Context, Process and Content Dimension To Full Integration of ICT in Delivery of Health Care Services in Selected Public Health Facilities of Machakos, Turkana and Nairobi Counties in Kenya

Abstract

Use of Information and Communications Technologies (ICTs) helps in improving delivery of health care services. However, despite heavy investment by Kenyan government in ICT infrastructures, the efficiency and benefits of ICT has not been achieved as health care system continue to suffer compromised quality of care due to disjointed patient management systems and poor management of resources. Therefore, the need to establish the barriers to full integration and utilization of ICT in the delivery of health care in Kenya which is key in the realization of universal health care and sustainable development goal number three in health (SDG#3) as that data would aid in increasing efficiency and ensure evidence based health system management. Broad objective of the study was to determine the ICT Process, Content and Context dimension to full integration of ICT in health care delivery in public health facilities of Machakos (semi-urban), Turkana (rural) and Nairobi (urban) Counties in Kenya. A cross-sectional quantitative study was used. The three counties were selected from the 47 counties using simple random sampling with replacement technique from the three clusters (rural, semi urban and urban). A total of 172 health facilities (Level 2-5) were selected using proportionate and simple random sampling with replacement in the three counties. A total of 369 study respondents (health care professionals) were selected from the various departments using stratified sampling technique and proportionately divided across the counties where the health care workers were randomly selected. A pretested self-administered questionnaire and observation sheet was used to collect data. Odds ratio at 95% Confidence Interval (CI) was used to determine association between dependent and independent variables. Data was analysed using Statistical Package for Social Sciences (SPSSTM) analytical software version 25 for windows. Univariate analysis was carried out based on frequencies and testing for association using bivariate analysis by use of Chi square test at 95% Confidence Interval while strength of the association was determined using Phi and Cramer’s V tests. Dependent variable was ICT utilization and independent variales were context, process and content dimensions. This study demonstrated that content and process dimensions were the most critical success factors associated with uptake of ICT utilization in public health facilities. In the rural county, the major limitation in the use of ICT was lack of ICT infrastructure (hardware and software) in the lower level facilities and level 5 facility at 50% and 21.9% respectively. In the semi urban county, the major limitation in the use of ICT in the lower level facilities was lack of ICT infrastructure at 33.3% while for the level 5 facility lack of computers was the major limitation at 36.4%. In the urban county the major limitation in use of ICT in the lower level facilities and level 5 facility was lack of ICT infrastructure at 46.8% and 30.4% respectively. The specific key attributes to ensure utilization of ICT was found to be Strong management involvement in ICT related matters and Availability and implementation of an ICT policy especially among the lower level facilities (Level2 -4) (process dimensions), Presence of an institutional induction training program on ICT (context dimension), Type of ICT support provided and its reliability and Level of services operations computerized (content dimensions)