts fo
rm
in
g
Ho
m
a
Bay Co
un
ty; Ho
m
a
Bay,
Rach
uon
yo
and
Sub
a
Districts.
Th
e
p
u
b
lic h
e
alth
syste
m
c
o
n
s
ists
o
f
th
e fo
llowi
ng
levels o
f
h
ealth
facilities: n
a
ti
o
n
a
l
referral
hos
pi
t
a
l
s
, pr
o
v
i
nci
a
l
ge
neral
hos
pi
t
a
l
s
, di
st
r
i
ct
hos
pi
t
a
l
s
, health
cent
r
es, and dispe
n
sari
es. National
re
ferral
hos
pitals are
at the ape
x
of the he
alth ca
re system
, p
r
ov
id
ing
sop
h
i
sti
cated
d
i
ag
no
st
ic, th
erap
eu
tic, and
reh
a
b
ilitativ
e serv
ices. Th
e two
n
a
tio
n
a
l referral ho
sp
itals
are Ken
y
atta Natio
n
a
l Hosp
ital in
Nairo
b
i
and
Mo
i
Referral a
nd
T
eaching Hos
p
ital in Eldoret.
The e
qui
vale
nt
private
refe
rra
l hos
pitals are Nairobi Hos
p
ital and
Ag
a
Kh
an
Ho
sp
ital in
Nairo
b
i. Prov
in
cial
ho
sp
itals act as referral ho
sp
itals to
th
eir d
i
strict h
o
s
p
itals. Th
ey
also provi
de
very specialized care. Th
e prov
in
cial lev
e
l acts as an in
te
rmed
iary b
e
tween
th
e n
a
tion
a
l
cen
tral
lev
e
l an
d
th
e
districts. Th
ey ov
ersee t
h
e i
m
p
l
e
m
en
tatio
n
o
f
h
ealth
po
licy at th
e d
i
strict le
v
e
l, m
a
in
tain
q
u
a
lity
stan
d
a
rds, an
d
co
ord
i
n
a
te and co
n
t
ro
l all d
i
strict h
ealth
activ
ities. Si
m
ilar
p
r
i
v
ate ho
sp
it
als at th
e p
r
ovin
c
ial
lev
e
l in
clud
e
Ag
a Kh
an
Ho
sp
itals in
Kisum
u
an
d
M
o
m
b
asa.
New Nyan
za
Pro
v
i
n
c
ial
Gen
e
ral
Hosp
it
al is th
e
refe
rral
ho
spita
l fo
r
Hom
a
Bay
Cou
n
ty
.
As a res
u
lt of
health sector re
form
s that have decentr
alized health service
s
, se
rvices are integrated as
o
n
e
go
es
do
wn
th
e h
i
erarchy o
f
h
ealth
stru
cture fro
m
th
e n
a
tion
a
l lev
e
l to
th
e
p
r
ov
incial an
d
d
i
strict lev
e
ls.
Unde
r decent
r
alisation,
the
district
handles supervisory
re
sp
onsi
bilities. Unfortunatel
y, supervision
has not
been
very effe
ctive, as one t
echnical pe
rs
on is ofte
n
required to s
upe
rvi
s
e several technical areas of
service
del
i
v
ery
at
l
o
wer
l
e
vel
s
.
T
h
e P
r
ovi
nci
a
l
Heal
t
h
M
a
nag
e
m
e
nt
Team
(PHM
T)
p
r
ovi
des s
u
per
v
i
s
i
o
n a
n
d
m
a
nagem
e
nt
sup
p
o
rt
t
o
t
h
e
di
st
ri
ct
s an
d s
u
b
-
di
st
ri
ct
s wi
t
h
i
n
t
h
e
pr
ovi
nce.
At
t
h
e di
st
ri
ct
l
e
vel
,
cu
rat
i
v
e
servi
ces are
pr
ovi
ded
by
di
st
ri
ct
hos
pi
t
a
l
s
and m
i
ssi
on ho
spi
t
a
l
s
. Pu
bl
i
c
heal
t
h
ser
v
i
ces
are
m
a
naged
by
t
h
e
Di
st
ri
ct
Heal
t
h
M
a
nagem
e
nt
Team
(DHM
T) an
d P
ubl
i
c
Health
Un
it of t
h
e d
i
strict ho
sp
itals. Th
e
DHMT and
Di
st
ri
ct
Heal
t
h
M
a
nagem
e
nt
B
o
ar
d (
DHM
B
)
pr
o
v
i
d
e m
a
nagem
e
nt
and
sup
e
r
v
i
s
i
o
n su
pp
o
r
t
t
o
ru
ral
heal
t
h
facilities (sub
-d
istrict ho
sp
itals, h
ealth
cen
t
r
es, an
d d
i
sp
ensaries). At
th
e sub
-
d
i
strict lev
e
l,
b
o
t
h
p
r
even
tiv
e
and c
u
rative se
rvices a
r
e provided
by
the
he
alth centres as
well as dis
p
en
saries and
out
reach services t
o
the
co
mm
u
n
ities
with
in
th
e catch
m
e
n
t
areas. Basic p
r
ev
en
tiv
e
an
d
cu
rativ
e
serv
ices for m
i
n
o
r ailm
en
ts are b
e
ing
add
r
esse
d at
t
h
e com
m
uni
t
y
and
h
o
u
se
hol
d l
e
vel
wi
t
h
t
h
e
i
n
t
r
od
uct
i
o
n
of
t
h
e com
m
uni
t
y
pac
k
age
[
1
]
.
Alth
oug
h sev
e
ral h
ealth-o
rien
ted NGOs
o
p
erate th
r
oug
hou
t th
e coun
tr
y, th
e
po
pu
lation
co
ver
e
d
b
y
th
ese NGO
h
e
alth
serv
ices can
n
o
t
b
e
easily d
e
termin
ed
.
Th
e MOH
and ex
ter
n
al don
or
s supp
or
t th
e h
ealth
services
offere
d by NGOs and the private s
ector in se
vera
l
way
s
. Depe
n
d
i
n
g o
n
t
h
ei
r c
o
m
p
arat
i
v
e ad
vant
a
g
e
,
NG
Os, FB
Os,
and com
m
uni
t
y
-based
or
ga
n
i
sat
i
ons (C
B
O
s) unde
rtake s
p
ecific health
services
. The
MOH
p
r
ov
id
es su
pport to
missio
n
health
facilities
b
y
train
i
ng
th
ei
r staff as
w
e
ll as secon
d
i
n
g
st
aff to
th
ese facilit
ies
and offe
ring
drugs
a
n
d vacci
nes.
C
u
r
r
ent
l
y
, t
h
e
pri
v
at
e sect
o
r
(
bot
h f
o
r-
pr
ofi
t
and
n
o
t
-
fo
r-
pr
ofi
t
)
c
o
nt
ri
b
u
t
e
s o
v
er
4
0
perce
n
t
o
f
heal
t
h
serv
ices in
t
h
e coun
try,
p
r
o
v
i
d
i
ng
m
a
in
ly cu
rativ
e
he
alth services
and very
few preve
n
tive
s
e
rvices.
Mo
d
a
lities ex
i
s
t for M
O
H sup
e
rv
ision
an
d
m
o
n
ito
rin
g
of
NGO, FBO and
o
t
h
e
r
p
r
i
v
ate-sector facilities. Th
e
NGOs and
p
r
i
v
ate
facilities
work with
commu
n
ities
in
co
llab
o
ration
with
the DHMT.
Th
e
co
mm
u
n
ity
pr
o
g
ram
m
es repo
rt to t
h
e
DHM
Bs,
w
h
i
c
h re
p
o
rts t
o
t
h
e hea
d
qua
r
t
ers t
h
r
o
ug
h
t
h
e Provincial
Health
Man
a
g
e
m
e
n
t
Bo
ard
s
. Th
eir activ
ities are gu
i
d
ed b
y
M
O
H stan
d
a
rd
s and
pro
t
o
c
o
l
s.
Whi
l
e
t
h
ere ar
e effo
rt
s by
t
h
e go
ver
n
m
e
nt
and
ot
he
r st
ak
ehol
ders t
o
i
m
pr
o
v
e pr
o
v
i
s
i
o
n of
heal
t
h
serv
ices in
Ken
y
a, t
h
ere are m
a
j
o
r
g
a
p
s
in
relatio
n
to
u
tilizatio
n
o
f
h
ealth
care serv
ices
esp
e
cially
at
co
mm
u
n
ity lev
e
l. Vari
o
u
s
stud
ies h
a
v
e
b
een co
ndu
cted
t
o
assess fact
o
r
s t
h
at in
fl
u
e
n
ce
utilizat
io
n
of health
serv
ices i
n
ternatio
n
a
lly an
d
ev
en
i
n
Ken
y
a an
d
so
m
e
o
f
th
e facto
r
s in
clude; co
st o
f
h
ealth
serv
ices an
d
q
u
a
lity
of services.
Th
e curren
t literatu
re ackn
owledg
es th
at th
ere are
m
u
lti
p
l
e d
e
term
in
ants o
f
health
, wh
ich
recogn
ize
t
h
e rol
e
o
f
bi
o
l
ogy
, be
ha
vi
o
u
r
, cul
t
u
re, eco
nom
i
c
s, psy
c
h
o
l
o
gi
cal
, envi
r
onm
ent
a
l
and soci
al
fact
ors
and t
h
e
in
ter
c
onn
ectedn
e
ss of
th
ese [
2
]-
[5
]. In
dev
e
lop
i
ng
c
ountries, these factors are
ne
wer c
onsi
d
erat
ions as
co
un
tries with
li
mited
resou
r
ces
strugg
le
to
co
p
e
w
ith
m
o
rtalit
y an
d
m
o
rb
id
ity as a resu
lt o
f
co
mm
u
n
i
cab
le
di
sease, i
n
j
u
r
y
, p
ove
rt
y
,
s
e
xual
a
n
d re
pr
o
duct
i
v
e
he
al
t
h
i
ssues,
a
n
d
m
o
re rece
nt
co
nce
r
ns
s
u
ch
as
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Fa
cto
r
s In
flu
en
cing
Utiliza
tio
n o
f
Hea
lth
Services in
Kenya
:
Th
e Case
of Homa
… (Oti
en
o S
t
ep
h
e
n
Od
iwou
r)
21
5
hype
rtension,
heart disease
[6] and di
abet
es that are
more lifestyle-ori
ent
e
d res
u
l
t
s
of de
vel
o
pm
ent
[7]
.
Howe
ver, m
o
re recent st
udie
s
are
begi
nni
ng to
discove
r
that unless
health and ill-
healt
h
in less
de
velope
d
co
un
tries is con
s
id
ered
in
t
h
is b
r
o
a
d
e
r con
t
ex
t, in
eq
u
a
lities will o
n
l
y b
eco
m
e
m
o
re ev
id
en
t [8
]. Th
erefore,
k
nowledg
e
o
f
th
e p
a
ttern
s t
h
at in
flu
e
nce t
h
e use
of
health and m
e
dical se
rvices i
n
developing c
o
unt
ries are
n
e
e
d
ed
to
ad
dre
s
s
th
is
.
St
udi
es c
o
nd
u
c
t
e
d i
n
Ke
ny
a an
d
ot
her
devel
opi
ng
co
unt
ri
es re
veal
t
h
e f
o
l
l
o
wi
n
g
fact
ors
as
influe
ncing utilization
of hea
lth
serv
ices: c
o
st/fina
n
cing,
acce
ss, health delivery,
a
ttitude, t
r
aditional
health
serv
ices, low
ed
u
cation
lev
e
l, awaren
ess
o
f
h
ealth services, qu
ality o
f
h
ealth services, and
equ
ity in
healthcare
provision. According to a
st
udy
conducted
by Dusti
n
, the t
w
o
bi
gge
st factors curre
ntly preventi
ng
healthcare
from
reaching a l
a
rg
e
r
proportion
of the
popul
ation a
r
e t
h
e
hi
gh c
o
st
of services, and
poor
access
to
h
ealth facilities [9
].
Wh
ile st
u
d
i
es
h
a
v
e
b
e
en
do
ne on
u
tilizatio
n
in
so
m
e
reg
i
on
s in Ken
y
a and
o
t
h
e
r co
un
tri
e
s, in
cl
u
d
i
ng
th
e 20
03
Ken
y
a Hou
s
eho
l
d
Health
Ex
p
e
nditu
re and
Utili
zatio
n
Su
rv
ey, n
o
st
u
d
y
h
a
v
e
b
een
do
n
e
i
n
Ho
m
a
B
a
y
C
ount
y
,
c
o
m
p
ri
si
ng t
h
e
t
h
ree
di
st
ri
ct
s;
R
achu
o
n
y
o
,
H
o
m
a
B
a
y
and Su
ba. T
h
e
pu
r
pos
e o
f
t
h
i
s
st
udy
was
to investigate factors that infl
uence
utilization
of health se
rv
ices in Hom
a
Bay
County,
Kenya. T
h
e study was
gui
ded
by
t
h
e
f
o
l
l
o
wi
ng
fi
ve
o
b
ject
i
v
es:
i.
To
estab
lish
t
h
e in
fl
u
e
n
c
e of
h
ealth
fin
a
n
c
ing
o
n
u
tilizatio
n of
h
ealth
serv
i
ces in
Ho
m
a
B
a
y Co
un
ty
ii.
To
assess t
h
e i
n
fl
u
e
n
c
e of
serv
ice
d
e
liv
ery
o
n
u
tilizatio
n
of
h
ealth
serv
ices in
Ho
m
a
Bay Cou
n
t
y
iii.
To
estab
lish
t
h
e in
fl
u
e
n
c
e of
q
u
a
lity h
ealth serv
ices
on
u
tilizatio
n
o
f
h
ealt
h
serv
ices in
Ho
m
a
Bay Co
u
n
ty
iv
.
To assess influence of accessibility
to
healthcare se
rvices
on
utilization of
health services in Hom
a
Bay
Co
un
try
v.
To
estab
lish in
fl
u
e
n
c
e of equ
ity in
h
ealth
care
p
r
ov
isio
n
o
n
u
tilizatio
n
o
f
h
ealth serv
i
ces in
Ho
m
a
Bay
Co
un
ty
The st
u
d
y
was
just
i
f
i
e
d
by
hi
gh
po
ve
rt
y
l
e
vel
s
of 6
8
% (a
v
e
rage
) acr
oss t
h
e t
h
ree
di
st
ri
ct
s form
i
n
g
Ho
m
a
Bay Co
u
n
t
y coup
led
with
in
ad
equ
a
t
e
h
ealth
in
frastru
c
ture and
o
t
h
e
r facto
r
s in
flu
e
n
ce
u
tilizati
o
n
o
f
h
ealth
serv
ices in
t
h
is co
un
ty. Ad
d
ition
a
lly,
h
ealth
b
e
ing
an
im
p
o
r
tan
t
asp
ect
o
f
liv
eliho
o
d
,
it is im
p
o
r
tan
t
to
assess th
e lev
e
l o
f
u
tilizatio
n
o
f
su
ch
serv
ices d
e
p
e
nd
ing on
th
e
p
r
ev
ai
lin
g
circu
m
sta
n
ces.
Th
e
study w
a
s
necessa
ry for
Hom
a
Bay County bei
n
g in
Nyanza P
r
ovi
n
ce, where
heal
th service
provision and
utilization
r
e
ma
i
n
s
a
ma
j
o
r
co
n
c
er
n
.
In
or
der t
o
im
pro
v
e p
r
ovi
si
o
n
of
heal
t
h
ser
v
i
ces i
n
Ke
ny
a, t
h
e Nat
i
o
nal
He
al
t
h
Sect
or St
r
a
t
e
gi
c Pl
an
II (
2
00
5
-
2
0
1
0
)
pr
op
oses t
o
i
m
prove ser
v
i
c
e del
i
v
ery
by
u
s
i
ng si
x l
e
vel
s
of ca
re del
i
v
e
r
y
.
Hom
a
B
a
y
C
o
u
n
t
y
h
a
s 165
h
ealth facilities acro
ss lev
e
ls 1
to
4, p
r
ov
id
ing
h
e
alth
serv
ices to
th
e p
e
o
p
l
e bu
t
v
a
ri
o
u
s
factors li
mi
t
u
tilizatio
n
of su
ch serv
ices in th
e co
un
ty. Th
is stud
y
h
a
s
gen
e
rated
ev
id
en
ce
o
n
so
m
e
of th
e
k
e
y
factors th
at
in
flu
e
n
ce u
tilizatio
n
o
f
h
ealth serv
ices in
o
r
d
e
r to
inform
p
o
licy
m
a
k
e
rs, Min
i
stry o
f
Health
- b
o
t
h
at co
un
ty
and ce
nt
ral
go
ver
n
m
e
nt
l
e
vel
s
- t
o
ef
fect
i
v
el
y
respo
n
d
to h
ealth
systems in
th
e coun
ty. Th
e stud
y
wou
l
d
b
e
n
e
fit th
e local co
mm
u
n
i
t
y
b
y
id
en
tifyin
g
k
e
y factors in
flu
e
n
c
ing
u
tilizatio
n
o
f
h
ealth
serv
ices an
d
sug
g
est
i
n
g
h
o
w
t
o
i
m
prove
t
h
e si
t
u
at
i
o
n.
T
h
e st
udy
w
oul
d al
s
o
bene
fi
t
r
e
searche
r
s
by
pr
o
v
i
d
i
n
g e
v
i
d
ence
fo
r
refe
rence
re
garding
utilization of
health se
rvi
ces in m
a
ny pl
aces including
Hom
a
Bay County.
The
study wa
s
conducted across the
t
h
ree
di
s
t
ri
ct
s;
Hom
a
B
a
y
,
R
ach
uo
ny
o
an
d
Su
ba,
f
o
r
m
i
ng
Hom
a
Bay Co
un
ty an
d it targ
eted
lo
cal co
mm
u
n
ity wh
o are th
e health be
neficiaries, public and
pri
v
ate health
facilities and key health stakehol
ders
, especi
ally health
NGO represe
n
tatives in the county. In carryi
ng
out
th
is stud
y, t
w
o assu
m
p
tio
n
s
were tak
e
n
i
n
to
con
s
id
eratio
n;
t
h
at
t
h
e
res
p
on
de
nt
s
wo
ul
d agree t
o
partic
ipate in
t
h
e s
u
r
v
ey
, a
n
d t
h
at
t
h
ey
w
o
ul
d
be
t
r
ut
hf
ul
–
p
r
o
v
i
d
i
n
g a
ccurat
e
i
n
f
o
rm
at
i
on
use
f
ul
f
o
r t
h
e
st
u
d
y
.
B
a
sed
o
n
t
h
i
s
rep
o
rt
, t
h
e
expect
e
d
res
p
on
de
nt
s part
i
c
i
p
at
ed i
n
t
h
e st
udy
an
d t
h
e fi
ndi
ng
s are i
n
l
i
n
e wi
t
h
ot
her
r
e
l
e
vant
stu
d
i
es t
h
at
hav
e
b
een
d
one elsewh
er
e with
in
th
e countr
y
and
o
u
t
si
de, wh
ich im
p
l
ies th
at m
o
st o
f
th
e
resp
o
nde
nt
s w
e
re
t
r
ut
h
f
ul
.
2.
R
E
SEARC
H M
ETHOD
Th
is was a cro
ss-sectio
n
a
l
d
e
scri
p
tiv
e and
p
a
rticip
atory stu
d
y
invo
lv
i
n
g
bo
th
qu
an
t
itativ
e an
d
q
u
a
litativ
e m
e
t
h
odo
log
i
es. The stu
d
y
was con
d
u
c
ted
in
two
p
h
a
ses. Ph
ase1
: Rev
i
ew of relev
a
n
t
literature to
in
fo
rm
th
e in
d
i
cato
r
s and
v
a
riab
les in
flu
e
n
c
i
n
g
u
tilizatio
n
o
f
h
ealth
serv
ices g
l
o
b
a
lly, in
th
e co
n
tin
en
t as well
as Ken
y
a and
g
a
ps th
at ex
ist in
Ho
m
a
Bay
Co
un
ty to
b
e
co
n
s
i
d
ered
du
ri
n
g
th
e im
p
l
e
m
en
tatio
n
stud
y. Ph
ase2
:
Field visit to conduct face to face
intervie
ws in qua
n
titative and
qualita
tive
m
e
thods
using structure
d
and
semi-stru
c
tured
qu
estion
n
a
i
r
es an
d
g
u
i
d
e
s fo
r
d
a
ta co
ll
ectio
n
.
Th
e qu
an
titativ
e in
fo
rm
atio
n
an
swers the
co
n
c
ern
s
o
f
how m
u
ch
an
d wh
at is th
e situ
atio
n
wh
ile
t
h
e
q
u
a
litativ
e
d
a
ta an
swer th
e
percep
tion
and
feelin
g
o
f
th
e co
mm
u
n
ity an
d
informan
ts o
n
th
e
gap
s
th
at ex
ist as far as u
tilizatio
n
o
f
health
serv
ices in
Homa Ba
y
C
o
u
n
t
y
i
s
co
nc
erne
d.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS
Vol. 3, No. 4, D
ecem
ber 2014
:
213 – 223
21
6
The st
u
d
y
em
pl
oy
ed s
u
r
v
ey
research
desi
gn a
nd
it in
vo
lv
ed
in
terv
iewing
th
e lo
cal co
mm
u
n
i
t
y
me
m
b
ers who are t
h
e
recipi
ents
of
h
ealth services
, health workers
and
pr
of
ession
als
as w
e
ll as o
t
her
k
e
y
stak
eho
l
d
e
r
s
.
Th
e stud
y popu
latio
n
in
cl
u
d
e
d
hou
seho
lds in
th
e co
un
ty, D
i
str
i
ct H
ealth Man
a
g
e
m
e
n
t
Team
(D
HM
T) m
e
m
b
ers
,
an
d N
G
O
s re
prese
n
t
a
t
i
ves. Th
e t
o
t
a
l
ho
use
hol
d p
o
pul
at
i
o
n o
f
H
o
m
a
B
a
y
C
ount
y
i
s
206,255 according to the
2009
Ke
nya Population and Housi
n
g Census
. This household
population is
di
st
ri
b
u
t
e
d ac
r
o
ss t
h
e t
h
ree
di
st
ri
ct
s as fol
l
o
ws:
H
o
m
a
B
a
y (7
9,
5
4
0
)
, R
a
c
h
u
o
n
y
o
(8
1,
3
9
5
) a
n
d S
uba
(4
5,
32
0
)
.
In
ad
d
ition
to
th
e ho
u
s
eho
l
d
s
, th
ere are
21
DHMT m
e
m
b
ers fro
m
th
e t
h
ree
d
i
stricts fo
rm
in
g
Ho
m
a
Bay
Co
un
ty as w
e
ll as 2
3
h
ealth
NG
O
s
. Based
o
n
th
e categ
or
ies o
f
r
e
spon
d
e
n
t
s
f
o
r
th
e stud
y, a sa
m
p
le o
f
400 w
a
s
d
r
awn
acro
s
s t
h
e
v
a
ri
o
u
s
cat
eg
ories.
Th
e sa
m
p
le was
pr
op
ortion
a
te to th
e
p
opu
latio
n. Tab
l
e
1 ou
tlin
es t
h
e
brea
k
d
o
w
n of st
udy
res
p
o
n
d
e
n
t
s
.
Tabl
e 1.
B
r
eak
do
w
n
of st
u
d
y
resp
o
nde
nt
s
Cat
e
gory
Sub category
Total Population
Sa
m
p
le
Percen
tage Sa
m
p
le
si
z
e
Co
m
m
unity
Household inter
v
ie
wees
206,
25
5 house
hold
s
18.
62%
384
Key
I
n
form
ants
DHMT
21
43%
9
Health
NGOs/CBOs
NGOs/CBO repres
entatives
23
30%
7
Tot
a
l
400
To effectively get accurate and
represe
n
tative data
, t
w
o
broa
d data c
o
llection m
e
thods
were
use
d
;
t
h
at
i
s
, sec
o
n
d
a
ry
an
d
pri
m
ary
dat
a
col
l
ect
i
o
n
.
Sec
o
nda
ry
dat
a
col
l
ect
i
o
n
was
d
one
t
h
ro
ug
h
des
k
revi
e
w
a
n
d
di
scussi
o
n
wi
t
h
key
st
ake
h
o
l
ders w
h
i
l
e
pr
im
ary
dat
a
col
l
ect
i
on was d
one t
h
r
o
u
g
h
i
ndi
vi
d
u
al
h
o
u
s
eh
ol
d
in
terv
iews an
d k
e
y inform
an
t in
terv
iews
with
h
ealth
w
o
rke
r
s a
nd
ot
he
r
k
e
y
st
akeh
ol
de
r
s
. T
h
e fi
r
s
t
l
e
v
e
l
of
v
a
lid
ation
invo
lv
ed
rev
i
ew o
f
k
e
y v
a
riab
les
with
th
e
gu
id
an
ce
o
f
m
y
sup
e
rv
iso
r
. Th
is was fo
llowed b
y
d
e
fen
s
e i
n
wh
i
c
h
a team
o
f
pan
e
lists p
r
ov
ided
furth
e
r gu
idan
ce.
In ord
e
r t
o
en
sure
reliabilit
y, reh
e
arsals were
d
o
n
e
with
th
e
assistan
t(s) t
o
en
su
re th
at th
ey fu
lly u
n
d
e
rst
o
od
th
e i
n
strumen
t
s an
d
were
m
o
tiv
ated
eno
ugh
to
carry o
u
t
th
e work with
ou
t in
trodu
cing
any
au
x
iliary q
u
estio
n
s
wh
ich
m
a
y
d
i
sto
r
t
t
h
e respon
ses.
The
p
r
ep
ared
i
n
terview gu
id
es
were p
r
e-tested
with
so
m
e
o
f
th
e
targ
et pop
u
l
atio
n
b
e
fore fu
ll
ad
m
i
n
i
stratio
n
to
the
selected sam
p
le.
Th
e d
a
ta cap
t
ured
co
nstitu
ted b
o
t
h
qu
an
titativ
e and
qu
alitativ
e d
a
ta.
Qu
an
t
itativ
e d
a
ta were an
alyzed
usi
n
g S
PSS
1
7
.
0
by
r
u
n
n
i
n
g f
r
e
que
nci
e
s,
cro
ss-t
a
bul
at
i
ons
, c
h
i
s
qua
r
e
t
e
st
s, co
rrel
a
t
i
on a
n
d
re
gre
ssi
on
t
o
g
e
n
e
rate v
a
riou
s relation
s
h
i
p
s
,
frequ
en
cies and
co
m
p
arison
s.
Qu
alitativ
e d
a
ta were tran
scri
b
e
d
and
su
mm
arized
alo
n
g
t
h
em
es an
d
su
b th
em
es to
b
ack up
qu
antitativ
e d
a
ta.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
The st
u
d
y
was
con
d
u
ct
ed t
h
r
o
u
g
h
i
n
di
vi
d
u
a
l
i
n
t
e
rvi
e
ws
o
f
38
4 (
1
79 m
a
les and
2
05
fe
m
a
l
e
s), key
in
fo
r
m
an
t in
ter
v
iew
s
w
ith
n
i
n
e
D
M
H
T
r
e
pr
esen
tativ
es and
sev
e
n
NGOs r
e
pr
esen
tatives.
Th
is p
a
r
t
o
f
th
e
rep
o
rt
f
o
cuse
s
on
dat
a
anal
y
s
i
s
, p
r
ese
n
t
a
t
i
on a
n
d
i
n
t
e
r
p
ret
a
t
i
on
base
d
on
t
h
e
dat
a
c
o
l
l
ect
ed f
r
om
i
ndi
vi
d
u
al
in
terv
iews and k
e
y in
fo
rm
an
t in
terv
iews. It
p
r
o
v
i
d
e
s ov
erv
i
ew
o
f
facto
r
s in
flu
e
n
c
ing
u
tilizatio
n
o
f
h
ealth
servi
ces i
n
H
o
m
a
B
a
y
C
oun
t
y
. The su
b s
ect
i
ons are
ba
sed o
n
t
h
e
fi
v
e
i
nde
pen
d
e
n
t
vari
abl
e
s t
h
at
were
st
udi
e
d
.
3.
1.
He
al
th
Fi
nanci
n
g
Kenya
is a l
o
w-i
n
com
e
country
with
a
se
verely lim
ited health
budg
et [10]. Access
to good healt
h
serv
ices is poor esp
ecially in
rural areas. In
th
e late
19
70
s
K
e
n
y
a exp
a
nded
its ru
ral
h
e
alth
facilities to
m
e
e
t
th
e n
e
ed
s
of its predo
m
in
an
tly rural po
or
po
pu
latio
n adopting the
1978
Alm
a
Ata Declaration
on Primary
h
ealth
care [1
1]. In
th
e 1
990
s Ken
y
a fo
llowed
th
e sh
ift in
h
ealth
po
licy t
o
ward
s in
stitu
tio
n
a
l and
stru
ctu
r
al
ref
o
rm
and
m
a
rket
ori
e
nt
at
i
o
n
o
f
heal
t
h
se
rvi
ces base
d
o
n
t
h
e 1
9
9
3
Wo
rl
d
Devel
opm
ent
R
e
po
rt
[
1
2]
.
Th
e ab
ility to
p
a
y fo
r
h
ealth
serv
ices
d
e
termin
es wh
et
h
e
r p
e
o
p
l
e
v
i
sit health
facilities o
r
no
t. The
study re
vealed that am
ong t
hose who
had visited health facilities
to
access health servi
ces, 49% had
been
t
o
g
o
v
e
rn
m
e
n
t
h
e
alth
facilities, 3
5
% h
a
d
b
een to
NGO/FB
O
m
a
n
a
g
e
d
h
eal
th
facilities while 1
6
%
h
a
d
been
to
p
r
i
v
ate h
ealth facilities wi
th
in
th
e coun
ty. Th
is i
m
p
lies th
at
maj
o
rity g
e
t h
ealth
serv
ices fro
m
p
u
b
lic/g
ov
ernmen
t h
ealth
facilities. Th
is inform
at
io
n
app
e
ars in Figure
1
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Fa
cto
r
s In
flu
en
cing
Utiliza
tio
n o
f
Hea
lth
Services in
Kenya
:
Th
e Case
of Homa
… (Oti
en
o S
t
ep
h
e
n
Od
iwou
r)
21
7
Government
health
factilities
49%
NGO/FBO
manned
health
facilities
35%
Private
health
facilities
16%
Ty
pes o
f
hea
l
th fa
cilities
v
i
sited
Fig
u
re 1
.
Typ
e
s
of h
ealth
facilities
v
i
sited
Pay
m
en
t for health
serv
ices
v
a
ries acco
r
d
i
ng
to
categ
ories o
f
h
ealth
facilities. A cro
ss t
a
b
u
l
ation
o
f
th
o
s
e who
v
i
sited
v
a
ri
o
u
s h
eal
th
facilities an
d
p
a
id
m
o
n
e
y i
s
rep
r
esen
ted
in
Tab
l
e 2
.
Am
o
n
g
189
respon
d
e
n
t
s
who
visited public health fac
ilities, 172
paid m
oney
whil
e
17 did not. Am
ong
135 who visited NGO/FBO
m
a
nned health
facilities,
103 paid wh
ile 32 did not. In
addition,
m
ong
t
h
e
60 res
p
ondent
s
who visited
private
h
ealth
facilities, 57
p
a
id
wh
il
e 3
d
i
d
n
o
t
. Lo
ok
ing
acro
ss
th
e th
ree catego
r
ies of h
ealth facilities v
i
sit
e
d
,
th
e
stu
d
y
rev
ealed
th
at 86
%
p
a
id fo
r h
ealth serv
i
ces wh
ile 14
%
d
i
d
no
t.
Tab
l
e
2
.
C
r
o
s
s
tab
u
l
ation
o
f
ty
p
e
o
f
h
ealth facilit
y v
i
sited
an
d p
a
ym
en
t o
f
m
o
n
e
y
Paid for services
Total
Yes
No
Type facilit
y visite
d
Gover
n
m
e
nt hospital (
H
ealth Centr
e
,
Dispensary,
Hospital)
172 (
91%)
17 (
9
%)
189 (
100%)
NGO/FBO
m
a
nne
d health facility
103 (
76%)
32 (
24%)
135 (
100%)
Private
57 (
95%)
3 (
5
%)
60 (
100%)
Total
332 (
86%)
52 (
14%)
384 (
100%)
Health
fin
a
n
c
i
n
g
/
fund
ing
is
main
ly fro
m
pu
b
lic
f
unds t
h
at include allocation t
o
the
Ministry of
Health
, Con
s
titu
en
cy Dev
e
lo
p
m
en
t Fu
nd (CDF), and
Lo
cal Au
t
h
ori
t
y Tran
sfer Fu
nd
(LATF).
Oth
e
r
st
akeh
ol
de
rs i
n
t
h
e heal
t
h
sec
t
or i
n
cl
ude
N
G
O
s c
ont
ri
but
i
o
ns,
pri
v
at
e i
n
di
vi
d
u
al
s an
d al
s
o
co
st
sha
r
i
n
g,
Th
e
go
ve
rnm
e
nt
of
Keny
a has al
way
s
i
ndi
cat
ed
t
h
e com
m
itm
ent
t
o
sup
p
o
rt
h
eal
t
h
needs
of
her
peo
p
l
e
an
d
i
n
t
h
i
s
r
e
g
a
r
d
, is a si
gn
ator
y to
A
buja D
ecl
arat
i
o
n
whi
c
h re
q
u
i
r
es
g
ove
rnm
e
nt
t
o
allocate at least 15% of
national
budget to health servi
ces.
This, however, has not been accom
p
lished as
can be
evi
d
ent from
2010/2011
nat
i
onal
b
u
d
g
e
t
whe
r
e t
h
e
go
ve
rnm
e
nt
al
l
o
cat
ed
6.
5%
of t
h
e
bu
d
g
et
t
o
heal
t
h
w
h
i
l
e
i
n
20
1
1
/
2
0
12 t
h
e
allo
catio
n
t
o
ward
s h
ealth is
5
.
5
%
.
Foc
u
si
n
g
o
n
H
o
m
a
B
a
y
C
ount
y
,
Hom
a
B
a
y
di
st
ri
ct
has al
l
o
cat
ed US
$
48
0
00;
R
ach
u
ony
o Di
st
ri
ct
has al
l
o
cat
ed
US
$ 1
0
9
1
5
0
whi
l
e
S
u
b
a
Di
st
ri
ct
has al
l
o
c
a
t
e
d US
$
2
1
7
9
66 t
o
wa
r
d
s
he
al
t
h
ser
v
i
ces (
A
O
P
7
)
.
Th
is allo
catio
n co
m
p
rises GoK bud
g
e
t, C
D
F and
LATF
. Discussi
ons
with
DHMT representative reveale
d
t
h
at
l
earni
ng
f
r
om
pre
v
i
o
us
bu
d
g
et
s, t
h
i
s
a
l
l
o
cat
i
on ca
n
n
o
t
ad
equ
a
tely su
ppo
rt
h
ealth requ
irem
en
ts in
the
Co
un
ty. Th
is im
p
l
ies th
at th
e d
e
ficit will h
a
v
e
to
b
e
raised fro
m
co
st-sh
a
ring
, th
at is, t
o
b
e
p
a
id
b
y
p
a
tien
t
s
wh
en
ev
er
th
ey v
i
sit
th
e h
ealth
facilities.
Acco
r
d
i
n
g t
o
a st
udy
by
Hj
ort
s
ber
g
o
n
i
n
com
e
as a determ
i
n
ant
of h
eal
t
h
seeki
n
g
beha
vi
o
r
i
n
Zam
b
ia [1
3
]
,
fin
a
n
c
ial resou
r
ces in
term
s o
f
in
co
m
e
were
fo
und
to
be b
e
tter co
rrelated
with h
ealth,
p
a
rticu
l
arly in
rural pop
u
l
atio
n
s
.
On
e con
s
id
eration
fo
r th
o
s
e th
at are
self-em
p
lo
yed in
farm
in
g
o
r
sm
a
ll
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
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252
-88
06
IJPHS
Vol. 3, No. 4, D
ecem
ber 2014
:
213 – 223
21
8
busi
n
ess
fr
om
fi
sh t
r
a
d
e,
fo
r
exam
pl
e, i
s
t
h
at
i
n
com
e
can be un
pre
d
i
c
t
a
bl
e i
n
t
e
rm
s of am
ount
and
reg
u
l
a
ri
t
y
and t
h
i
s
can
be
pr
o
b
l
e
m
a
t
i
c
i
n
usi
n
g
heal
t
h
c
a
re.
On
w
u
je
k
w
e and
Uz
oc
hu
k
w
u i
n
a st
u
d
y
i
n
S
out
heast
Ni
geri
a
fo
u
nd t
h
at
r
u
ra
l
pop
ul
at
i
o
n
s
were l
e
ss l
i
k
el
y
t
o
pay
t
h
e cost
of heal
t
h
car
e t
r
eatm
e
nt
upfr
ont
an
d m
o
re l
i
k
el
y
to
p
a
y in in
stal
l
m
en
ts [14
]
. Th
e assu
m
p
tio
n
in
th
e
Nig
e
rian stu
d
y
t
h
erefore was t
h
at reg
u
larity o
f
in
co
me m
a
y
be a m
o
re appropriate pre
d
ictor,
for these
particula
r
survey populations
, of no
t just willingness to
pay for
h
ealth
care serv
ices,
bu
t ab
ili
ty to
do
so
. This is also
t
h
e case fo
r Ho
m
a
Bay Co
un
ty in Ken
y
a wh
ere
m
o
s
t
p
e
op
le liv
e b
e
l
o
w pov
erty line.
From
t
h
e fi
ndi
ngs
, m
o
st
pe
o
p
l
e
are
n
o
t
abl
e
t
o
pay
for
adequate health s
e
rv
ices due
to low
i
n
com
e
an
d th
is cor
r
ob
or
ates the f
i
nd
ing
s
o
f
a st
u
dy co
ndu
ct
ed
i
n
M
a
da
gascar
b
y
Gl
i
c
k
[1
5]
.
The
Ke
ny
an
si
t
u
at
i
o
n
may ev
en
b
e
worse con
s
id
erin
g
t
h
e
h
i
gh
co
st
o
f
liv
i
n
g
wh
ich
fo
rces p
e
o
p
l
e t
o
sp
en
d th
e little th
ey hav
e
on
f
ood
r
a
th
er
than
sp
end
i
ng
on
tr
eatm
e
n
t
. Th
e lin
k
a
g
e
s
o
f
h
ealth
to
p
o
v
e
r
t
y r
e
d
u
c
tion
and
to
long-
ter
m
econom
i
c growth a
r
e
powe
rful
,
m
u
ch st
r
o
nge
r t
h
an
i
s
ge
neral
l
y
u
n
d
erst
oo
d.
P
ove
rt
y
h
a
s ad
ver
s
e ef
fe
ct
s o
n
h
ealth
statu
s
; co
nv
ersely, p
oor h
ealth
co
nt
ri
but
es t
o
bei
n
g
po
or. T
h
i
s
scenari
o
im
pl
i
e
s
t
h
at
m
o
st
peop
l
e
are
n
o
t
ab
le to
access h
ealth
serv
ices d
u
e
to
in
abilit
y to
p
a
y fo
r su
ch
serv
ices co
n
s
i
d
eri
n
g
h
i
gh
lev
e
l o
f
pov
erty in
th
e Coun
ty.
3.2.
He
alth Se
rvice Deli
very
Effectiv
e
h
ealth
serv
ice d
e
li
v
e
ry is d
e
term
in
ed
b
y
th
e ex
isten
ce of
h
e
alth
facilities,
staffing
and
av
ailab
ility o
f
d
r
ug
s and
o
t
her equ
i
p
m
en
t/su
p
p
lies. Th
e st
u
d
y
assessed
h
ealth
serv
ice
d
e
liv
ery in term
s o
f
h
ealth
facilitie
s, staffing
and
av
ailab
ility o
f
o
t
h
e
r equ
i
p
m
e
n
t th
at facilitat
e
d
e
liv
ery o
f
health
serv
ices.
Wh
ile
in
Ho
m
a
Bay,
th
ere were h
e
alth
facilities p
r
o
v
i
d
i
ng
v
a
rious h
ealth
serv
ices to
th
e p
e
op
l
e
, it was rev
e
laed
th
at
su
ch
facilities h
a
v
e
inad
equate staffing
of h
ealth wo
rk
ers an
d so
m
e
o
f
th
e
h
ealth
workers do
no
t h
a
v
e
ad
equ
a
te sk
ills. As elsewh
ere in
th
e cou
n
t
ry
, d
i
strict h
o
sp
i
t
als in
th
e Co
un
ty co
n
c
en
trat
e o
n
th
e
d
e
liv
ery o
f
health care se
rvices and
gene
rate their own
expe
nditure
pl
ans a
nd
bu
d
g
e
t
req
u
i
r
em
ent
s
base
d o
n
g
u
i
d
el
i
n
es
f
r
o
m
h
ead
qu
ar
ter
s
thr
oug
h
th
e pr
ov
in
ce. A
n
d
as
r
e
ve
laed in
3.1, t
h
e gover
nm
ent health servi
ce is
sup
p
l
e
m
e
nt
ed by
ot
he
r st
ake
hol
ders
wh
o t
o
get
h
e
r
pr
o
v
i
d
e
bet
w
een
3
0
and
40
perce
n
t
of t
h
e
ho
spi
t
a
l
bed
s
i
n
Ken
y
a. As shown in Tab
l
e 3, th
ere
are
1
6
5
h
ealth
facilitie
s of
v
a
ri
ou
s typ
e
s spread acro
ss t
h
e t
h
ree districts
m
a
ki
ng H
o
m
a
B
a
y
C
o
u
n
t
y
.
Table
3.
Health
facilities in Hom
a
Bay County
Indicator
District
Ho
m
a
Bay
Rachuonyo
Suba
Hospitals
3
4 4
Health centres
9
13
15
Dispensar
i
es 34
34
25
M
e
dical Clinics
5
6
Nur
s
ing Ho
m
e
s
2
3
VCT centr
es
5
2
Other
1
Tot
a
l 53
66
46
165
Sou
rce:
Mo
MS
,
20
11
; D
i
strict S
t
rateg
i
c Plan
s
200
5-2
010
Th
e stud
y rev
e
aled
th
at wh
ile Ho
m
a
Bay C
o
un
ty h
a
s a con
s
id
erab
le
n
u
m
b
er o
f
h
ealt
h
facilities to
address
health needs of the
p
e
op
le,
h
ealth serv
ice
d
e
liv
ery is h
i
nd
er
e
d
by
sh
ort
a
ge
o
f
ade
q
uat
e
l
y
t
r
ai
ned
heal
t
h
w
o
r
k
e
r
s
and al
so i
n
ad
equat
e
esse
nt
i
a
l
equi
pm
ent
and s
u
ppl
i
e
s.
, For i
n
st
ance
, i
n
H
o
m
a
B
a
y
di
st
ri
ct
there we
re 11 health fac
ilitie
s without all tr
acer drugs
for
m
o
re than two weeks (A
OP
7). This im
plie
s that
those who we
re sick during the pe
ri
od of the study coul
d not
receive re
qu
ire
d
services and this
, in the long
run
,
i
n
fl
u
e
n
ces u
tilizatio
n
of
h
ealth
serv
ices in
Ho
m
a
Bay
Co
un
ty. Th
is
d
e
term
in
an
t is co
n
c
ern
e
d
with
wh
ich
typ
e
o
f
h
ealth
facility is
m
o
r
e
av
ailab
l
e to
p
r
o
s
p
ectiv
e users. Th
is wou
l
d
in
clud
e the lev
e
l of exp
e
rti
s
e and
treat
m
e
n
t
th
at co
u
l
d
b
e
assumed
fro
m
th
e typ
e
of
facility,
th
at is a
ho
sp
i
t
al v
e
rsu
s
a d
i
sp
ensary,
or if
p
u
b
lic
facilities are li
mited and not accessible,
so
pri
v
ate facilitie
s have
filled the ga
p, as is the
case in Vietna
m [16],
[1
7]
, or
U
g
a
n
d
a
[
18]
,
[
1
9
]
,
or
In
di
a
[
2
0]
,[
21]
.
a.
Qual
i
t
y
of
he
a
l
th ser
v
i
ces
Qu
ality of
h
ealth
serv
ices
h
a
s
g
r
eat i
n
fl
u
e
n
c
e on
u
tilizatio
n
o
f
h
ealth serv
i
ces and
t
h
e st
ud
y assessed
this in term
s of ti
m
e
taken wit
h
in t
h
e
health facility
to recei
ve treatm
e
nt, how hea
lth workers ha
nd
le pat
i
ents,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
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S I
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SN
:
225
2-8
8
0
6
Fa
cto
r
s In
flu
en
cing
Utiliza
tio
n o
f
Hea
lth
Services in
Kenya
:
Th
e Case
of Homa
… (Oti
en
o S
t
ep
h
e
n
Od
iwou
r)
21
9
av
ailab
ility o
f
o
t
h
e
r b
a
sic amen
ities and
wheth
e
r
p
a
tien
t
s
are g
i
v
e
n ad
equ
a
te ti
m
e
to
exp
l
ain
th
ei
r prob
lems
whe
n
e
v
er t
h
ey visit health
fa
cilities.
Ti
me t
a
ken withi
n
the health
faciliti
es to recei
ve
medical attenti
o
n m
a
y
i
n
fl
ue
nce
heal
t
h
see
k
i
n
g
beha
vi
o
u
r
o
f
t
h
e
pe
opl
e.
Tabl
e
4 s
h
o
w
s t
i
m
e t
a
ken b
e
t
w
ee
n ar
ri
val
t
o
a
n
d
de
p
a
rt
ur
e
from
health fac
ilit
ies whe
n
pat
i
ents visit
health
facilities to recei
ve health services.
Table
4. Tim
e
taken
withi
n
the h
ealth
facility to recei
ve tre
a
t
m
ent
Ti
m
e
ta
k
e
n w
i
thin health
facility
Frequen
c
y
Percen
tage
L
e
ss than 1 hour
10
2.
6%
2 – 3 hour
s
64
16.
7%
3 – 4 hour
s
135
35.
5%
4 – 5 hour
s
126
32.
8%
M
o
r
e
than 5 hour
s
49
12.
8%
Reg
a
rd
ing
ti
me tak
e
n
b
e
tween
arri
v
a
l an
d
dep
a
rt
u
r
e ti
m
e
with
in
th
e h
eal
th
facility, al
mo
st 7
5
% of
health seeke
r
s spe
n
t
m
o
re than 3 ho
urs at the facility chosen
to access
medical services. Much as the study
r
e
v
eals th
atm
a
j
o
r
ity of
th
e
patien
t
s f
e
lt th
at th
ey w
e
r
e
h
a
n
d
l
ed
i
n
a
good
m
a
n
n
e
r wh
en
they v
i
sited
h
ealth
facilities an
d
t
h
at th
ey
were
g
i
v
e
n
ad
eq
u
a
te op
portun
ity
to exp
l
ain
t
h
eir
p
r
ob
lem
s
to
th
e do
ctors i
n
o
r
d
e
r t
o
provide
releva
nt dia
g
nosis, the long
waiting peri
od be
fore receiving
servic
es m
a
y be det
r
imental to those
who
n
eed urg
e
n
t
at
ten
tio
n
and
th
i
s
m
a
y in
th
e lo
ng
run
h
i
nd
er u
tilizatio
n
o
f
su
ch
serv
ices.. Th
ese fi
n
d
i
n
g
s are
im
port
a
nt
beca
use, as re
veal
e
d
by
Al
de
rm
an and La
vy
[2
2]
, as wel
l
as t
h
e fi
ndi
ngs
of t
h
e st
udy
con
d
u
c
t
ed i
n
Nyeri, Ken
y
a
b
y
Ng
ure [2
3
]
, wh
en
patien
t
s p
e
rcei
v
e
qu
ality
o
f
h
ealth
serv
ices as
p
oor o
r
low, t
h
eir healt
h
seeki
n
g be
havi
or
re
duce
s
.
b.
Accessibility to
hea
l
thca
re serv
ices
This st
udy
assessed accessibi
lity to healthca
re se
rvices
in term
s of
distance to
health fa
cilit
y, m
eans
o
f
tran
spo
r
t and
av
ailab
ility o
f
m
ean
s o
f
transp
ort.
Dist
an
ce to
h
ealth
facilities d
e
term
in
es
p
e
op
le’s ab
ility to
trav
el to
su
ch
h
ealth
facilities to
seek m
e
d
i
cal atten
tio
n
.
Tab
l
e
5
shows
av
erag
e d
i
stan
ce
to
h
ealth
facilitie
s
according t
o
the res
p
ondents
interviewe
d.
Tab
l
e 5
.
Av
erag
e d
i
stan
ce
t
o
h
ealth
facilities
As far as di
st
a
n
ce i
s
conce
r
n
e
d, som
e
58%
of t
h
e re
s
p
ondents recorded t
h
at th
ey had to travel
m
o
re
than
5km
to access health s
e
rvices,
In fac
t
, a whole
18% of t
h
e re
sponde
nts ha
d t
o
do
10km
and ove
r
.
Add
itio
n
a
lly,
av
ailab
ility o
f
reliab
l
e
m
ean
s o
f
tran
sp
ort
an
d
th
e ab
ility o
f
p
e
op
le to
afford
su
ch
m
ean
s
determ
ine their choice of whi
c
h m
eans
of transport to use
to
reach
health facilities. Table 6 shows m
eans of
tran
sp
ort to h
e
alth
facilities as rev
ealed
b
y
t
h
e st
u
d
y
.
Tab
l
e
6
.
Means of tran
sp
ort t
o
th
e n
e
arest
health
facility
Means of transpo
r
t
Frequen
c
y
Percen
tage
W
a
lking 128
33.
3%
Bicy
cles/
m
otor
cycles
155
40.
4%
Public tr
anspor
t (
v
ehicles)
84
21.
9%
Pr
ivate vehicles
17
4.
4%
Tot
a
l 384
100%
The study re
ve
als that 33.3%
walk to t
h
e he
alth f
acilities, 40.4% use
bic
y
cles/
m
otor cycles to reach
h
ealth
facilitie
s, 21
.9
%
u
s
e
p
u
b
lic v
e
h
i
cles wh
ile 4
.
4
%
u
s
e
p
r
i
v
ate v
e
h
i
cles to
reach h
ealth
faciliti
es. Th
i
s
i
m
p
lies th
at 3
3
% o
f
tho
s
e
walk
ing
to
h
ealth
facilities
m
o
st
lik
ely can
no
t affo
rd
to
p
a
y for th
e ex
istin
g
means
of t
r
a
n
s
p
ort
.
I
t
i
s
al
so wo
rt
h n
o
t
i
n
g t
h
at
very
sm
al
l
prop
o
r
t
i
on
(4
%)
of t
h
ose i
n
t
e
rvi
e
wed
use
d
pri
v
at
e
vehi
cl
es.
Distance
to health
facilities
Frequen
c
y
Percen
tage
L
e
ss than 1 k
m
32
8.
3%
2 – 3 k
m
137
35.
7%
5 k
m
144
37.
5%
10 k
m
60
15.
6%
M
o
r
e
than 10 k
m
11
2.
9%
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
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252
-88
06
IJPHS
Vol. 3, No. 4, D
ecem
ber 2014
:
213 – 223
22
0
Accessib
ility i
ssu
es fo
r tho
s
e liv
in
g
in
rural
areas are well d
o
c
u
m
en
ted
,
wh
et
h
e
r it is i
n
d
e
v
e
lop
e
d
co
un
tries [24
]
, o
r
d
e
velop
i
ng
co
un
tries [25
]
. Th
is
is
n
o
t
t
h
e
onl
y
i
ssue
faci
ng t
hose
i
n
rural areas, whe
r
e
there
may b
e
qu
esti
o
n
s
ab
ou
t th
e
q
u
a
lity of t
h
e
serv
ice, cap
acity o
r
t
h
e
facilities o
f
th
e
n
e
arest serv
ice. Perh
ap
s
there are fe
w options for resi
dents
of these
areas, and wi
t
h
limited choices, they ar
e bound to
use any
health
facility, wh
atev
er th
e
qu
ality
in
stead of takin
g
no
action
at all. Or p
e
rhap
s i
n
stead th
ey tu
rn
to altern
ativ
e
t
h
era
p
i
e
s [
2
6]
,
t
r
adi
t
i
onal
m
e
tho
d
s
[
27]
a
n
d/
or
sel
f-m
edi
cat
i
ons
[
28]
,
[
2
9
]
.
A num
b
er of factors influe
nc
e the choice of a hea
lth se
rvic
e; nam
e
ly, phy
sical access to health care
,
in
clu
d
i
n
g
d
i
stan
ce
fro
m
th
e health
facility; av
ailab
ility
o
f
tran
sp
ortatio
n, an
d
th
e
cond
itio
n of t
h
e
ro
ads. As
est
a
bl
i
s
hed
by
No
oral
i
an
d
t
e
am
[30]
, t
h
e
di
st
ance sep
a
rat
i
ng
pot
e
n
t
i
a
l
pat
i
e
nt
s fr
o
m
t
h
e nearest
heal
t
h
facility is an
im
p
o
r
tan
t
b
a
rri
er to
its
u
s
e,
p
a
rticu
l
arly
in
rural areas. Th
is
was actu
a
lly co
nfirm
e
d
b
y
this stu
d
y
an
d
th
ese fact
o
r
s ind
i
v
i
d
u
a
ll
y an
d
co
llectively in
flu
e
n
ce utilizat
io
n
o
f
h
e
alth
serv
ices in
Ho
m
a
Ba
y
Co
un
ty
esp
ecially in
ru
ral areas
wh
ere th
er
e are
no prop
er ro
ad
s
o
v
e
r l
o
ng
d
i
stan
ces
t
o
h
ealth
facilities
co
up
led
with
lack
of ad
eq
u
a
t
e
m
ean
s o
f
t
r
ansp
ort to reach
t
h
o
s
e facilities.
c.
Equity in he
al
thc
a
re pr
ovision
Th
e stud
y assessed
equ
ity in
h
ealth
care
p
r
ov
ision
in
term
s
o
f
respo
n
d
i
ng to
th
e h
ealth
n
eeds o
f
t
h
e
p
e
op
le esp
ecially th
e ab
ility
o
f
h
ealth
facilities to
resp
ond to
co
mm
o
n
ail
m
en
ts in
th
e co
un
ty.
H
ealth
n
eeds
were a
ssesse
d
i
n
t
e
rm
s com
m
on
ai
lm
ent
s
i
n
Hom
a
B
a
y
C
ount
y
.
K
n
o
w
l
e
d
g
e
of c
o
m
m
on ai
lm
ent
s
i
n
fo
r
m
s
t
h
e
d
ecision
b
y
h
e
alth
facilities t
o
sto
c
k
relev
a
n
t
d
r
ug
s
th
at can
ad
equ
a
tely ad
dress su
ch
co
mm
o
n
ail
m
e
n
ts in
Hom
a
B
a
y
C
ount
y
.
Tabl
e
7 s
h
o
w
s c
o
m
m
on
ai
lm
ent
s
i
n
H
o
m
a
B
a
y
C
ount
y
as f
o
u
n
d
out
fr
om
t
h
e st
udy
.
Tabl
e
7. C
o
m
m
on ai
lm
ent
s
Type of ail
m
ent
Frequen
c
y
Percen
tage
M
a
lar
i
a 114
29.
7%
Respir
ator
y
T
r
act
Infection
113
29.
4%
Diar
r
hoea 42
10.
9%
Pneu
m
onia 85
22.
1%
Skin infection
30
7.8%
As reveale
d
i
n
Table 3.7,
t
h
e comm
on
ailm
e
n
ts
in
the C
ounty are m
a
laria, re
sp
irat
o
r
y tract in
fection
an
d
p
n
e
u
m
o
n
i
a. Av
ailab
ility
o
f
relev
a
n
t
drug
s is in
form
ed
b
y
k
nowledg
e o
f
co
mm
o
n
ailmen
ts o
u
tlin
ed ab
ov
e
an
d th
is
h
a
s influ
e
n
ce
on
effectiv
e h
ealth
respo
n
s
e b
y
t
h
e
h
e
alth
facilities. Tab
l
e
8
sh
ows
respon
ses
reg
a
rd
i
n
g
av
ailab
ility o
f
relev
a
n
t
drug
s
wh
en
ev
er p
a
tien
t
s
v
i
sit h
ealth
facilities.
Tab
l
e
8
.
Av
ailab
ility o
f
relevan
t
dru
g
s
fo
r co
mm
o
n
ail
m
en
ts
Availability of all
prescribe
d
drugs
Frequen
c
y
Percen
tage
All dr
ugs
171
44.
5%
Not all dr
ugs
213
55.
5%
Tot
a
l 384
100%
Resp
ond
en
ts
were ask
e
d
wh
eth
e
r th
ey g
e
t all
th
e d
r
ug
s wh
en
ev
er th
ey v
i
sit h
ealth
facilities an
d
44.5.5% said t
h
at they recei
ved all
drugs
while 55.5% m
e
ntione
d t
h
at they
don’t
get all drugs
. T
h
is im
plies
that m
a
jority of patients
do
not recei
ve
all prescri
b
ed
drugs and he
nce m
a
y
not
be a
b
le bene
fit fully from
the
available
health se
rvices. In
som
e
cases,
not every patient
c
a
n reach
h
ealth facilities to ac
cess health services.
W
i
t
h
in this
pol
itical and econom
i
c c
l
imate,
diseases s
u
ch
as
m
a
laria and HIV&AIDS
have a large impact in
Kenya and
place a heavy dis
ease burd
en
on the State, the econom
y
, on
fam
i
lies and on s
o
cial networks.
Malaria accounts for m
o
re t
h
an a million
deaths pe
r y
ear, 90 per ce
nt occurri
ng in sub-Sa
hara
n Africa and
affect
i
n
g chi
l
d
ren u
n
d
er fi
ve y
ears of age
.
I
n
H
o
m
a
B
a
y
Cou
n
t
y
, 2
9
.
7
% of t
h
ose i
n
t
e
r
v
i
e
wed m
e
nt
i
one
d t
h
at
they had
been
to the health
facility due to malaria and 29.4% ha
d vi
sit
e
d health facil
ities because of RTI,
th
ese
b
e
ing
commo
n
ail
m
en
ts in
the co
un
t
y
, wh
ich
is i
n
lin
e with
t
h
e
Mo
MS
d
a
ta of 20
11
fro
m
th
e th
ree
di
st
ri
ct
s. I
n
or
d
e
r t
o
a
d
dres
s
h
eal
t
h
nee
d
s
of
t
h
e
peo
p
l
e
in Ho
m
a
Bay Co
u
n
ty, h
ealth
serv
i
ces shou
ld
target th
e
com
m
on ai
lm
ent
s
m
e
nt
i
one
d by
t
h
e resp
o
n
d
e
nt
s. The st
udy
reveal
s t
h
at
4
5
.
5
% o
f
t
hose i
n
t
e
r
v
i
e
we
d rec
e
i
v
ed
d
r
ug
s wh
en
they v
i
sited
h
ealt
h
facilities an
d th
is i
m
p
lie
s th
at 5
4
.5
%
do
n’t
g
e
t drug
s. Th
is m
ean
s th
at a g
ood
proportion is
not able t
o
utilize health
servic
es whe
n
in nee
d
because the
drugs a
r
e
not adequate.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Fa
cto
r
s In
flu
en
cing
Utiliza
tio
n o
f
Hea
lth
Services in
Kenya
:
Th
e Case
of Homa
… (Oti
en
o S
t
ep
h
e
n
Od
iwou
r)
22
1
4.
CO
NCL
USI
O
N
Prov
ision
o
f
ad
equ
a
te h
ealt
h
serv
ices is imp
o
rtan
t in
add
r
essin
g
t
h
e h
eal
th
n
e
ed
s of the p
e
op
le in
o
r
d
e
r t
o
im
p
r
o
v
e
th
eir
q
u
a
lity o
f
life.
W
i
t
h
in
creasi
n
g
h
ealth
d
e
m
a
n
d
s
,
u
tilizatio
n
o
f
su
ch
serv
ices n
e
eds to
be
assessed
cri
t
i
cal
l
y
. Al
t
h
o
u
g
h
t
h
e g
o
v
er
nm
ent
of
Ke
ny
a a
n
d
ot
he
r st
a
k
eh
ol
ders
ha
ve m
a
de eff
o
rt
s t
o
i
m
pr
o
v
e
u
tilizatio
n
o
f
health
serv
ices,
th
ere are a num
b
e
r o
f
fact
o
r
s th
at n
e
g
a
tiv
ely affect u
tilizatio
n
as
h
a
s
b
e
en foun
d
out
fr
om
t
h
e st
udy
.
Wh
ile th
e
go
vern
m
e
n
t
h
a
s allo
cated
bud
g
e
t to
h
ealth
serv
ices at th
e d
i
strict lev
e
l in
Ho
m
a
Bay
Co
un
ty, th
is
bu
dg
et is
no
t sufficien
t and
add
itio
n
a
l
reso
urces are t
o
b
e
raised
fro
m
co
st-sh
a
ring
.
With
low
in
co
m
e
lev
e
l o
f
m
o
st p
e
op
le in
Ho
m
a
Bay
Co
un
ty, raising
m
o
n
e
y to
p
a
y fo
r h
ealth
serv
ices is a ch
allen
g
e
and
he
nce this
affects utilization
of
health s
e
rvices in
Hom
a
Bay County.
Furt
her m
o
re, m
o
st of thos
e who
are no
t ab
le t
o
affo
rd
h
ealth
serv
i
ces
res
o
rt t
o
ot
her alternative m
e
dici
ne w
h
i
l
e
ot
h
e
rs are
i
n
fl
ue
n
ced
by
cul
t
u
ral
fact
o
r
s
an
d
hence
d
o
not
seek
m
e
di
cal
at
t
e
nt
i
on at
a
l
l
.
Av
ailab
ility o
f
h
ealth
facilities is
an
i
m
p
o
rtan
t asp
ect
o
f
serv
ice d
e
liv
ery an
d
28
% of th
o
s
e
in
terv
iewed
are still n
o
t
ab
le to
reach
h
ealt
h
facilities.
Ad
d
ition
a
lly, staffing
is in
ad
equ
a
te in
m
o
st o
f
th
e
h
ealth
facilitie
s in
Ho
m
a
Bay
Cou
n
t
y. Ot
h
e
r asp
ects th
at
were assessed were av
ailab
ility
of requ
ired
dru
g
s
as
well as su
pp
lies an
d
equ
i
p
m
en
t, and
th
ese
were fou
n
d
to
b
e
in
ad
equ
a
te. In
adequ
a
te staffing
in
m
o
st h
ealth
facilities as well as sh
o
r
tag
e
of d
r
ug
s and
o
t
her relev
a
n
t
supp
lies in
th
ese facilities h
i
n
d
e
r u
tilizatio
n
o
f
h
ealth
services
.
Qu
ality o
f
h
e
alth
serv
ices in Ho
m
a
Ba
y C
o
un
ty was assessed
in
term
s
o
f
ti
m
e
tak
e
n with
in
th
e
h
ealth
facilities, ho
w h
ealth
workers
h
a
n
d
l
e p
a
tien
t
s and
av
ailab
ility o
f
relev
a
n
t
drug
s. Fro
m
th
ese fin
d
i
ng
s, i
t
can
b
e
co
n
c
l
u
ded
th
at
qu
ality o
f
h
ealth
serv
ices affect u
tilizatio
n
o
f
su
ch
serv
ices i
n
Ho
m
a
Bay Co
un
ty
d
u
e
to
long tim
e
taken on the
que
ue
to r
eceive tre
a
tm
ent and how m
o
st health
workers
handl
e
patients whe
n
they
v
i
sit h
ealth
facilit
ies
.
The study asse
ssed accessi
bility to h
ealthcare services in t
e
rm
s of
distance to health fa
cilities and
mean
s of transp
ort to
tho
s
e
health
facilities as well as m
e
a
n
s
o
f
tran
spo
r
t
to
reach
th
e
health
facilities. Th
e
findings
of t
h
e
study
reveal t
h
at m
o
st people travel lo
ng
di
st
ances i
n
or
der t
o
re
ceive
health se
rvices
and
maj
o
rity of t
h
e
m
walk or use
bicycles and
m
o
tor cycl
es
to reach
those health f
acilitie
s. These
factors im
ply
th
at th
ey can
not fu
lly b
e
n
e
fit
fro
m
th
e serv
ices
prov
id
ed
b
y
th
ese h
ealth
facilities.
Capacity to respond to th
e health needs
of
the pe
ople in
Hom
a
Bay
County
is a critical aspect of
eq
u
ity in
h
ealth
care pro
v
i
si
on. The study reveals that re
levant dr
ugs a
r
e not sufficie
n
t to treat common
ail
m
en
ts in
Ho
m
a
Bay
Co
un
ty. Ad
d
ition
a
lly,
m
o
st p
e
op
le in
terv
iewed
felt th
at h
e
alth
facilities
d
o
no
t
respon
d fu
lly to
th
e co
mm
u
n
ity’s h
ealth
n
e
ed
s i
n
Ho
m
a
Bay Co
un
ty.
From
t
h
ese
fi
ndi
ng
s,
we
su
gge
st
t
h
e
f
o
l
l
o
wi
ng
rec
o
m
m
e
ndat
i
o
n
s
fo
r i
m
pro
v
em
ent:
go
ve
rnm
e
nt
sh
ou
l
d
i
m
p
r
ove b
u
d
g
e
t allo
catio
n
to
ward
s health
care in
o
r
der to cater
for required
health services and whe
r
e
t
h
ere are
defi
c
i
t
s
t
h
ere sh
oul
d be
pl
ans
fo
r
fi
nanci
a
l
su
p
p
o
r
t
fr
om
dev
e
l
opm
ent
and
ot
he
r im
pl
em
ent
i
n
g
p
a
rt
n
e
rs; th
e
go
v
e
rn
m
e
n
t
sh
ou
ld
en
su
re ad
eq
u
a
te an
d trained
h
ealt
h
staff
in
th
e
h
ealth
facilities. In
add
itio
n,
these health facilities should be e
qui
ppe
d with a
d
equa
te drugs a
n
d other
require
d
supplies, includi
ng
am
bul
ances
w
h
ere ne
cessary
, i
n
or
der t
o
p
r
ovi
de rel
e
va
nt
h
ealth
sup
port as an
d
wh
en
re
qui
red; there is
need
t
o
im
pro
v
e ser
v
i
ce del
i
v
ery
by
adhe
ri
n
g
t
o
t
h
e servi
ce c
h
art
e
r
s
t
h
at
ha
ve bee
n
de
vel
ope
d by
m
o
st
heal
t
h
facilities in
Homa Bay Co
un
ty; an
d Min
i
stry o
f
Health
sho
u
l
d
streng
th
en
p
a
rt
n
e
rsh
i
p with
NGOs
to
i
m
p
r
ov
e
in order to rea
c
h local communities w
ho are una
ble to reach health facilitie
s. Based on
the findings of thi
s
stu
d
y
, an
area b
e
ing
reco
m
m
en
d
e
d
for furth
e
r
research
is th
e in
flu
e
n
c
e o
f
cu
lt
u
r
e on
u
tilizatio
n
of h
ealth
services
in
Ke
nya.
ACKNOWLE
DGE
M
ENTS
Prof. Richa
r
d
O. Muga, Chai
rm
an National Health
In
sur
a
nce Fu
nd
(N
HIF)
Board and
Deputy Vice
Chancellor, Great Lakes
Uni
v
ersity of
Kis
u
m
u
(GL
U
K)
g
a
v
e
us a l
o
t
o
f
en
cou
r
ag
emen
t to d
e
term
in
e th
e
facto
r
s th
at i
n
flu
e
n
ce
u
tilizati
o
n of
h
ealth
serv
ices i
n
Ho
m
a
Bay Co
un
ty
as th
e
find
ing
s
wo
u
l
d
info
rm
h
ealth
sy
st
em
s st
rengt
heni
n
g
i
n
t
h
e
cou
n
t
y
as wel
l
as provi
de e
v
i
d
e
n
ce t
o
i
n
f
o
rm
nat
i
onal
resp
onse i
n
re
v
e
rsi
n
g
t
r
en
ds i
n
heal
t
h
sect
o
r
.
Dr.
S.
M
.
M
a
gada
of
M
i
ni
st
ry
of M
e
di
cal
Ser
v
i
ces was ve
ry
i
n
st
r
u
m
e
nt
al
i
n
pro
v
i
d
i
n
g
au
tho
r
ization
t
o
co
ndu
ct th
is
research
.
Utilizatio
n
of
h
ealth
serv
ices h
a
s b
e
en
a co
n
c
ern
for
v
a
rio
u
s
h
ealth stak
eho
l
d
e
rs i
n
Ho
m
a
Bay
C
o
u
n
t
y
base
d on m
y
di
scussi
ons
wi
t
h
Dr.
A
k
eche
,
D
r
.
Ol
u
o
ch a
n
d D
r
. O
m
ondi
, t
h
e D
M
OHs
fo
r R
a
c
h
u
o
n
y
o
,
Hom
a
Bay and Suba
Districts respectively, and re
prese
n
tativ
es fro
m
so
m
e
h
ealth
NGOs in Nyanza Province;
Mild
m
a
y In
tern
atio
n
a
l,
APHIAPl
u
s, Plan
In
tern
ati
onal
,
AM
R
E
F, M
S
F and R
T
I. T
h
ei
r i
n
fl
uen
c
e
on t
h
e
decision to
res
earch on th
e
s
u
bject is
gratefully acknowledged. Lastly
but
by
no m
eans t
h
e least, the lecturers
as wel
l
as st
udent
s
were
of
great
s
u
p
p
o
rt
t
o
m
y
st
udi
es and
part
i
c
ul
a
r
l
y
t
h
i
s
st
udy
.
W
e
wi
sh t
o
gi
ve
t
h
em
special tha
n
ks.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS
Vol. 3, No. 4, D
ecem
ber 2014
:
213 – 223
22
2
REFERE
NC
ES
[1]
Muga, et
al., “The 2004 K
e
n
y
a
Service Pr
ovisio
n
Assessment (KSPA) 2004 Survey
”, 2004.
[2]
Ansari, et al
., “
A
ccess of Healt
h
Care and Hospita
l
i
z
a
tion for
Am
bulator
y
Car
e
Sensitive Con
d
itions”
,
Medica
l
Care
Re
se
arc
h
Re
vie
w
,
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