University of Nairobi, Nairobi, Kenya.
Center for Global Health, Arizona State University, Tempe, AZ, USA.
Int J Health Policy Manag. 2018 Dec 1;7(12):1130-1137. doi: 10.15171/ijhpm.2018.83.
Primary healthcare facility managers (PHFMs) occupy a unique position in the primary healthcare system, as the only cadre combining frontline clinical activities with managerial responsibilities. Often serving as 'street-level bureaucrats,' their perspectives can provide contextually relevant information about interventions for strengthening primary healthcare delivery, yet such perspectives are under-represented in the literature on primary healthcare strengthening. Our objective in this study was to explore perspectives of PHFMs in western Kenya regarding how to leverage human resource factors to improve immunization programs, in order to draw lessons for strengthening of primary healthcare delivery.
We employed a sequential mixed methods approach. We conducted in-depth interviews with key informants in Kakamega County. Emergent themes guided questionnaire development for a cross-sectional survey. We randomly selected 94 facility managers for the survey which included questions about workload, effects of workload on immunization program, and appropriate measures to address workload effects. Participants provided self-assessment of their general motivation at work, their specific motivation to ensure that all children in their catchment areas were fully immunized, and recommendations to improve motivation. Participants were asked about frequency of supervisory visits, supervisor activities during those visits, and how to improve supervision.
The most frequently reported consequences of high workload were reduced accuracy of vaccination records (47%) and poor client counseling (47%). Hiring more clinical staff was identified as an effective remedy to high workload (69%). Few respondents (20%) felt highly motivated to ensure full immunization coverage and only 13% reported being very motivated to execute their role as a health worker generally. Increasing frequency of supervisory visits and acting on the feedback received during those visits were mostly perceived as important measures to improve program effectiveness.
Besides increasing the number of staff providing clinical care, PHFMs endorsed introducing some financial incentives contingent on specified targets and making supervisory visits meaningful with action on feedback as strategies to increase program effectiveness in primary healthcare facilities in Kenya. Targeting health worker motivation and promoting supportive supervision may reduce missed opportunities and poor client counseling in primary healthcare facilities in Kenya.
基层医疗保健机构管理者（PHFMs）在基层医疗保健系统中占据独特地位，是唯一将一线临床活动与管理职责相结合的干部。他们通常作为“基层官僚”，可以提供有关加强基层医疗保健服务的干预措施的相关背景信息，但在关于加强基层医疗保健的文献中，这种观点的代表性不足。我们在这项研究中的目的是探讨肯尼亚西部 PHFMs 对如何利用人力资源因素来改善免疫规划的看法，以便为加强基层医疗保健提供经验教训。
我们采用了顺序混合方法。我们在卡卡梅加县进行了深入的访谈。在横断面调查中，根据出现的主题制定了问卷。我们随机选择了 94 名设施管理者进行调查，其中包括工作量、工作量对免疫规划的影响以及解决工作量影响的适当措施等问题。参与者对自己的一般工作动机、确保其管辖范围内所有儿童完全免疫的具体动机以及改进动机的建议进行了自我评估。参与者被问到监督访问的频率、监督访问期间主管的活动以及如何改进监督。
报告的工作量过高的最常见后果是疫苗接种记录准确性降低（47%）和客户咨询不佳（47%）。招聘更多临床工作人员被认为是解决高工作量的有效方法（69%）。很少有受访者（20%）对确保完全免疫覆盖率高度有动力，只有 13%的受访者对一般执行其卫生工作者角色有很强的动力。增加监督访问的频率并根据这些访问期间收到的反馈采取行动，被大多数人认为是提高计划效果的重要措施。
除了增加提供临床护理的工作人员数量外，PHFMs 还支持引入一些与具体目标挂钩的财务激励措施，并使监督访问具有实际意义，在反馈中采取行动，以提高肯尼亚基层医疗保健设施的计划效果。针对卫生工作者的动机并促进支持性监督，可能会减少肯尼亚基层医疗保健设施中错失的机会和客户咨询不佳的情况。
