Topic | Quote |
Physical access | ‘other clients who are near here but during the time of rain, there is a river, that over flows, it makes accessibility a problem because there is no bridge’ |
Budget execution | ‘Because we usually rely on the national treasury to release the funds to the counties. So, you find that most of the time [national treasury] delays in dispersing the funds, so sometimes we get a delay in procuring our health commodities. In such instances we get shortages but somehow, we try to curb by using the Facility Improvement Fund (FIF) for the bigger facilities’† |
‘(I would like] A system that does not require me to break the law and sign for cash that I’m not supposed to sign. I’d prefer a system where I do not have to be there for it to run, you see. I’d prefer a system where allocations like Linda mama (insurance program to fund maternal care) go to what Linda mama is supposed to do. Not diverting funds to go assist and manage the hospital’† | |
Lack of funds | ‘we encourage people to get NHIF (National Hospital Insurance Fund) because that means the treatment will be free if they are cover is up to date so I feel like we have made that effort. And currently we collect a lot of, actually most of the money we use to run the hospital comes from the NHIF claims. Yeah because we…we …we haven’t received money from the county, in almost three years now’† |
‘Yes to some extent in terms of the projects that we are implementing. Sometimes officers need to be on the field and you cannot go to the field when you do not have access to maybe the funds or the facilitation that you require’ | |
Stock outs | ‘(when] we don’t have supplies, we don’t have drugs you find that our patients actually go down, the patients number goes down. Once we get the supplies all the hospital will be filled up’ |
‘The delays in payment. We procure but then they stay even three months before paying the suppliers and the supplier says we can’t supply you until our debt is cleared’ | |
‘to improve on the services, we actually need more supplies because the supplies that we receive from KEMSA (Kenya Medical Supplies Authority), sometimes they normally bring us a fixed budget, they do not bring what we ordered maybe because of the financial constraints from the county’† | |
Motivation | ‘(Regarding stock outs] it is demoralizing because patients have confidence in you and you have nothing to offer, you are losing the confidence you have’ |
‘We have never gone without pay. At least the relation is okay. At least every monthly we get our salaries.’† | |
‘Maintaining of personnel, you know staff need to be motivated. Like work with promotions, if promotions are done in time, they will really motivate staff…You know the board is an independent body, and when they do their promotions they don’t tell us why they have promoted these ones, why they have not promoted the others’† | |
Staffing levels | ‘like the number of staff, of nurses is really not really good it really needs a lot to be done so we have a shortage of nurses. So, if nurses are increased it will really help in burn out because current cadre of nurses is really beyond the required standard it would improve the performance’ |
‘If we do not have enough budget, you cannot employ [staff), and start the process of determining how much budget is needed for health in terms of human resources’† | |
Absenteeism | ‘Those [absenteeisms] are very rare cases, very rare cases and even then we do have an advisory committee that deals with all the disciplinary issues and they are very effective though we don’t get such not unless they are very adamant (Laughs)’ |
Excerpts were from transcribed interviews of healthcare providers and administrators in five Kenyan counties. All quotes from key informant interviewees are denoted with a †; all other quotes were from focus group discussions.