KeMU

The Alma Ata Declaration of 1978 emphasized the importance of primary care as an approach to achieve health for all. Kenya has gradually expanded primary care health service delivery to increase access and comprehensiveness of healthcare services. It has equipped referral facilities with modern equipment, while primary care health facilities continued to struggle with limited resources. As a consequence, this gap has become a big impediment to Kenya’s quest to achieve universal health coverage. Structural arrangement has been cited as the major contributing factor to quality health services delivery. This study examined relationship between structural arrangements and provision of quality primary care health service in public health centers. The objectives was to assess whether infrastructural resources, financial resources, staffing and governance influence provision of quality primary care services in public health centers in Nakuru County. Acrosssectional study design with mixed data collection methods was adopted for this study. A total of 110 respondents from 33 public health centers in Nakuru County were included in the study sample. The respondents were Clinical officers, Nurses, Pharmaceutical Technologist and Laboratory Technologists. Data entry and analysis was done using SPSS Version 20. Descriptive analysis was used to profile the characteristic of the respondents. Mean, Standard deviation, correlation and regression was used to determine the relationships. The findings showed that modern equipment and adequate supply of essential commodities was associated with high quality primary care health service delivery (r=0.453, p<0.01). Sufficient funds and effective management of resources significantly determined quality of primary care health service (r=0.365, p<0.01). Health worker skills, experience and training were statistically associated with quality primary care service (r=0.567, p<0.01). Transparency and accountability were strongly and positively associated with improved quality of primary care service at the public health centers (r=0.613, p<0.01). Regression analysis showed financial resource (β= 0.32) and governance (β= 2.49) significantly improved quality of primary care health service delivery. Study concludes good structural arrangements lead to good processes and ultimately good health outcome. The study recommends that county government of Nakuru should i) supply adequate equipment to perform the necessary work, ii) provide sufficient allocation and timely release of funds to health centers, iii) provide career progression and continuous professional development among its health workforce, and iv) institute staff retention measures and frequent auditing of health centers assets and liabilities and provide a report to the public.