Obwaka E, Jenniskens F, Temmerman M, Pido O, Ndinya-Achola J, Mohammedali F; International Conference on AIDS.
Int Conf AIDS. 1993 Jun 6-11; 9: 945 (abstract no. PO-D36-4367).
University of Nairobi.
OBJECTIVE: To identify system barriers to effective health care delivery in antenatal and STD facilities in Nairobi City Commission clinics and to recommend means by which these can be minimised. METHODS: Interviews with persons in the NCC system, clients, staff and policy makers, archival research/literature review on the evolution of the NCC system and factors pertaining to its present structure, observation in clinics. RESULTS: Major factors that create barriers to effective utilisation by the clients include: brusque behaviour of staff towards clients, rigid adherence to protocol at the expense of good health care objectives, invasion of client's privacy at clinic entry point for means of identification, gender bias in favour of females and language barriers. With regard to staff, lack of supplies in the clinic and low salaries rank high among barriers resulting in ineffective delivery of health care in ANC/STD clinics. Other barriers include discrepancy between job description of staff and responsibilities they are expected to perform, bureaucratic lag and red tape, architectural problems in many clinics that do not facilitate effective functioning of the clinic and work environment that contradicts training. A factor influencing the user hostility is the fact that system protocol restricts free choice based on quality of service and therefore interferes with system self assessment. CONCLUSION: The factors found strongly suggest that the NCC health care system (ANC/STD) is more system authority reinforcing at the expence of service orientation. This may be in part be as a result of transfer of behaviour patterns from previous system probably dating as far back as the colonial era. The deteriorating macro economic situation over the last 5 years has also contributed substantially to the emergence of many of these factors.
Publication Types:
Keywords:
- Ambulatory Care Facilities
- Cities
- Delivery of Health Care
- Female
- Health Services Research
- Humans
- Kenya
- Research
- education
Other ID:
UI: 102207666
From Meeting Abstracts