The Influence of Demographic Factors in Access to Public Health Care in Kenya: A Case of Nairobi County, Kenya

Journal of Social and Political

Sciences

ISSN 2615-3718 (Online)

ISSN 2621-5675 (Print)

Published: 18 May 2020

The Influence of Demographic Factors in Access to Public Health Care in Kenya: A Case of Nairobi County, Kenya

Davies N. Chelogoi, Fred Jonyo, Henry Amadi

University of Nairobi

pdf download

Download Full-Text Pdf

10.31014/aior.1991.03.02.181

Pages: 439-454

Keywords: Social Class, Access to Healthcare

Abstract

Access to public healthcare in Nairobi County is unequal among social classes. Lower social classes have worse healthcare than either the upper or the middle classes. These health inequalities are correlated with socio-economic inequalities. The higher socio-economic classes have better access to healthcare than the lower socio-economic classes. Higher incomes, education, employment and wealth result in better health of the households in the County. Unequal access to healthcare contributes to disparities in health status, increases costs for both the insured and the uninsured. Lack of access to healthcare reduces disposable incomes, particularly burdening the lower income households. These households cannot afford the care they need. This has forced them to forego such care altogether. The objectives of the study were three, namely: to evaluate the influence of demographic variables in access to public healthcare, to evaluate the influence of socio-cultural factors in access to public health care, and to evaluate the influence of institutional factors in access to public healthcare. The study used descriptive design, specifically, cross- sectional design for collection, measurements and analysis of data. The study took place in Nairobi County. The target population was households living in Nairobi County, where the sample was drawn from. The sampling techniques included multi-stage random sampling, random sampling, stratifies random sampling, cluster random sampling, convenient sampling and purposive sampling. The sample size was obtained using Chadha’s formula (2006) to arrive at 1066 sample size. Data collection instruments included observations, face- to- face interviews, questionnaires, in-depth interviews and focus group discussions. Qualitative data was analyzed thematically but quantitative data was analyzed using descriptive statistics. Data were analyzed using SPSS version 23. The results show that there were positive correlations between independent and dependent variables. The P-value was statistically significant. The results were not due to random chance and that P- 0.01< 0.05 and this confirms a positive relations ships between the variables. The relationships were mutually inclusive and highly correlated. On that basis, the null hypotheses were rejected and the alternate hypotheses accepted. The results show that demographic (disposing of), socio-cultural (need) factors influence access to healthcare. Socio-economic factors should be addressed to benefit all the households. Socio-cultural factors should be distributed fairly among the households. Health systems should be improved and adequately financed to provide the requisite resources to all the households.

References

  1. Aday LA. (1993), Equity, accessibility, and ethical issues: is the U>S health care reform debate asking the right questions? Am Beav Scie. 36: 724-740.

  2. African Union, (2001), Abuja Declaration on HIV/AIDS, tuberculosis and other related infectious diseases. Addis Ababa.

  3. Agabin N. et al. (2015), Undocumented and uninsured: after effects of the Patient Protection and Affordable Care Act. J Med Pract Manage; 30(5):345–58.

  4. Andersen RM, et al. (2001), Improving access to care in America: individual and contextual indicators, Jossey-Bass; 3–30.

  5. Almeida LM et al.(2013), Migration and maternal health: experiences of Brazilian women in Portugal. Rev Bras Saude Matern Infant; 13(4):309–16.

  6. Athanasakis K. et al. (2009), The economic and social extensions of Alzheimer. Neurologia,18: 220-227.

  7. Avila RM. et al.(2013), Language and immigrant status effects on disparities in Hispanic children’s health status and access to health care. Matern Child Health J; 17(3):415–23.

  8. Aye M, et.al. (2002), Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast. Soc Sci Med; 55:1929–46.

  9. Bartley M. (2004), Health inequality - An introduction to theories, concepts and methods. Malden (U.S.): Polity Press.

  10. Braveman P. et al. (2002), Social inequalities in health within countries: not only an

  11. issue for affluent nations, Soc Sci Med, 54, pp.1621-35.

  12. Braven P. et al. (2003), “Defining Equity in Health”, Journal of Epidemiology and Community Health,57; 254-258.

  13. Brawley M. (2000), The Client perspective: what is quality healthcare service? A literature review, Kampala, Uganda.

  14. Bourdieu P. (1984), Distinction, A social Critique of the Judgment of Taste, Trans,

  15. Richard Nice, Cambridge, M.A. Harvard University Press.

  16. Carmona R, et al. (2014), Use of health services for immigrants and native population: a systematic review. Rev Esp Salud Publica; 88(1):135–55.

  17. Carroll KM, et.al. (2005), Behavioral therapies for drug abuse. Am J Psychiatry; 162(8):1452–1460.

  18. Chadha. (2006), Sample size determination in healthstudies.

  19. Constitution of Kenya. (2010), Fourth schedule. Nairobi, Kenya: Government of Kenya.

  20. Cutler, D. et. al. (2002), “The Economic Impacts of the Tobacco Settlement,” Journal of Policy Analysis and management, 21:1-9.

  21. Donabedian A. (1990), The Seven Villas of quality; 1115-1118.

  22. David M. (2002),“Health Care and the Public Sector.” Handbook of Public Economics.

  23. Davidson PL, Andersen RM, Wyn R, Brown ER. (2004). A framework for evaluating safety-net and other community-level factors on access for low-income populations. Inquiry; 41(1):21–38.

  24. Deci E. et al. (1999), A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol Bull; 125(6):627–668.

  25. Deineger K. et al.(1996), “Anew Data Set Measuring Income Inequality,” World Bank Economic Review 10: 565-591.

  26. Elgar FJ. et al. (2015), Socioeconomic inequalities in adolescent health 2002-2010: a time-series analysis of 34 countries participating in the health Behavior in School-aged Children study, Lancet.

  27. Fields G. (2004), Department for Labour Economics Discussion Paper UK: Cornell University; 'Regression-based decomposition: A new tool for managerial decision-making.

  28. Fraenkel J. et al. (2000), How to design and evaluate research in Education, New York NY: Mc Grawhill companies Inc.

  29. Government of Kenya.(2002), Economic Survey, Government Printers, Nairobi.

  30. -------------------------------(1999), National Poverty Eradication Plan 1999-2015, Department of Development Co-ordination, Office of the President, Government Printer, Nairobi.

  31. -------------------------------.(1996), National Report and Plan of Action on Shelter and Human Settlements to Habitat 11 Conference, Ministry of Public Works and Housing, Nairobi.

  32. ---------------------------------(2001), 1999 Population and Housing Census Volume I Central Bureau of Statistics Nairobi.

  33. -------------------------------- (2015), Comparative Health Expenditure, Nairobi, Kenya

  34. ----------------------------------- (2013), Devolution of Health services in Kenya,KPMG;.7.

  35. ----------------------------------- (2016), Master Facility List, Nairobi;.32.

  36. ---------------------------------------(1996), Welfare Monitoring Survey 1994, Basic Report, Nairobi: Central Bureau Statistics.

  37. ------------------------------------------(1998a), Kenya Demographic and Health Survey.Nairobi: Government Printer.

  38. ------------------- (2012), Vision 2030, Second Medium Term Plan, 2013-2017, Transforming Kenya, Pathway to devolution, socio-economic development, equity and national unity, Government Printer, Nairobi.

  39. Gulliford M. (2002),What does 'access to health care' mean? J Health Serv Res Policy; 7(3):186-8.

  40. Gummesson, E. (1991), Qualitative Methods in Management Research(Revised Edition).

  41. Hall P, et.al. (2009), In: Successful Societies: How Institutions and Culture affect Health. Hall P, Lamont M. (editor). Cambridge: Cambridge University Press. Health, social relations and public policy; pp. 82–103.

  42. Head J, et al. (2007) The Potential Impact on Health and Sickness Absence of Management Standards for Work-Related Stress. Research Report to Health and Safety Executive. Health and Safety Executive.

  43. House, WJ. (1978), “Nairobi’s Informal Sector A Reservoir of Dynamic Entrepreneurs of a Residual Pool of Surplus Labour?” University of Nairobi Working Paper No 347, Institute of Development Studies, Nairobi.

  44. Republic of Kenya (1998), Integrated Labour Force Survey 1998/99. Nairobi. Central Bureau of Statistics.

  45. Republic of Kenya (1998b), National Poverty Eradication Plan. Nairobi: Government Printer.

  46. Institute of Medicine. (2001), Crossing the Quality Chasm: A New Health System for the 21st Century.

  47. Gwatkin DR. et al. (20040, Making health systems more equitable; 1273-1287.

  48. Jong-wook L. (2003), Global health improvement and WHO: shaping the future. Lancet, 20; 362(9401):2083-8.

  49. Karanikolos M, et.al. (2013),Financial crisis, austerity, and health in Europe. Lancet, 381: 1323-1331.

  50. Kawachi, I. et al. (2002), A glossary for health inequalities: J Epidemiol Community Health, 56, pp.647-52.

  51. Kawachi I, et al. (2003), Neighborhoods and Health, New York, NY: Oxford University Press.

  52. Kelly S, et al. (1997), Searching for the biological pathways between stress and health. Annual Review of Public Health; 18:437–462.

  53. Kerlinger, F.N. (1986), Foundations of Behavioral Research (3rded). New York: Holt,

  54. Rinehart & Winston.

  55. Keruly JC, Conviser R, Moore RD. (2002), Association of medical insurance and other factors with receipt of anti-retroviral therapy. Am J Public Health; 92:852–857.

  56. Koblinsky MA, et.al. (1999), Organizing delivery care: what works for safe motherhood? Bull World Health Organ; 77(5): 399–406.

  57. Krasnik A. (1996), The concept of equity in health services research, Scand J Soc Med: 24:2-7.

  58. Krieger N. (2001), Theories for social epidemiology in the 21st century: an ecosocial perspective. International Journal of Epidemiology; 30:668–677.

  59. Leedy & Ormrod. (2005), Practical research: Planning and design(8th ed.). Upper Saddle River, NJ: Prentice Hall.

  60. Lin N. (2001), Social capital: a theory of social structure and action. New York: Cambridge University Press.

  61. Lynch JW et al.s (2000). Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ; 320:1200–1204.

  62. Mahler H. (1987), The safe motherhood initiative: a call to action. Lancet; 1 (8534):668–670.

  63. Mackenbach J. et al. (1997), “Measuring the magnitude of Socio-Economic Inequalities in Health: An Overview of Available Measures Illustrated With Two Example From Europe”, Social Science and Medicine; 44: 757-771.

  64. Marmot M. (2010), Marmot Review, Fair Society, Healthy Lives, Strategic Review of Health Inequalities in England, University college London.

  65. Marmot M, et.al. (1997), Social inequalities in health: next questions and converging evidence. Social Sciences & Medicine; 44:901–910.

  66. Mbogua, JP. (2000), “Problems of Shelter and Planning Constraints in the City of Nairobi” Paper presented to the Annual National Convention of the Architectural Association of Kenya held at Safari Park Hotel, Nairobi.

  67. McCormick et al. (2000), Annual report on access to and utilization of health care for children and youth in the United States. Ambul Pediatr; 1:3–15.

  68. Miller WR et al. (2002), Motivational Interviewing: Preparing People for Change 2nd ed. New York, NY: Guildford Press.

  69. Minas M et al. (2010), Prevalence of chronic diseases and morbidity in primary health care in central Greece: an epidemiological study. BMC Health Serv Res, 28: 252.

  70. Ministry of Health, (2014), Health Sector Human Resource Strategy 2014-18.

  71. Ministry of Health. (2017), Health Sector Report, 2017/18.

  72. Morgan G. et al. (2003), what does 'access to health care' mean? J Health Serv Res Policy: 7:186–188.

  73. Mortimer D. et al. (2006), Economic evaluation of interventions for problem drinking and alcohol dependence: do within-family external effects make a difference? Alcohol ; 41(1):92–98.

  74. Moyer C. et al. (2013), “Drivers and deterrents of facility delivery in sub-Saharan Africa: A systematic review,” Reproductive Health, Vol. 10:40.

  75. Mugenda G. (2008), Social research theory and principles, Kijabe printing press.

  76. Murray CJ. et al. (1999), Critical Reflection-health inequalities and social group differences: what should we measure? Bull World Health Organization, 77:537-44.

  77. Obudho, RA and Aduwo. (1992),“The Nature of the Urbanization Process and Urbanism in the City of Nairobi, Kenya African Urban Quarterly Vol7 No 1 & 2.

  78. Obudho and Aduwo, (1988), “The Role of Nairobi in Spatial Planning in Kenya, Towards a

  79. Planning Alternative,” First International Conference on Urban Growth and Spatial Planning of Nairobi, Nairobi.

  80. Olima et al. (2001), “The Dynamics and Implications of Sustaining Urban Spatial Segregation in Kenya – Experiences from Nairobi Metropolis” A Paper Presented at the International Seminar on Segregation in the City Held at Lincoln Institute of Land Policy in Cambridge, USA.

  81. Penchansky, Ret et al. (1981), The concept of access: definition and relationship to consumer satisfaction. Med. Care2: 127–140.

  82. Pogge T. (2002). Can the capability approach be justified? Philos Top; 30(2):167–228.

  83. Ronsmans C et al. (2006), Maternal mortality: who, when, where, and why. Lancet: 368(9542):1189–1200.

  84. Royal College of Psychiatrists. (2010), No Health without Public Mental Health: The Case for Action (Position Statement PS4/2010), Royal College of Psychiatrists.

  85. Ruger JP, et.al. (2009), Measuring the costs of outreach motivational interviewing for smoking-cessation and relapse-prevention among low-income pregnant women.

  86. Sen AK. (1999), Development as Freedom, Oxford: Oxford University Press. .

  87. -------------- (1992), Inequality Re-examined, Oxford: Clarendon Press.

  88. -----------------(1994), ‘Capability and Well-being’ in Martha C. Nussbaum and Amartya K. Sen. (eds), The quality of life, Oxford: Clarendon Press: 30-53

  89. ----------------------(1994), ‘Well-Being, Capability and Public Policy’, Giornale Degi Economist e Annali di Economiia, 53, 333-47.

  90. ------------------------------(1997), ‘Editorial: Human Capital and Human Capability’, World Development, 25 (12), 1959-61.

  91. -------------------------------(2005), ‘Human Rights and Capabilities’, Journal of Human Development, 6(2), 151-66.s

  92. Schellenberg JA, et al. (2003), Inequities among the very poor: health care for children in rural southern Tanzania. Lancet; 361:561–566.

  93. Schneider EC et al.s (2002), Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA; 287:1288–1294.

  94. Siegrist J. (1998), Reciprocity in basic social exchange and health: can we reconcile person-based with population-based psychosomatic research? Journal of Psychosomatic Research; 45:99– 105

  95. Simkhada B, et.al. (2008), Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs; 61(3):244–260.

  96. Situma, (1992), “The Environmental Problems in the City of Nairobi” African Urban Quarterly,Vol 7 Nos 1 and 2:167.

  97. Smith, E. R. (1996), What do connectionism and social psychology offer each other? Journal of Personality and Social Psychology, 70, 893-912.

  98. Smith, Adam 91776), reprinted in Edwin Cannon (eds.), (1976), The Wealth of the Nations, Chicago: University of Chicago Press.

  99. Smith KB et al. (2008), disadvantage of health Aust J Rural Health: 16:56-66.

  100. Stevens RD. (2000), Safe motherhood: an insight into maternal mortality in the developing world. Health Millions; 26(3):34–37.

  101. Turin, D.R. (2010),HealthCare Utilization in the Kenyan Health System: Challenges and Opportunities." Student Pulse, 2(09).

  102. UNDP. (2005), Human Development Data, New York.

  103. USAID. (2013), “Kenya HIV/AIDS Fact Sheet”, Kenya.

  104. Van D. et al. (2004), Explaining the differences in income-related health inequalities across European countries. Health Economics; 13:609–628.

  105. Veugelers PJ et al. (2003), services use Chronic Dis Can 24:116-123.

  106. Wamala SP. (2007), Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health; 61:409–415.

  107. Whitehead M. (1992), The concepts and principles of equity and health. Int J Health Serv; --22(3):429–445.

  108. -----------------------(2006), Leveling up (part 1): a discussion paper on concepts and principles of tackling social inequalities in health. Studies on social and economic determinants of population health, Copenhagen, WHO Regional Office for Europe.

  109. World Health Organization, (2005), Guiding Principles for Feeding Non breastfed Children 6 to 24 Months of Age. Geneva, Switzerland.

  110. World Health Organization, (2011), MDG 5: improve maternal health.

  111. World Health Organization, (2007), Achieving Health Equity, from root causes to fair outcomes, Geneva.

  112. World Bank, (1997), World Development Report 1997, Investing in Health, New York: Oxford University Press.

  113. Xu K, et al. (2006), Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda. Soc Sci Med; 62:866–876.

  114. Yin, R. (1984),Case study research: design and methods. Sage publications.

About Us

The Asian Institute of Research is an online and open-access platform to publish recent research and articles of scholars worldwide. Founded in 2018 and based in Indonesia, the Institute serves as a platform for academics, educators, scholars, and students from Asia and around the world, to connect with one another. The Institute disseminates research that is proven or predicted to be of significant influence for the general public.

Contact Us

Please send all inquiries to the email:

editorial@asianinstituteofresearch.org

Business Address:

5th Floor, Kavling 507, Fajar Graha Pena Tower, Jl. Urip Sumohardjo No.20, Makassar, Indonesia 90234

Copyright © 2018 The Asian Institute of Research. All rights reserved

Stay Connected

  • Instagram - Black Circle
  • Facebook - Black Circle
  • LinkedIn - Black Circle