TABLE OF CONTENTS
DECLARATION…………………………………………………………………………………………………………… i
DEDICATION……………………………………………………………………………………………………………… ii
ACKNOWLEDGEMENTS…………………………………………………………………………………………. iii
TABLE OF CONTENTS……………………………………………………………………………………………… iv
LIST OF FIGURES…………………………………………………………………………………………………….. vii
LIST OF TABLES……………………………………………………………………………………………………… viii
DEFINITION OF OPERATIONALIZATIONAL TERMS…………………………………………… ix
ABBREVIATIONS AND ACRONYMS………………………………………………………………………… x
ABSTRACT………………………………………………………………………………………………………………… xi
CHAPTER ONE: Introduction……………………………………………………………………………………… 1
- Background of the study……………………………………………………………………………….. 1
CHAPTER TWO:Literature review…………………………………………………………………………….. 10
- Introduction………………………………………………………………………………………………………………… 10
CHAPTER THREE:Methodology……………………………………………………………………………….. 32
3.0 Introduction………………………………………………………………………………………………………. 32
3.1. Research design…………………………………………………………………………………………………. 32
- Variables……………………………………………………………………………………………………………………… 32
CHAPTER FOUR:Results…………………………………………………………………………………………… 38
- Introduction………………………………………………………………………………………………………………… 38
CHAPTER FIVE:Discussion……………………………………………………………………………………….. 50
5. 3 Factors that motivate and hinder utilization of the HIMS…………………………………….. 56
5.3.1 Appointment of Community Health Workers…………………………………………………… 57
CHAPTER SIX:Summary, Conclusions and Recommendations……………………………………. 60
7.0 REFERENCES…………………………………………………………………………………………………… 63
Appendix one:Informed consent form………………………………………………………………………….. 67
Appendix two: Questionnaire for Community Health Workers (CHWs)………………………… 68
Appendix three: Focus group discussion guide with CHWs……………………………………………. 75
Appendix four: KIIs…………………………………………………………………………………………………….. 76
Appendix five: Map of the study area…………………………………………………………………………… 77
Appendix six:Letter from AMREF………………………………………………………………………………. 78
LIST OF FIGURES
Figure2.1: ConceptualFramework……………………………………………………………… 29
Figure 4.1: Current Status of the HIMS…………………………………………………….. 40
Figure 4.2: Utilization of the HIMS by CHWs…………………………………………….. 41
Figure 4.3: Utilization of reports generated by the HIMS……………………………… 42
Figure 4.4: Use and no use in age groups……………………………………………………… 48
LIST OF TABLES
Table 4.1: Demographic characteristics of respondents……………………………………….. 39
Table 4.2: System performance indicators by User Satisfaction levels………………….. 43
Table 4.3: The System’s User Friendliness………………………………………………………….. 44
Table 4.4: Comparison of system indicators by level of user satisfaction……………….. 45
Table 4.5: Comparison of CHW sex and level of education by reported “use” of the system………………………………………………………………………………………………………………………… 47
Table 4.6: Appointment of Community Health Workers……………………………………….. 48
DEFINITION OF OPERATIONALIZATIONAL TERMS
HIMS- An integrated effort to collect, process, report and use health information and knowledge to influence policy making, programme action and research.
Computerized system-A component of the Health information management system.
ABBREVIATIONS AND ACRONYMS
| AMREF | African Medical Research Foundation |
| APHIA | AIDS, Population and Health Integrated Assistance |
| CBHMIS | Community based health management information system |
| CHEW | Community Health Extension Worker |
| CHW | Community Health Worker |
| CORP | Community Owned Resource Person |
| CU | Community Unit |
| CHC | Community health committee |
| CHW | Community Health Worker |
| FGD | Focus Group Discussions |
| GOK | Government of Kenya |
| HMIS | Health management information system |
| HIV | Human Immuno Deficiency Virus. |
| KCO | Kenya country Office |
| MOH | Ministry of Health |
| NGO | Non-Governmental Organization |
| PHC | Primary Health Care |
| SPSS | Statistical Package for Social Sciences |
| WHO | World Health Organization |
ABSTRACT
Health Information Management System is a system that entails collecting, processing, reporting and using health information and knowledge to influence decision making.AMREF facility provides services in urban informal settlements where Health Information Management System is used.The objective of the study was to determine factors that influence utilization of the HIMS in the AMREF- Kibera facility.It further sought to establish the current status of the HIMS in place in the Kibera facility, to determine the extent of use of the HIMS by the Community Health Workers in the Kibera facility To establish factors that motivate utilization of the HIMS in the Kibera facility and to establish barriers to the utilization of the HIMS in the Kibera facility.Community health workers are tasked with the role of being change agents of health indicators in the community. A cross sectional study design was employed . The study employed both the quantitative and qualitative data collection methodology. Data was collected using questionnaires, focused group discussion and key Informant Interviews. A sample size of 196 Community Health Workers was recruited using simple random sampling method.
Quantitative data was analyzed using SPSS version 16 while qualitative data was transcribed, categorized into themes for easier interpretation and analysis. Chi square test showed a relationship between system quality, indivividual and institutional characteristics and utilization of the system by community health workers . The findings indicate that 27% have had access to the computers. The level of education, mentors that champion use of the system and organizations culture, motivate the utilization of the system.Age,community health worker engagement level,inaccessibility of the output information and lack of resources are barriers to the utilization of the system .The recommendations therefore include;Channel more resources to the facility to improve Community Health Workers participation i.e improve use of computers,offer more openings to the Community Health Workers who are not permanent in the facility to increase their involvement in the facility and to ensure they are retained in the facility and have periodic training and retraining in computer packages and the system for sustainability of the programme.The findings of the study will be very informative to the various health sector stakeholders and more so reinforce the good practices for better health care service delivery in the long run.
CHAPTER ONE: Introduction
Background of the study
The World Health Organization (WHO) defined the health information management system as an “integrated effort to collect, process, report and use health information and knowledge to influence policy making, programme action and research,(WHO,2011). Health information is much more than collecting figures. Data have no value in themselves; value and relevance come when they are analyzed, transformed into meaningful information and used. “The ultimate objective of a health information management system is to produce information for taking action in the health sector. Performance of such a system should therefore be measured not only on the basis of the quality of data produced, but on evidence on the continued use of these data for improving health systems operations and health status,”(WHO, 2003).
According to WHO, 2011 on analyzing disrupted health systems in countries in crisis training course, the investment in Health Information Management Systems (HIMS) now could reap multiple benefits, including: Helping decision makers to detect and control emerging and endemic health problems, monitor progress towards health goals, and promote equity. Empowering individuals and communities with timely and understandable health- related information, and drive improvements in quality of services is also among the benefits. Strengthening the evidence base for effective health policies, permitting evaluation of scale-up efforts, enabling innovation through research and improving governance, mobilizing new resources, and ensuring accountability in the way they are used all form the vital aspects of the HIMS (Lau F et al,2006).
Without reliable, relevant health information, health care managers and providers cannot make decisions to allocate resources effectively, improve the quality of health services, or address epidemics such as HIV/AIDS.
As health systems were re-structured, the demand for sound information and the skills to manage and use information are increasing significantly. Health Information Management Systems based on modern ICT technologies linking the various levels of the health system and addressing information needs cannot be ignored. In Kenya, the health information needs have changed over time due to health sector reforms and decentralization of health planning to districts (AMREF,2005). Against this background, HIMS was reviewed and recommendations used to improve and automate the information system. A pilot HIMS was developed and automated for Ministry of Health in Kwale district, Coast Province. Lesson Learnt when developing an integrated HIMS, it is important to use a finite number of indicators to monitor and evaluate the health system’s performance. Information collected and the information flow must be streamlined and simplified. While negotiation and selection of a smaller set of indicators can be difficult, it encourages managers at different levels of the health system to determine their critical needs. It requires them to ask how much information they can legitimately require from already overburdened front-line health providers to collect (Gething et al, 2009).
