INFLUENCE OF SELECTEDSTRATEGIES ON IMPLEMENTATION OF DONOR ASSISTED E-HEALTH MANAGEMENT SYSTEMS IN KENYA: A SURVEY OF PUBLIC HEALTH FACILITIES IN NAKURU COUNTY

Abstract

E-health is emerging as one of the most important paradigms of healthcare management due to its significant potential to deliver cost-effective, quality health care, and spending on ehealth systems by governments and development partners. Consequently, the usage of ehealth systems is increasing worldwide. However, E-Health adoption remain low in many countries and even when some of the known barriers have been mitigated by the implementers using several strategies, in several cases, the system falls into disuse or is used only as a redundant system in healthcare management. In Nakuru County, the adoption rates are still low at 21% with most medical practitioners preferring to use the hybrid system or rely purely on paperwork. Therefore, the main objective of the study was to analyze the influence of selected strategies used in implementation of donor assisted e-health management systems in Kenya focusing on public health facilities in Nakuru County. Specifically, it sought to establish the influence of facilitation strategy, training strategy, domestication strategy and Monitoring and Evaluation (M&E) strategy on implementation of e-health management systems in public health facilities in Nakuru County. The study was guided by The Systems Theory,The Resource based View and the Technology Acceptance Model. The study used descriptive survey research design targeting the health Ministry at both the national and county government and involved 42 public health facilities and 7 partnering NGOs in the County. The accessible population were, therefore, 220 persons comprising e-Health program managers and staff. Both purposive and stratified random sampling methods were used to obtain a sample size of 111 respondents from which 79 participated in the study. Data was collected using questionnaires and analyzed using both descriptive and inferential statistical methods. The study findings indicated that facilitation strategy (t = 0.92, p ˃ 0.10) and training strategy(t = 0.12, p ˃ 0.10)did not have a statistically significant relationship with the implementation of e-health management systems in the area as per the regression results. However, M&E strategy (t = 2.01, p < 0.10) and domestication strategy (t = 1.81, p ˂ 0.10) did manifest a statistically significant relationship with the implementation of e-health management systems in public health facilities in Nakuru County.In addition, all the four independent variables could explain up to 27.2% of the variations in the implementation variable.From the findings it can be concluded that Monitoring and Evaluation, Domestication as implementation strategies wereimportant factors boostingthe e-health systems implementation in public health facilities in Nakuru County other than the other two variables;(Facilitation and Training). Thereseacher recommends that stronger emphasis should be put on facilitating e-health system implementation to cover all resource gaps. Similarly, more emphasis should be put on training to follow a needs assessment plan to fill gaps encountered during the implementation process. It is also recommended that the project implementers continually sensitize the donors and other development partners on the need to have more local input on the system that will enable both the implementers and end-users to build on the system and increase its perceived usefulness and usability. Finally, there is need for the implementing organizations to ensure that in addition to the M&E evaluations, quality evaluation and reporting be also made to raise the quality standards of the system after implementation.