CHALLENGES FACING HEALTHCARE WORKERS OFFERING FREE MATERNAL

SERVICES AT ANC IN HOSPITALS LOCATION IN MSAMBWENI SUB COUNTY-

KWALE COUNTY.

DENNIS MATARA ONSONGO

D/UPHRIFT/20011/636

A RESEARCH DISSERTATION SUBMITED TO THE DEPARTMENT OF HEALTH

RECORDS KENYA MEDICAL TRAINING COLLEGE MSAMBWENI CAMPUS IN

PARTIAL FULFILMENT OF THE REQUIREMENT OF THE AWARD OF DIPLOMA

IN HEALTH RECORDS INFORMATION TECHNOLOGY

FEBRUARY, 2022
DECLARATION
This dissertation is my original work and has not been presented for a diploma in any other

institution.

Signature……………………….

Date……………………

Dennis Matara Onsongo

D/UPHRIFT/20011/636

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SUPERVISOR’S APPROVAL

INTERNAL SUPERVISOR

Signature……………………….

Date…………………………

Ms. Esther kiarie

Kenya Medical Training College-Msambweni

Department of Health Records and Information Technology

EXTERNAL SUPERVISOR

Signature…………………

date………………….

Mr. Clinton Moseti Omweri

Bachelor of education (arts)

Department of education and human resources development.

ii
DEDICATION

I dedicate this research dissertation to my lovely parents Mr. and Mrs. Onsongo and my brother

Jared Onsongo for their financial support, prayers and encouragement during the study.

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ACKNOWLEDGEMENT

I thank the Almighty God for His grace and strength. He has granted me good health throughout

my college life up to this time. My deepest appreciation goes to my research lecturer Mr. Kenneth

Muriki for the guidance throughout my entire theory session and Ms. Esther kiarie whose critical

review of my write up helped me shape dissertation, my external supervisor Mr. Clinton Omweri

Moseti for his guidance in my write up of my research dissertation and my friends Dacklinces

Nyanchage lukeNaom misati, Vincent okari for their support and encouragement on my research

dissertation writing.

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TABLE OF CONTENTS
DECLARATION ..................................................................................................................................................... i
SUPERVISOR’S APPROVAL .............................................................................................................................. ii
DEDICATION ....................................................................................................................................................... iii
ACKNOWLEDGEMENT ..................................................................................................................................... iv
TABLE OF CONTENTS........................................................................................................................................ v
LIST OF TABLES ............................................................................................................................................... viii
LIST OF FIGURES ............................................................................................................................................... ix
ABBREVIATIONS AND SYNONYMS ............................................................................................................... x
DEFINATION OF TERMS ................................................................................................................................... xi
ABSTRACT .......................................................................................................................................................... xii
CHAPTER ONE: INTRODUCTION .................................................................................................................... 1
1.1 BACKGROUND .......................................................................................................................................... 1
1.2 PROBLEM STATEMENT .......................................................................................................................... 3
1.3JUSTIFICATION .......................................................................................................................................... 3
1.4 RESEARCH QUESTIONS .......................................................................................................................... 5
1.5 RESEARCH OBJECTIVES ......................................................................................................................... 5
1.5.1 BROAD OBJECTIVES ........................................................................................................................ 5
1.5.2 OBJECTIVES........................................................................................................................................ 5
1.6 SCOPE AND LIMITATION STUDY ......................................................................................................... 5
CHAPTER TWO: LITERATURE REVIEW......................................................................................................... 7
2.0 INTRODUCTION ........................................................................................................................................ 7
2.1 HUMAN RESOURCE ................................................................................................................................. 7
2.1.1WORKLOAD ......................................................................................................................................... 7
2.1.2 STAFFING ............................................................................................................................................ 7
2.1.3 TURNOVER ......................................................................................................................................... 8
2.2 MANAGEMENT ......................................................................................................................................... 8
2.2.1 MOTIVATION...................................................................................................................................... 8
2.2.2 SUPERVISION ..................................................................................................................................... 9
2.2.3 SUPPORT.............................................................................................................................................. 9
2.3 CAPACITY BUILDING .............................................................................................................................. 9
3.2.3 TRAINING .......................................................................................................................................... 10
2.3.2SKILLS................................................................................................................................................. 10
2.3.3 KNOWLEDGE.................................................................................................................................... 11
CHAPTER THREE: RESEARCH METHODOLOGY ....................................................................................... 12
3.0 INTRODUCTION ...................................................................................................................................... 12

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 3.1 STUDY DESIGN ....................................................................................................................................... 12
3.2 STUDY AREA ........................................................................................................................................... 12
3.3 STUDY POPULATION ............................................................................................................................. 12
3.3.1INCLUSION CRITERIA ..................................................................................................................... 12
3.3.2 EXCLUSION CRITERIA ................................................................................................................... 12
3.4 VARIABLES .............................................................................................................................................. 12
3.4.1 INDEPENDENT VARIABLES.......................................................................................................... 12
3.5SAMPLING TECHNIQUE ......................................................................................................................... 13
3.6 SAMPLE DETERMINATION .................................................................................................................. 13
3.7 DEVELOPMENT OF DATA COLLECTION TOOL .............................................................................. 14
3.8DATA COLLECTION PROCESS ............................................................................................................. 14
3.9PRETESTING ............................................................................................................................................. 14
3.10 VALIDITY ............................................................................................................................................... 14
3.11 RELIABILITY ......................................................................................................................................... 14
3.13 ETHICAL CONSIDERATION................................................................................................................ 15
CHAPTER 4: DATA ANALYSIS, PRESENTATION AND INTERPRETATION. ......................................... 16
INTRODUCTION ............................................................................................................................................ 16
4.0 SOCIAL DEMOGRAPHIC FACTOR ...................................................................................................... 16
4.1 HUMAN RESOURCE FACTOR .............................................................................................................. 17
4.1.1Respondents’ response on staffing ...................................................................................................... 17
4.1.2 Respondents’ response on workload ................................................................................................... 18
4.1.3 Respondents’ response on turnover .................................................................................................... 18
4.2 MANAGEMENT FACTOR ...................................................................................................................... 19
4.2.1 Respondents’ response on motivation................................................................................................. 19
4.2.1 Respondents’ response on support ...................................................................................................... 21
4.3CAPACITY BUILDING ............................................................................................................................. 21
4.3.1 respondents’ response on training ....................................................................................................... 21
4.3.2 Respondents’ response on skills.......................................................................................................... 22
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION ........................................... 25
5.1 Discussion ................................................................................................................................................... 25
5.2 CONCLUSION........................................................................................................................................... 26
5.3 RECOMMENDATION .............................................................................................................................. 27
5.4 FURTHER RESEARCH ............................................................................................................................ 27
APPENDIX I: BUDGET ...................................................................................................................................... 30
APPENDIX II: Work plan .................................................................................................................................... 31
APPENDIX III Map ............................................................................................................................................. 32

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APPENDIX IV: NACOSTI LETTER .................................................................................................................. 33
APPENDIX IV: DATA COLLECTION PERMISSION ..................................................................................... 33
APPENDIX V: DATA COLLECTION LETTER ............................................................................................... 35
APPENDIX VI: DATA COMPLETION LETTER ............................................................................................. 36
APPENDIX VII: QUESTIONNAIRE .................................................................................................................. 37

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LIST OF TABLES

Figure 4.1 respondents’ response on motivation .................................................................................... 20

Figure 4.2 Respondent’s response on supervision .................................................................................... 20
Figure 4.3 Respondents’ response on support ........................................................................................ 21
Figure 4.4 Respondents’ response on training ......................................................................................... 22
Figure 4.5 Respondents’ response on skills .............................................................................................. 23
Figure 4.6 Respondents’ response on kwoledge ....................................................................................... 24
Figure 7 Map ............................................................................................................................................. 32
Figure 8 NACOSTI letter ............................................................................................................................ 33
Figure 9 Permission letter ......................................................................................................................... 34
Figure 9 Authorization letter..................................................................................................................... 35
Figure 10 Data completion letter .............................................................................................................. 36

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LIST OF FIGURES

Figure 4.2 Respondent’s response on supervision .................................................................................... 20

Figure 4.3 Respondents’ response on support ........................................................................................ 21
Figure 4.4 Respondents’ response on training ......................................................................................... 22
Figure 4.5 Respondents’ response on skills .............................................................................................. 23
Figure 4.6 Respondents’ response on kwoledge ....................................................................................... 24
Figure 7 Map ............................................................................................................................................. 32

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ABBREVIATIONS AND SYNONYMS
ANC- antenatal clinic

MOH- ministry of health

WHO- world health organization

EAC- East Africa community

SDGS- sustainable development goals

HR-human resources

NACOSTI-National commission for science technology and information

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DEFINATION OF TERMS

Management- Getting things done through other people

Capacity building- Means by which skills, experience technical and management

capacity are developed within an organizational structure

Human resource – The personnel department of an organization dealing with a

recruitment, Administration management and training of

employees.

Antenatal clinic- A clinic dealing with pregnant mothers

Maternal- Of or pertaining to a mother having the characteristics of a motherly.

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ABSTRACT
Introduction. Trained Healthcare workers are essential to any effective healthcare system yet
critical shortages, Inadequate skills mixes and uneven geographical distributions of the health
workforce pose a lot of challenges in achieving universal healthcare, this is Due to poor
governances and human resources factors, hence these challenges will lead to complications of
delivery such as miscarriage, ectopic pregnancy hypertension and maternal mortality.
Objectives: The objectives of the study were to identify management factors, determine Human
resource factors and find out capacity building factors. Methodology: The researcher used
descriptive cross- sectional study design which was conducted among ANC Healthcare workers.
Both simple random and cluster sampling technique was used in the selection of 41 respondents
and the questionnaire was used to collect data, validity was done by experts from HRI
department, Reliability was done and data was analyzed and presented by Microsoft Excel.
Conclusion: The researcher found that majority of the respondents 95.6% revealed that there
was no enough staffing, while workload was 53.65% who said that they can offer services to 21-
30 clients per 8hours by one staff and in management 85.37%which were majority of the
respondents who responded that they are not motivated by their employer while 14.6%
responded that they are motivated and also in terms of support majority of the respondents
responded that they were not supported 73.17% while minority responded that they were
supported which was 26.82% and in capacity building response on training by the majority was
that68.7% are not taken for training while 61.54% who are taken for training they improve their
level of skills. Recommendation: The county director of health in conjunction with the nursing
in charges should take staffs to on training, motivate the health workers and employ more staffs
to reduce burden of workload in the maternal services.

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CHAPTER ONE: INTRODUCTION
1.1 BACKGROUND
Trained healthcare workers are essential to any effective health system yet critical shortages,
inadequate skills and uneven geographical distributions of the health workforce pose healthcare
coverage (WHO, 2016).

Globally in India maternal child health providers at the Antenatal clinic doctors’ midwives and
nurses offering free maternal services are the key elements for the pregnant women health
(Truth,2015). Also, shortage of skilled healthcare workers offering free maternal services in India
influences the quality of services to pregnant woman at the prenatal clinic (Des et al 2014).

In sub Saharan Africa Chad one of the African countries where health services delivery is affected
by number of number of factors, among this healthcare workers factors Human resource is a vital
component in service delivery therefore ,the health system cannot function effectively without
sufficient number of skilled, motivated and supported Antenatal healthcare givers offering free
maternal services(Ayielo,2015).Both developed and developing countries trained medical
personnel appear to be serious shortage of healthcare workers, low salaries to caregivers or delay
in salaries allocation are one of the challenges the healthcare workers overcome (Rhino,2013).
Study done in Senegal by Paul f. clank (2013) health care workers; nurses, health records and
information officers, nutritional officers public health officers radiographers are most trained
caregivers with regular patient contact at the Antenatal clinic (ANC). The widespread evidence
suggests that the problems in the health care have particularly negative effect on the workplace
experience of the Antenatal clinic healthcare workers offering maternal services. News accounts
regular reports on the challenges healthcare workers overcome in the work places, this ranges from
low pay in Morocco to safely and healthcare problems in South Africa to heavy workload in
Somalia to mandatory overtime in Mozambique. all these stories show the healthcare works are
with challenges and these challenges extend everywhere sienna (2012).

world youngest country South Sudan is a low-income country with the very low ratio of physician
in total population 1per 65,574 population and similarity midwives 1per 65,574 population
(MOH,2012) compared 30 to world health organization (WHO) recommend density of skilled
healthcare professionals of 22.8 per 10,000 population (Truth 2013).

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In Kenya antenatal clinic healthcare workers; nurses’ midwives and other personnel constitute
more than 50% of the labor force. this healthcare workers advocate for the health promotion,
educate patients and the pregnant mothers at the on dangers in pregnancy illness and injuries, they
provide care and assist cute and participate in providing support to the pregnant mothers at the
Antenatal clinic (ANC) department. They cannot present the powerful force for bringing about
the changes to meet the health for all if they are not motivated, supported, appreciated and
recognized by the facility administration this is a study done by Langat’s (2015) at Malindi sub-
county hospital. To provide good health services , Heath workers distribution needs to be in line
with that of the population after needs after allowing some factors such as disease burden , poor
geographic distribution of healthcare workers remains a major human resource challenge in Kenya
Fatma (2013).public hospitals experience a severe shortage of healthcare workers is compounded
by several factors including; inability to attract and retain workers performance Management and
productivity issues, unequal distribution of health workers and migration to other countries This
issues cuts across and undermine services delivery efforts at the antenatal clinic ( Abdallah et Al
2013).

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1.2 PROBLEM STATEMENT
Introduction of free maternal services to pregnant women at ANC has led to increase in challenges
that healthcare workers overcome from global scope to local scope and on current trends shows
that shortage of healthcare workers, increase in workload, shortage of staffing, negatively
influences the quality of services to pregnant mother's hence this challenge increased largely in
Vietnam. (Des et al,2014).

In sub-Saharan Africa in Chad there are 3 trained healthcare workers which are doctors’ nurses or
midwives per 1000 population while (WHO) Defined minimum threshold considered necessary to
ensure Basic maternal and child health is 23 healthcare workers per 10000 population WHO
(2016). Also, Comoros experience shortage of healthcare workers with 3 doctor, 4 nurses and 3
midwives per 10,000 population compared to other countries in Africa region relative situation,
2.1 doctor 9.3 nurses per 10,000 population (Muhammed et Al, 2014).

South Sudan which is a lowly income country experience the greatest shortage of healthcare
workers which leads to heavy workload at antenatal clinic with 3% of the world health workers
WHO (2018). Also, Uganda experience great challenges by the Healthcare workers since most of
them are exposed to long working hours, lack of training to handle complicated cases, lack of
protective gadgets and little experience in patient management at the Antenatal clinic (Odenkirk
et Al,2012).

A study conducted in Moi Teaching and Referral Hospital in Eldoret Kenya, it identified that
despites the adoption of free programmed at Antenatal clinic showed a serious gap within the
system directly affecting the healthcare workers and this gap includes human resource factors and
also management factors (ego et al, 2014).

1.3JUSTIFICATION
Globally maternal child health providers; doctors’ midwives and nurses are the key elements of
delivery of healthcare services to a woman at antenatal clinic (truth,2013). The majority of the
African countries are unable to meet the basic requirements for good system due to poor
governance and human resource factors which are linked to ineffective integration of resources in
limited nations (Petersen, 2017). these challenges lead to complications of delivery such as
miscarriage, ectopic pregnancy, hypertension and maternal mortality.

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The study done on healthcare service providers and administrators to free maternal services at
antenatal clinic showing motivation, staffing shortage factors affecting healthcare workers in
Malindi sub-county hospital (Lingayat 2015). however, under objectives; human resource
management and capacity building has not been conducted in Msambweni sub county in kwale
county.

This research was also a requirement of the diploma award in health records and information
technology.

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1.4 RESEARCH QUESTIONS
What are the Human resource factors affecting healthcare workers offering free maternal services
at Antenatal clinic in Msambweni sub county in kwale county?

What are the management factors affecting healthcare workers offering free maternal services at
Antenatal clinic in Msambweni sub county in kwale county?

What are the capacity building factors affecting health care workers offering free maternal services
at ANC in Msambweni sub county hospitals in kwale county?

1.5 RESEARCH OBJECTIVES

1.5.1 BROAD OBJECTIVES
TO determine challenges affecting healthcare workers offering free maternal services at ANC in
Msambweni sub county hospitals in kwale county.

1.5.2 OBJECTIVES
To determine the human resource factors affecting healthcare workers at ANC. In Msambweni sub
county hospitals in kwale county.

To identify management factors affecting healthcare workers offering free maternal services at
ANC Msambweni sub county hospitals in kwale county.

To Find out the capacity building factors affecting healthcare workers offering free maternal
services at ANC in Msambweni sub county hospitals in kwale county.

1.6 SCOPE AND LIMITATION STUDY

The study was conducted in Government hospitals at msambweni sub county in kwale county
targeting all healthcare workers at antenatal clinic The study was focusing on challenges facing
healthcare workers offering free maternal services at ANC. The method of data collection was
questionnaire and the study took duration of one month. The limitation of the study was that the
population was small hence researcher was unable to exhaust all information.

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CONCEPTUAL FRAMEWORK

INDEPENDENT VARIABLES DEPENDENT VARIABLE

MANAGEMENT

 motivation
 Support
 supervision

CAPACITY BUIDING

 Training CHALLENGES FACING

 Skills HEALTHCARE WORKERS
 knowledge AT ANTENATAL CLINIC

HUMAN RESOURCE

Staffing

Workload

Turnover

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CHAPTER TWO: LITERATURE REVIEW

2.0 INTRODUCTION
This chapter reviews literature of various studies that was done related to variables. The researcher
was focusing on challenges facing Healthcare workers offering free maternal services at antenatal
clinic with the regard to the study objectives which was Management Factors Human resource
factors and capacity building factors reviewed in order to familiarize with the body of literature
and identify any gaps on which the study was conducted.

2.1 HUMAN RESOURCE

Human resource is a vital event in delivering health services. The health care system cannot
function effectively without sufficient number of healthcare workers who are skilled to give the
quality services to the pregnant mothers at the Antenatal clinic (ANC) (AYIELE 2015).

2.1.1WORKLOAD
A study done by monsoon (2011) in Saudi Arabia showed that workload to the healthcare workers
at the Antenatal clinic who are offering free maternal services were unsocially acceptable
occupational choice. with the current shortage of health care workers working for longer hours,
low payment of financial incentives therefore, the healthcare workers are concerned by lack of
recognition and appreciation which seen to be have generated frustration, disappointments and
regret which adviserly influences health workers satisfaction and hence their retention to perform
their duties at the clinic. However, in some hospitals there was consensus among healthcare
workers at the clinics and the administration do not listen (gazzaz,2010).

2.1.2 STAFFING
The study done by Hernderson (2017) the Severe shortage of health workers, lack of effective
planning limited budgets, migration of health workers, inadequate number of students entering and
completing professional training limited employment opportunities low salaries, poor working
conditions weak support and supervision and limited opportunities influences the quality of
services to the pregnant woman at the antenatal clinic (des et al 2014). Similar study done staffing
as a human resource factor in healthcare system (manpower 2011) stated that the staffing is a
broadly defined process of attracting, selecting and retaining competent individuals to achieve
organizational goal in the healthcare system (manpower 2011). Kenya is experiencing a severe

7
shortage of health workers and this shortage is compounded by several factors including the
inability to attract and retain healthcare workers, performance management and productivity
issues, unequal distribution of health of health workers and the migration of the health workers to
other countries. this issue cuts across the undermine of all types of delivery effort for example
antenatal clinic (Abdallah,2013).

2.1.3 TURNOVER
Turnover was major issue impacting the performance and profitability of healthcare organization
require a stable, highly trained and fully engaged healthcare worker. Yet a growing shortage of
qualified healthcare worker has led to increase in turnover rate among health workers at the
antenatal clinic section (price 2013).this turnover rate is likely to become even worse over for the
coming years as the growth of the health care industry continues to outstrip the availability supply
of health care workers its stated that there will be shortage of 500 thousand of health care workers
in united by 2030 ( sahor Mansour 2011).Health workers turnover creates staffing shortage that
increases the work demand placed on the organization’s remaining healthcare worker .This
heightens the risk of the remaining antenatal clinic health care workers (Anderson2013).In
addition , the staffing shortages caused by healthcare workers turnover at the antenatal clinic can
lead to an increase to absentees level among health workers working remains (Glass et al 2010).In
financial terms , antenatal healthcare providers turnover is costly for health care organization as it
consumes resources that could be directed at care business activities such as quality improvement
programmers, staffs development and health care provider(Jones,20140.

2.2 MANAGEMENT
Improving the quality of services delivery by healthcare workers at the antenatal clinic requires
adequate investment in management by planning organizing coordinating commanding and
controlling, preventing and solving problems in the department also communicating effectively
within health facility departments healthcare workers hence reducing conflicts, motivation,
support recognition in order to for the health workers to work effectively and efficiently to achieve
positive outcomes (2015).

2.2.1 MOTIVATION
Motivation Refers to the process that initiates guide and maintains goal-oriented behavior that
increases the workforce of the employees in an organization. Motivation is associated with their

8
daily duties in the healthcare facility (Rhino,2013). study done by Charles (2020) at the antenatal
clinic are an essential element in the functionality of the healthcare system. However, the health
workforce impact on health care system tends to be overlooked. Countries within the sub-Saharan
region as in the East Africa community (EAC) have weak and sub- optimally functioning health
care system as countries globally aim to attain universal and sustainable Development Goal 3 by
motivating recognizing and appreciating the healthcare workers. Primary issue arising pertain to
complexities of multi-tasking in an environment of staff’s shortage lack of support and poor
supervision from managers are the key challenges the healthcare workers overcome when offering
free maternal services since since there were no motivation (Rachael manongi (2015).

2.2.2 SUPERVISION
This refers to the act of providing knowledge which help to organize activities and results by too
management in an organization. Study conducted in Kenya found supervision of health care
workers was poor which results to stress to the health care workers in the facility when offering
free maternal services at that antenatal clinic level Odhiambo (2016)

2.2.3 SUPPORT
Many health workers suffer themselves from illness, self-stigma and discrimination they cannot
afford the services or treatment that they prescribe for others. The warfare of the healthcare are
advocacy issue and government should ensure the healthcare workers are provided with
comprehensive health scheme .The management does not have health workers specific clinic, they
does not ensure safely workplace also the healthcare workers are not provided with necessary
vaccinations in order to prevent them from being infected by other to communicable diseases since
they were not supported there was inefficient improved quality of of care at the antenatal clinic
Muhammed ( 2014).

2.3 CAPACITY BUILDING

Capacity building was a means by which skills, experience technical and management capacity
are developed within an organizational structure (contractors, consultant s or contracting agencies)
often through through the provision of technical assistance, short-term or long-term training and
specialist inputs e.g., computer system medical specialist antenatal clinics healthcare workers egg
nurses, clinical officers, health record offers. The process may involve the development of human,

9
material and financial resource.It only occurs once a person has observed that knowledge, learned
new skills on training ( kuschminder et al 2014).

3.2.3 TRAINING
Training refers to the act or process of either acquiring or increasing the knowledge, experience
and skills of an employee for performing a particular job effectively. Therefore, Training health
care workers must be conducted to strengthen the capacity of health workers at the health facility
and if the there is no good training to the Healthcare workers it will lead to poor service delivery
to the pregnant mother's at the antenatal clinic Bat Alden ( 2013).study done on lack of training
as one of the challenges among small health workers professionals working in Tanzania health
facility found that staff primarily lacks training & analytical skills to improve their working
experience ( Harrison, 2018).Mostly of the healthcare professionalism working in the maternal
services cited insecure Education and on job training as a factor influencing their decision to stay
or leave in the facility. The health care workers at the Antenatal clinic perceived opportunities
for continuous Education and advancing training as an important aspect of motivation
satisfaction and retention for them, on job Education and training are opportunities which
enhance their knowledge and practices. However, on job services seemed to vary considerably
across the different health facility sectors compared to other counter parts at the government
sector senior and junior care workers Working at the Government hospitals sounded more
frustrated and disappointed for having less opportunities for attending the services which helps
them to improve their working experience at the antenatal clinic (Gazza et al, 2013).

2.3.2SKILLS
Study done by M.Gichangi(2014) states that most deficiencies in quality of care at the facility by
health care providers results from gaps in knowledge or the inappropriate application of the
available technology rather than lack of resources therefore skills is by training get more
experience inorder to use in giving quality services at the antenatal clinic to the pregnant
mother's.

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2.3.3 KNOWLEDGE
Health workers who are trained well regularly have the best knowledge on active management
of pregnant mothers, delivery and immediate routine Newborn care .study done on knowledge
of healthcare workers to maternal mother's was particularly low across the country since
training of the healthcare givers is very low. Poorly resourced and low case load facilities has a
lower avarage knowledge scores compared with resourced and busier facilities. Therefore, this
leads to low quality of healthcare service delivery at the antenatal clinic( Georgina et Al ,2018)

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CHAPTER THREE: RESEARCH METHODOLOGY
3.0 INTRODUCTION
The purpose of this chapter was to outline the methods that was used to gather information. It
describes the study design, study area, target population, variables and sampling procedures. It
also lays out research instruments and methods of data collection. The ethical issues that was taken
into consideration during data collection process are also discussed here.

3.1 STUDY DESIGN

The descriptive cross- sectional study design was used to determine multiple outcomes and it can
collect data at specific time and find out challenges facing healthcare workers at Antenatal clinic.

3.2 STUDY AREA

This study was conducted in Msambweni sub county, in Kwale county, Msambweni sub county
was among the four sub counties in kwale county, Msambweni sub county was located along
Mombasa-lunging Road, some of the landmarks found within are primary schools and secondly
schools.

3.3 STUDY POPULATION

The study population was all health workers offering free maternal services At ANC in
Msambweni sub county hospitals in kwale county

3.3.1INCLUSION CRITERIA
The study included all health workers who was available at antenatal clinic in Msambweni sub
county hospitals in kwale county

3.3.2 EXCLUSION CRITERIA

The study excluded all the healthcare workers who were available at the Antenatal clinic in
Msambweni sub county but not willing to participate.

3.4 VARIABLES
3.4.1 INDEPENDENT VARIABLES
HUMAN RESOURCE

✓staffing

✓workload

12
✓turnover

MANAGEMENT

✓motivation

✓supervision

✓support

Capacity building

✓training

✓skills

✓knowledge

3.5SAMPLING TECHNIQUE
The sampling method used was simple random sampling, which was a probability sampling
method. The researcher found the list of all hospitals in Msambweni sub county in kwale county.
After that the researcher will randomly pick any 5 hospitals from the list The researcher used
cluster sampling method to show the list of total number respondents from each hospital within
Msambweni sub-county.

3.6 SAMPLE DETERMINATION

As shown in the table below the total number of healthcare workers in 5 hospitals within
Msambweni sub-county. Since their small population, all the nurses formed the sample size of
the study.

Msambweni Bodo Mafi Sini Diani health munje Total health

referral dispensary dispensary Centre dispensary nurses in 5
hospital hospitals

15 6 6 8 6 41

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3.7 DEVELOPMENT OF DATA COLLECTION TOOL
Tool that was used in the study was questionnaire, the study used the questionnaire because the
study population involve the literate personnel and it was easier to administer and analyst’s
questionnaire will be easier to formulate and it help to collect the information that was required.
The questionnaire prepared to reduce bias and the ambiguity. The respondents were given time to
study and fill the questionnaire that they were being given to them.

3.8DATA COLLECTION PROCESS

The data was collected using self-administering questionnaire which served as an appropriate tool.
The researcher explained to the respondents the importance of the study given based on the
respondent’s consent.

3.9PRETESTING
The research was pretested at changamwe sub county hospitals in Mombasa County of which 10%
of the 5 hospitals in changamwe sub county. The sample size was administered with the
questionnaire under the supervision of the research expert to stimulate formal data collection on a
small scale to identify practical problems with regard to data collection instruments.

3.10 VALIDITY
Research is valid only if its actual studies are verifiable (orodho, 2009). The validation of the
instrument was done by the researcher to ensure that the content and format of the questionnaire
was consistent with the objectives. The researcher was responsible to ensure that the tool was free
from error, the research implement this by ensuring that the individual does not lie to give response
at her desire. The researcher ensured that the questions in the questionnaire were relevant to that
of proposed research objectives and literature review.

3.11 RELIABILITY
The researcher tested reliability method which involves administering the same question in
different way during pre-testing to ensure reliability of the data instrument. The findings of pre-
testing was used to ensure efficacy of the tool to capture reliable data prior to the actual study.

3.12 DATA ANALYSIS AND PRESENTATION

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Data was collected and collated to ensure none of the information was lost or left out. cleaning,
editing of the data and coding of the data was done to ensure completeness and consistency
and thereafter it was analyzed manually using calculators and Microsoft Excel. Data was
presented in frequency tables, charts and graphs percentage used for interpretation.

3.13 ETHICAL CONSIDERATION

A Letter of authority was obtained from national commission for science and technology and
innovation (NACOSTI). A letter from the principal KMTC Msambweni to the hospital
administration of the study area requesting the study to be carried out. The researcher explained
the benefits and manners in which the study was conducted for every respondent before interview
was done, privacy and confidentiality was maintained.

15
CHAPTER 4: DATA ANALYSIS, PRESENTATION AND INTERPRETATION.
INTRODUCTION
This chapter presents the findings of the data collected from sampled healthcare workers offering
free maternal services at antenatal clinic in hospitals located in msambweni sub-county kwale
county.

All the 41 respondents participated in answering the questionnaire there was 100%response rate.
The data was interpreted according to the research questions. The analysis was done through
descriptive statistics and findings of the study was presented in form of frequency, tables and
charts.

4.0 SOCIAL DEMOGRAPHIC FACTOR

Table 4.1 respondents’ response on social demographic

N=41

INDICATOR FREQUENCY PERCENTAGE (%)

GENDER

Male 15 36.59

Female 26 63.41

N= 41 100

AGE

Below 30 20 41.88

31 -40 18 43.90

41-50 3 7.32

N= 41 100

MARITAL STATUS

16
 Single 14 34.15

Married 27 65.85

N= 41 100

RELIGION

Christian 23 56.10

Islam 18 43.91

N= 41 100

LEVEL OF EDUCATION

Diploma 38 92.68

Certificate 3 7.31

N= 41 100

YEARS OF SERVICE

0-5 23 56.10

5-10 13 31.7

Above 10 5 12.2

N= 41 100

4.1 HUMAN RESOURCE FACTOR

Human resource factors were divided into 3 include, staffing, workload and turnover.

4.1.1Respondents’ response on staffing

The table below shows majority of the respondents 39(95.12%) staffs were few while 2(4.88%)
staffs were enough

Table 4.2 Respondents’ response on staffing

17
N=41

Respondents Frequency Percentage %

Yes 2 4.88

No 39 95.12

N= 41 100

4.1.2 Respondents’ response on workload

The table below shows majority of the respondents 22(53.65%) had high workload 13(31.7%)
slighter higher workload5(12.2%) low workload 1(2.44%) lower

Table 4.3 Respondents’ response on workload

N=41

Workload indicator Frequency Percentage

11-20 5 12.20

21-30 22 53.65

31-40 13 31.70

41-50 1 2.4 4

41 100

4.1.3 Respondents’ response on turnover

Majority of the healthcare workers who move are between 32(78.05%) and minority who move
are 9(21.5) as shown on the table below

18
Table 4.4 respondents’ response on turnover

N=41

Turnover indicator Frequency Percentage (%)

0-3 32 78.05

4-6 9 21.5

N= 41 100

4.2 MANAGEMENT FACTOR

4.2.1 Respondents’ response on motivation
The figure below shows Majority of the respondents 35(85.37%) not motivated while
6(14.63%) were motivated

19
 RESPONDENT'S RESPONSE ON MOTIVATION
YES NO

15%

85%

Figure 4.1 respondents’ response on motivation

4.2.2 Respondent’s opinion towards supervision

The figure below 17(45%)of the respondents said the supervision was fair 10(24.39%)strict(17.0%)good
4(9.7%)harsh 4(9.7%) supportive

RESPONDENT'S RESPONSE ON SUPERVISION

45.00%
40.00%
35.00%
30.00% FAIR
25.00% STRICT
20.00%
GOOD
15.00%
10.00% SUPPORTIVE
5.00% HARSH
0.00%

Figure 4.2 Respondent’s response on supervision

20
4.2.1 Respondents’ response on support
The figure below shows most of the respondents 30(73.17%) said do not receive support
11(26.82%)received

N=41

RESPONDENTS' RESPONSE ON SUPPORT

80 73.17
70

60
PERCENTAGE

50

40

30 26.82

20

10

0
YES NO
SUPPORT

PERCENTANGE

Figure 4.3 Respondents’ response on support

4.3CAPACITY BUILDING
4.3.1 respondents’ response on training
The pie chart below 27(65.85%) respondents said they did not receive training
14(34.14%)received training

N=41

21
 RESPONDENTS' RESPONSE ON TRAINING

34%
YES
NO
66%

Figure 4.4 Respondents’ response on training

4.3.2 Respondents’ response on skills.

The figure below 8 (61.54%) respondents said training helped them improve their skills 5(
38.46%) said training did not improved their skills

N=14

22
 IMPROVEMENT OF SKILLS

61.54
PERCENTAGE

38.46

YES NO
SKILLS

PERCENTAGE

Figure 4.5 Respondents’ response on skills

4.3.3 Respondents’ response on knowledge

The figure below shows26 (61%) respondents said they can work on their own 16(39%) cannot.

N=41

23
 RESPONDENTS' RESPONSE ON KNOWLEDGE

YES
39%

NO
61%

Figure 4.6 Respondents’ response on kwoledge

24
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION
5.1 Discussion
The study findings on staffing showed majority of the respondents 39(95.12%) responded that
there were shortage of staffing as a human resource factor in the healthcare system, while
2(4.885%) staffs were enough this aligned with a study done by Manpower(2011) said Kenya
that experiencing a severe shortage of health workers and this shortage is compounded by several
factors including the inability to attract and retain healthcare workers, performance management
and productivity at the antenatal clinic. Study on workload majority of the respondents 22(53.65%)
serves clients between 21-30 With averagely 8hrs per day while 1(2.44%) responded that can
serve 41-50%) per 8 hrs. the study done by monsoon (2011) in Saudi Arabia showed that workload
to the healthcare workers at the Antenatal clinic who are offering free maternal services were
unsocially acceptable occupational choice. Study on turnover revealed that majority of the
respondents 32(78.05%) said turnover was high in the healthcare facility 9(21.5%) responded that
healthcare work workers move from where free maternal services are offered. this aligned with a
study done by (price2013) which said that Yet growing of shortage of healthcare workers has to
of led to increase in turnover rate among healthcare workers at antenatal clinic section.

Study findings on motivation majority of the respondents 36(85.37%)not receive motivation to

who offer free maternal services while 6(14.63%) were motivated This agrees with another study
done by Rachael manogi (2015) that showed that level of motivation from employer to healthcare
workers offer free maternal services was very poor. Study findings on supervision 17(45%)
respondents said the supervision was fairly good while 4(9.97%) said that supervision was harsh
this disagrees with a study done by Odhiambo(2016) in Kenya found supervision of health care
workers was poor which results to stress to the health care workers in the facility when offering
free maternal services at that antenatal clinic level. Study done on support 30(70.17%) responded
that they are not given support by their employer while 11(26.82%) said that there was support
that which was training,equipment this agrees with a study done by Mohammed (2014) on
healthcare workers support and said that the management does not have healthcare workers special
clinic, they does not ensure safely workplace also healthcare workers and given necessary
vaccinations in order to prevent them from being infected also eqiupments.

25
 The study findings showed that majority of the respondents 27(65.85%) have never gone for
training 14(34.14%) this agrees with a study done by Harrison (2018) in Tanzania which stated
that staff primarily lacks training and analytical skills to improve their working experience.

Study findings on skills 8(61.54%) who went for training received skills while 5(38.46%) did not
gain skills on training this agreed with a study done by M.Gichangi (2014) in Kenya, which stated
that most deficiencies in quality of care at the facility by health care facility result from gaps in
knowledge or inappropriate technology. On knowledge the study findings showed that 26(61%)
responded that they confirmed to see it hard when they work on their own without assistance that
is, training and support with a reason that they have knowledge while 16(39%)responded they find
it hard when to work on their own with a reason that they lack support and training and even if
they are being trained this disagrees with a study done by Georgina et Al (2018) which stated that
Health workers who were trained well regularly have the best knowledge on active management
of pregnant mothers, delivery and immediate routine Newborn care, therefore, this leads to low
quality of healthcare service delivery at the antenatal clinic.

5.2 CONCLUSION
The researcher found out that human resource factors was among the challenges facing healthcare
workers offering free maternal services, the majority22(53.7%) said the workload was too high at
the facility and staffing was one of the challenges they face at the facility when offering free
maternal service and this lead to heavy workload. Majority 32(78%)of the respondents said there
was high turnover among the health care workers however the least of the respondents said there
were no turnover in some of the facilities.

According to the findings, it shows that majority35(85%) of the respondents said that they are not
motivated by their employer in terms of appreciation and recognition thus this is one of the
challenges facing healthcare workers who offer free maternal services at the healthcare facilities
located in msambweni sub-county hospitals. Majority 30(70%)of the respondents said they were
not supported by their employer when offering this services, however least of the respondents

had fair supervision , support by their employer and others said supervision was so strict, harsh
which was a challenge to the health care workers.

26
The study revealed that majority27(65.9%) of the respondents were not trained to offer free
maternal services and this was a challenge because they were not taken for training to improve
to increase the level of knowledge and skills to offer this free maternal services to pregnant
mothers who come to facility for medical services.

5.3 RECOMMENDATION
The county government director of health together with the nursing in charges should provide
continuous training to the healthcare workers order to improve their skills and knowledge when
offering free maternal services in the healthcare facility.

The hospital administration should ensure that healthcare workers are motivated and their roles
and responsibility to be clear defined in their job description.

The county government in conjunction with the ministry of labor should employ more staffs to
reduce the burden of workload at specifically at the antenatal clinic.

5.4 FURTHER RESEARCH

Further research should be done to compare challenges facing private health facilities and
government health facilities offering free maternal services in Kwale County hospitals.

27
REFERENCES

Adano U Evans MJ (2010)-Health workers recruitment and deployment process in Kenya.

Adeloye D, David RA, Olaogun AA, et al (2017)- Health workforce and governance the crisis in
Nigeria.

Azevedo MJ (2017)-The State of Health System(s) in Africa: challenges and opportunities. In:
Historical Perspectives on the State of Health a Health Systems in Africa. Vol. II. Cham: Palgrave
Macmillan.

E Lang’at, mwariri L (2015)-Health healthcare service providers and facility Administrator’s

perspective of free maternal services delivery policy in Malindi district Kenya.

Essien MJ (2010) -The socio-economic effects of medical unions strike on the health sector of
Akwa Ibom State of Nigeria.

Fenny AP, Yates R, Thompson R. (2018) Social health insurance schemes in Africa leave out the
poor. Into Health.

Gross JM, rogers MF, Teplinsky (2011)-impact of out migration of health workers in Africa region

Khumbo K, Michael G, Earnest Barassa (2014)-Skills of general Health workers in primary eye
care in Kenya Malawi and Tanzania.

M, Gotsadze G, Mataradze G, Menabde G. (2013)- Human resources for health challenges of

public health system reform in Georgia. Human Resource Health.
Mullei k, Mudhune, Wafula J, Masomo v (2010)-Attracting and retaining health workers in Kenya.

Musango L, Elovainio R, Nabyonga J, Toure B. (2013)-The state of health financing in the African
Region.

Ngatho S M, Michael JD, Eliaba YD, Ashraful AB (2018)-Barriers faced by the health workers to
deliver maternal care services and perceptions of the factors preventing their clients from receiving
services South Sudan.

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Omaswa F. (2014)-Solutions for Africa’s health workforce crisis through Country Based Research.
Hum Resource Health Nigeria

Orenyi MD, Paul AO, Joseph O (2018)-Assessment of effect of labor strikes on access to service
delivery in Secondary Health institutions in Cross River State, Nigeria.

U.S Muhammad, Maram, EL Zain (2014)-challenges facing healthcare service providers south
Sudan.

Van de Ven AH, Delbecq AL. (2011)-The nominal group as a research instrument for exploratory
health studies. Am J Public Health. Sector in India.

WHO (2011)-Everybody’s Business: Strengthening Health Systems to Improve Health

Outcomes: WHO’s Framework for Action? Switzel: World Health Organization, Geneva.

WHO (2017)-What Needs to Be Done to Solve the Shortage of Health Workers in the African
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World Health Organization Report (2006) – Working Together for Health.

World Health Organization. Report (2010)-Health systems financing: the path to universal
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29
APPENDIX I: BUDGET
ITEM QUANTITY PRICE PER ITEM TOTAL PRICE

Plain papers 1 ream 500 500

Biro pens 5 pens 25 125

Ruler 1 30 30

Book 1 80 80

Flash disk 1 1000 1000

Internet session 20 sessions 50 1000

Typing and printing 1900

Binding 2 copies 50 100

Travelling To and from 500 500

Accommodation Single room 2500 2500

Miscellaneous 3500 3500

Total 11250

30
APPENDIX II: Work plan
TASKS FE MARC APRI MAY JU JUL AU SE OC NOV DEC JAN
B H L NE Y G P T
Presentation
and
approval of
research
topic
Proposal
writing

Preparation
of data
collection
tool
Data
collection

Data
analysis and
presentation

Dissertation

31
APPENDIX III Map

Figure 7 Map

32
APPENDIX IV: NACOSTI LETTER

Figure 8 NACOSTI letter

33
APPENDIX IV: DATA COLLECTION PERMISSION

Figure 9 Permission letter

34
APPENDIX V: DATA COLLECTION LETTER

Figure 9 Authorization letter

35
APPENDIX VI: DATA COMPLETION LETTER

Figure 10 Data completion letter

36
APPENDIX VII: QUESTIONNAIRE
NUMBER……………

INTRODUCTION

The researcher is a health record and information student in Msambweni campus. The study is on
challenges facing healthcare workers offering free maternal services at Antenatal l clinic in
Msambweni sub county. Have identified you to be respondent so as to give information regarding
the above study. information obtained is for learning purpose and will be very confidential.

TOPIC; STUDY ON CHALLENGES FACING HEALTHCARE WORKERS OFFERING FREE

MATERNAL SERCES AT ANC IN MSAMBWENI SUB COUNTY IN KWALE COUNTY.

INSTRUCTIONS

Do not write your name on the questionnaire

Answer the questions by ticking in the boxes provided according to your review
Each and every question should have one answer
Confidentiality to be maintained

Your response and co-operation will be highly appreciated

1. Kindly indicate your gender

Male [ ]

Female [ ]

2 kindly indicate your age

A Below 30[ ]

B) 31-40 [ ]

C) 41-50 [ ]

D) Above 50 [ ]
37
3 Kindly indicate marital status

A)single [ ]

B) Married [ ]

C) Divorced [ ]

D)Separated [ ]

E) Widowed [ ]

4what is your religion

a) Christian [ ]

b) Islam [ ]

c)Others [ ]

5Highest level of education

PHD [ ]

A) Masters [ ]

B) Bachelor’s degree [ ]

C)Higher diploma [ ]

D)Certificate [ ]

6 years of service

A) Less than 5yrs [ ]

B)5-10 [ ]

C)Over 10 yrs. [ ]

SECTION B HUMAN RESOURCE

7.How many health workers have Left for the last 6 months?.......

38
less than 10[ ]

more than 20 [ ]

less than 5 [ ]

8. a) Do you have shortage number of staffs?

Yes [ ]

No [ ]

b) If yes specify…….

9). How many clients do you attend per day?……….

10) How many hours do you work per day?……

SECTION B MANAGEMENT

11.a) Have you ever been motivated?

Yes [ ]

No [ ]

b) If yes specify……

12) i) Does the hospital have any supervisor?

Yes [ ]

No [ ]

ii). If yes How often are you supervised?

a) daily [ ]

39
b) weekly [ ]

c)monthly [ ]

d) null [ ]

iii) What is your opinion about your supervision?

…………………….

13.Do you receive any support from your employer?

Yes [ ]

No [ ]

If yes specify…..

SECTION C CAPACITY BUILDING

14). a) Have you ever attended any training?

Yes [ ]

No [ ]

b) if yes specify which training………

15. Did the training helped improve your skills?

yes [ ].

No [ ]

if yes specify

16. Do you find it hard when performing maternal services at your own?

Yes [ ]

No [ ]

b) if Yes explain……

40
THANK YOU

41