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Advances in Social Sciences Research Journal – Vol. 10, No. 4
Publication Date: April 25, 2023
DOI:10.14738/assrj.104.14433.
Omambia, S. M., Karanja, S., Nyamongo, D., & Mutai, J. (2023). Organizational Factors Associated with The Implementation of a
Health Management Information System at Kenyatta National Hospital. Advances in Social Sciences Research Journal, 10(4). 160-
174.
Services for Science and Education – United Kingdom
Organizational Factors Associated with The Implementation of a
Health Management Information System at Kenyatta National
Hospital
Salim. M. Omambia
https://orcid.org/0000-0002-8795-4987
Kenya Medical Training College,
P.O. Box 30195-00100 Nairobi, Kenya
Simon Karanja
Jomo Kenyatta University of Agriculture and Technology
P.O. Box 62000-00200 Nairobi, Kenya
Daniel Nyamongo
Jomo Kenyatta University of Agriculture and Technology
P.O. Box 62000-00200 Nairobi, Kenya
Joseph Mutai
Kenya Medical Research Institute
P.O. Box 54840 00200 Nairobi, Kenya
ABSTRACT
Healthcare organizations are increasingly spending and allocating huge budgets in
embracing modern technology innovations and ways of dealing with healthcare
related issues. While modern technology benefits cannot be disputed,they however
come at an expense and require a rigorous process before adopting the innovation.
Studies done indicated Health care organizations find the process a rigmarole and
opt for easier ways to incorporate or adopt the innovations, these usually results to
a collapse or bottlenecks in the outputs of the innovations, in fact, majority of
organizations have abandoned their ultra-modern system only to go back to their
old manual system. The main objective of the study was to determine
Organizational factors associated with implementation of a Health Management
information Systems among healthcare workers at Kenyatta National Hospital. The
research was conducted at KNH and adopted a cross-sectional study design. The
target population of the study were 4,900 healthcare workers at KNH who were
involved in implementing HMIS. The sample techniques used were mixed method
sampling of stratified sampling, snowball sampling and convenience sampling. A
sample total of 263 respondents was calculated for the quantitative study. The
study utilized a questionnaire and a key informant interview schedule. Before
processing the quantitative data, the data collected from the field was cleaned,
coded, entered into a computer software and analyzed using SPSS version 21 while
qualitative data was manually analyzed based on themes that were developed from
responses (thematic analysis). Data presentation from the quantitative data was in
form of quantitative statistics such as frequency distribution, percentages, tables,
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Omambia, S. M., Karanja, S., Nyamongo, D., & Mutai, J. (2023). Organizational Factors Associated with The Implementation of a Health Management
Information System at Kenyatta National Hospital. Advances in Social Sciences Research Journal, 10(4). 160-174.
URL: http://dx.doi.org/10.14738/assrj.104.14433
use of chi square for analysis, p values and odds ratios. Qualitative findings were
presented in verbatim form. This study was submitted to KNH/UON Ethical Review
Committee for ethical approval. Consenting was sought from individuals. Results
indicated that majority of those interviewed were of the opinion that HMIS had
improved services delivery by effecting efficiency especially in accident and
emergency department, the wards and reception areas, generally there was
improved efficiency in information handling in that, it had helped to identify
patients in and through the system and there was reduction in costs. However, a few
respondents were of the view that, HMIS had not improved efficiency to a larger
extent since a lot of things were still done manually, no proper training and the
system not fully implemented. Main challenges included, lack of technical
assistance which led to loss of data which had never been recovered to date and
scarce resources. In relation to the cadre of the hospital, the systems were quite
complex, inadequate healthcare staff experience, scarcity of infrastructure and
shortage of ICT technicians to assist in trouble shooting. There were very many
refunds to patients by finance, resistance by users due to the perception that, it was
a business-oriented system rather than goal oriented. Results show that the ratio of
males to females was 1:1, 133(50.6%) and females 129(49.4%) thus gender
balanced. A greater number of the respondents were aged between 26-35, 91
(34.6%), followed closely by the age bracket 36-45, 74(28.1%), the minority were
aged 55 and above, 12(4.6%). In Kenyatta more than half of the respondent’s
education level was college, 160(60.8%) with very few at secondary, 5(1.9%).
population age, level of education and duration worked at KNH, (p value 0.008,
0.050 and 0.004). KNH might not be where they want or need to be as far as HMIS is
concerned but they have made strides towards the right direction. Technologically,
HIMS have already taken a vital role in the healthcare industry and are obliged to
be organizational tools meant to create a better healthcare environment. It is
essential for the KNH management to ensure that there is a system thinking where
each and every individual staff is not only motivated but also feels part and parcel
of the HIMS process. KNH needs to devise a HIMS specifically for their clientele
INTRODUCTION
In accordance with (GHO, 2016) the spread of a disease doesn't stop at a country's borders.
With more people traveling to other countries and living in crowded cities, it's easier for germs
to spread. Infectious diseases that start in one part of the world can quickly reach another.
Resistance to medicines such as antibiotics is on the rise. This makes it harder to treat certain
diseases. Natural and man-made disasters create refugee populations with immediate and long- term health problems. As attested by (Pratt and Hyder, 2016), International health, also called
geographic medicine or global health, is a field of health care, usually with a public health
emphasis, dealing with health across regional or national boundaries. Health systems research
is increasingly being conducted in low and middle-income countries (LMICs). Such research
should aim to reduce health disparities between and within countries as a matter of global
justice.
As stated by (WHO, 2016) in their latest version and current WHO framework for globally
improving on Health systems, seven building blocks are clearly defined that together constitute
a complete health system. This was underscored at the G20 meeting Osaka in the emphasis of
a strategic harnessing of the power of data to healthcare systems strengthening that makes a
rapid and affordable progress towards achieving UHC (G20, 2019). In relation to international
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 10, Issue 4, April-2023
Services for Science and Education – United Kingdom
health concerns majority of the National referral systems in developed countries among them
Canada, United States of America and the United Kingdom have had to budget for huge amounts
of money for an impetus towards Health Management Information System (HMIS) adoption
whereas developing countries are still lagging behind and struggling to make do with the old
traditional healthcare setups. Health systems are the core foundations of how countries
respond to new disease threats and improving health of the people. The iterative nature of the
process cannot be further overemphasized; any changes in mission, operations, functions, or
information and data needs must be assessed to reveal their impact on analyses already
completed, since these changes could have a profound effect on the system to be acquired
(WHO, 2012).
According to (Health Systems Action Network, 2006) African policy makers are increasingly
called on to use evidence-based research to inform development decisions. But this requires
the rigorous collection of data as well as a coordinated system to disseminate it. This is why
Kenya-based African Population Health Research Center is advocating for national policies to
enable strong data systems. Precise and nuanced knowledge and understanding of what
constitutes an effective health system is growing all the time and health systems strengthening
is rising on political agendas worldwide. Generally, health system strengthening (HSS) can
simply be defined as any array of initiatives and strategies that improve one or more of the
functions of the health system which in return leads to better health through improvements in
access, coverage, quality, or efficiency. For the Millennium Development Goals to be achieved
and even reaching Universal Health Coverage, Health information Systems are critical. The
International body for Health Information (IFHIMA) suggests that what governments should
do to improve HIM systems and HIM professional status to get recognition like any healthcare
provider in India should be implementation of standardized practices throughout the country,
enhancing of education and training programs (IFHIMA, 2018).
As assessed by the Kenya Health policy (2014-2030) definition of the Country’s long-term
intent in health through strengthening of health information, the target of the policy is to attain
a level and distribution of health at a level commensurate with that of a middle-income country,
with specific impact targets of attaining a 16% improvement in life expectancy; a 50%
reduction in annual mortality from all causes; and a 25% reduction in time spent in ill health.
Towards strengthening national capacitates for International Health Regulations (IHR), the
country inaugurated the first Public Health Emergency Operations Centre (PHEOC) in 2016 to
better coordinate activities of relevant stakeholders involved in prevention, detection and
response to public health events (PHEs). It is expected that when PHEOC is fully
operationalized, it will enhance public health emergency preparedness and response for PHEs
in the country (GHO, 2016).
A study by Nussbaum, (2011) argues that disadvantage consists of having a low level of not only
health achievement but also health (or capability) security. Countries with insecure health are
those countries with a low prospect of sustaining their achieved level of population health.
Health Achievement refers to the level of population health attained by a given country.
Countries that are worst-off would comprise those that perform substantially worse on
morbidity and mortality indicators relative to a decent or optimal level of health. The study
proposes that this would, for instance, refer to countries that are particularly prone to the