Journal of Social and Political
Sciences
ISSN 2615-3718 (Online)
ISSN 2621-5675 (Print)
Published: 17 August 2020
The Influence of Socio-Cultural Factors in Access to Healthcare in Kenya: A Case of Nairobi County, Kenya
Davies N. Chelogoi, Fred Jonyo, Henry Amadi
University of Nairobi
Download Full-Text Pdf
10.31014/aior.1991.03.03.208
Pages: 745-760
Keywords: Social class, Access to Public Healthcare and Socio-Economic Status
Abstract
The study examined factors that determine access to healthcare among the households in Nairobi County. The problem of concern in this study was that access to healthcare challenges have persisted despite expansion in healthcare system in Nairobi County. 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. The study sought to find out why the disparity in access to healthcare in Nairobi County persists despite government efforts to address the issue. The study employed a qualitative design. The households living in Nairobi County provided the frame in which the population sample was drawn using multistage cluster random sampling to arrive at a sample size of 1066. Qualitative data was collected using observations, focus group discussions and in-depth interviews. Content analysis was used to analyze qualitative data. The results confirms robust positive correlations between independent intervening variables (explanatory variables: socio-cultural variables) and dependent variables (access to public healthcare). The independent intervening variables had significant influences on access to public healthcare. The P-value was statistically significant. The results were not due to random chance and that P- 0.01< 0.05 confirms a positive relationships between the variables. The study objective and question were achieved. The hypotheses were disconfirmed.
References
African Union (2001), Decision OAU/SPS/Abuja/3. Addis Ababa; Abuja Declaration on HIV/AIDS, tuberculosis and other related infectious diseases.
Alamiro, E. S. and A. Weber (2002), Making health policies more pro-poor. Eschborn: GTZ (Deutsche Gesellschaft für Zusammenarbeit).
Allegranzi B and Nejad S.B. et al.(2011). “Burden of endemic healthcare associated infection in developing countries: Systematic review and meta-analysis”. Lancet, Vol. 377: 228-241.
Arrow K.J. (1963), “Uncertainty and the welfare economics of medical care.” American Economic Review, Vol. 53: 941-73.
Atela and Githure. (2016). What Kenya can do to achieve universal health coverage. African Institute for Development Policy (AFIDEP)
Amarita N. (2011). The role of gender inequalities in women’s reproductive healthcare: A population –level study of Namibia, Kenya, Nepal and India.
Andersen, R at el. (2001). Improving access to care in America: individual and contextual indicators, In: Andersen RM. et al. Changing the U.S. health care system: key issues in health services, policy, and management. San Francisco, CA: Jossey-Bass.
Avila, R et al. (2013).Language and immigrant status effects on disparities in Hispanic children’s health status and access to health care. Maternal and Child Health Journal, 17(3), 415-423.
Ayé, M. et al. (2002). Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast. Social Science & Medicine, 55(11), 1929-1946
Agabin N, Coffin J. (2015), Undocumented and uninsured: after effects of the Patient Protection and Affordable Care Act. J Med Pract Manage; 30(5):345–58.
Almeida LM, Caldas JP. (2013), Migration and maternal health: experiences of Brazilian women in Portugal. Rev Bras Saude Matern Infant; 13(4):309–16.
Andersen RM, Davidson PL. (2001), Improving access to care in America: individual and contextual indicators. In: Andersen RM, Rice TH, Kominski EF, editors. Changing the U.S. health care system: key issues in health services, policy and management. San Francisco, CA: Jossey-Bass; pp. 3–30.
Andersen, R. (1979). The relationship between first language transfer and second language organization. Data from the English of Spanish speakers.
Athanasakis K. and Psychogios K. (2009). The economic and social extensions of Alzheimer. Neurologia,18: 220-227.
Avila, RM and Bramlett, MD. (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.
Avila, RM. et al. (2013), Language and immigrants status effects in disparities in Hispanic children’s health status and access to healthcare, Maternal Child Health J. 17(3): 415-23.
Aye, M, et.al. (2002), Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast. SocSci Med; 55:1929–46.
Bircher and Kuruvilla (2014). “Defining health by addressing individual, social, and environmental determinants: New opportunities for healthcare and public health,” Journal of Public Health Policy, Vol. 35(3): 363-86.
Bitran, R. et al. (2000). “Equity in the financing of social security for health in Chile,” Health Policy, Vol. 50 (3): 171–96.
Barr, D. A. (.2014). Health disparities in the United States: Social class, race, ethnicity, and health. Baltimore: John Hopkins University Press.
Brawley, M. (2000). The client perspective: What is quality health care service? A literature review. Delivery of improved services for health: USAID Cooperative Agreement, 617-00.
Brotherton, SE. et al. (2004-2005). US graduate medical education: Trends in primary care specialties, 294 (9): 1075-82.
Bartley, M. (2004). Gender, health inequality and welfare state regimes; a cross –national study of thirteen European countries, J Epidemiol Community Health; 69: 38-44.
------------------------ Health inequalities and social institutions, Soc Theory Health; 68: 63-79.
-------------------------- Health inequality: An introduction to Theories, Concepts and Methods.
based with population-based psychosomatic research? Journal of Psychosomatic Research; 45:99– 105
Berk, M. et al. (1998), “Measuring Access to Care: Improving information For Policymakers, “Health Affairs 17: 180-186.
Berkman, LF. (2000). Social epidemiology, New York, USA: Oxford University Press.
Bourdie, P. (1987), What makes a social class? On the Theoretical and Practical Existence of Groups, Berk Journal of Sociology, 32: 1-17
------------------- (1984), Distinction. A social Critique of the Judgment of Taste, Trans,
Braveman, P. and Tarimo, E. (2002), Social inequalities in health within countries; not only an issue for affluent nations, SocSci Med, 54; 1621-35.
------------------------------- (2003), “Defining Equity in Health”, Journal of Epidemiology and Community Health, 57: 254-258.
---------------------------------- (2007),“International Perspectives on Health Disparities and Social Justice,” Ethnicity and Disease, Vol.17.
--------------------------------(1989), “Defining Equity in Health”, Journal of Epidemiology and Community Health, 57; 254-258.
Brawley, M. (2000). The client perspective: what are quality healthcare services? A literature review, Kampala, Uganda.
Brown, DF. (2009). “Social Class and Satus.” In Mey, Jacob. Concise Encyclopedia of Pragmatics, Elsevier, 952.
Bryman, A. (2001), Social Research Methods, Oxford, UK: Oxford University Press.
Cambridge: Polity Press.
Carmona, R. et al. (2014), Use of health services for immigrants and native population: a systematic review. Rev EspSaludPublica; 88(1):135–55.
Carroll, KM. et.al. (2005). Behavioral therapies for drug abuse. Am J Psychiatry; 162(8):1452–1460.
Carrin, G. et al. (2005). Social health insurance: Key factors affecting the transition towards universal coverage: International Security Review; 58 (1).
Cassel, L. (1976). The contribution of the social environment to host resistance, Int J Epidemiology; 104: 107-23.
Coffey, A. and Holbrook, and P. et al. (1996). ‘Qualitative Data Analysis: Technologies and representations,’ Sociological Research, Vol. 1 no.1
Culyer, A. J. and Wagstaff, (1993), “Equity and equality in health and healthcare,” Journal of Health economics 12; 431-57.
Culyer, A. E. van Doorslaer. et al. (1992), “Access, Utilization and equity: A further Comment” Journal of Health Economics, 11 (2); 207-10.
Cutler, D. M., J. et.al. (2002), “The Economic Impacts of the Tobacco Settlement,” Journal of Policy Analysis and management, 21:1-9
CARE Malawi. (2013). The Community Score Card (CSC): A generic guide for implementing CARE’s CSC process to improve quality of services. Lilongwe, Malawi: Cooperative for Assistance and Relief Everywhere, Inc.
Central Bureau of Statistics (CBS)-Kenya, Ministry of Health (MOH)- Kenya, and ORC Macro (2004), Kenya Demographic and Health Survey 2003. Calverton, Maryland: CBS, MOH, and ORC Macro.
Cheng, T-M. (2004), “Taiwan’s new national health insurance program: Genesis and experience so far.” Health Affairs, Vol. 22(3): 61-76.
Davidson, P et al. (2004). A framework for evaluating safety-net and other community-level factors on access for low-income populations. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 41(1), 21-38.
Donabedian, A. (1990) The Seven Pillars of Quality. Archives of Pathology & Laboratory Medicine, 114, 1115-1118.
Durham J. et al. (1998). Self-assessed health status and selected behavioral risk factors among persons with and without health coverage-----------United States, 1994-1995: 47 (9): 176-47.
Davidson, PL. et al. (2004). A framework for evaluating safety-net and other community-level factors on access for low-income populations. Inquiry; 41(1):21–38.
De Vaus, D. (2001), Research Design in Social Research, London: Sage.
De Vaus, D. (2014), Income and poverty in the United States, Current Population Reports 2014; 60-249.
Deci, EL. et al. (1999), A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol Bull; 125(6):627–668.
DeNavas-Walt C. et al. (20130, Income and Poverty in the United States, Current Publication Reports 2014; 60-249.
Donabedian A. (1990), The Seven Pillars of Quality; Arch Patho Lab Med; 115-118.
Donald A. et al. (1990), The seven pillars of quality, Arch Path Lab Med, 114: 1115-1118.
Donald A. et al. (2009), Health Disparities in the United States, Social Class, Race, Ethnicity, and Health, John Hopkins University Press, pp.312.
David, M. (2002), “Health Care and the Public Sector.” Handbook of Public Economics.
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.
Fraenkel, J. et al (2000), How to design and evaluate research in Education, New York NY: McGrawhill companies Inc.GOK, 2010, Constitution of Kenya, Fourth schedule. Nairobi, Kenya: Government of Kenya.
Gallo, V. et al. (2012). Social inequalities and mortality in Europe- results from a large multi-national cohort, PloS One, 7 (7), e39013.
Government of Kenya, (2015), Comparative Health Expenditure, Nairobi, Kenya
-----------------------------.(2012), Vision 2030, Second Medium Term Plan, 2013-2017, Transforming Kenya, Pathway to devolution, socio-economic development, equity and national unity, Government Printer, Nairobi.
Githinji (2016), “Strengthening health systems in communities,” An Under-appreciated Asset to Tackle NCD Global Heart (formerly CVD Prevention and Control), Vol. 11(4): 455-45
Government of Kenya (2018), The Public Participation Bill, 2018. Kenya Gazette Supplement. Nairobi: Government Printer.
Government of Kenya (2014b), Service availability and readiness assessment mapping (SARAM). Available at file:///C:/Users/jmbithi/Downloads/ SARAM_KEN_report_2013.pdf Accessed 22-02-2017.
Government of Kenya (2016), The Health Bill, 2016. Nairobi: Government Printer.
Government of Kenya. (2014a). The Constitution of Kenya.
Kwon, S., (2002), “Achieving health insurance for all: Lessons from the Republic of Korea,” ESS Paper No. 1, Geneva: International Labor Office.
Kenyan Healthcare Federation. (2016). Kenyan healthcare sector market study report: Opportunities for the Dutch life sciences and health sector.
Kiambati, H and Kiio. Et al. (2013), Understanding the labour market of human resources for health in Kenya. Working Paper.
Kimani, D. and Maina, T. (2015). Catastrophic health expenditures and impoverishment in Kenya. Washington, DC: Futures Group, Health Policy Project.
KIPPRA (2017), Assessment of healthcare delivery under the devolution. Nairobi: Kenya Institute for Public Policy Research and Analysis.
Kenya National Bureau of Statistics - KNBS (2009), Economic Survey. Nairobi: Government Printer.
Kenya National Bureau of Statistics - KNBS (2017), Economic Survey. Nairobi: Government Printer.
Kenya National Bureau of Statistics - KNBS (2010). Kenya Demographic and Health Survey, 2008-09. Calverton, Maryland: KNBS and ICF Macro.
Kenya National Bureau of Statistics – KNBS. (2015). Kenya Demographic and Health Survey 2014. Calverton, Maryland: KNBS and ICF Macro.
Kenya National Bureau of Statistics. (2018). The 2015/16 Kenya Integrated Household Budget Survey Basic Reports. Nairobi: Kenya National Bureau of statistics
Li, S. (2006), Healthcare financing policies of Canada, the United Kingdom and Taiwan.
Marchildon, Gregory P. (2005). Health systems in transition: Canada.
Ministry of Health. (2014a), Kenya Health Sector Referral Strategy.
Ministry of Health - MOH (2009). Revised Kenya National Malaria Strategy 2009-2018. Division of Malaria Control.
Ministry of Health - MOH (2014). Health Sector Human Resource Strategy 2014-18.
Ministry of Health - MOH (2016). National and County Health Budget Analysis 2016/17 .
Ministry of Health - MOH (2017). Health Sector Report, 2017/18.
MONDKAL and Intra Health International (2012). Human Resources for Health (HRH) Assessment Report for Northern Kenya.
Moyer, C. and Mustafa, A. (2013). “Drivers and deterrents of facility delivery in sub-Saharan Africa: A systematic review,” Reproductive Health, Vol. 10:40.
Mwaura, R., Barasa, N et al. (2015). Repositioning the role of the National Hospital Insurance Fund.
------------------------------. (2013), Devolution of Health services in Kenya,KPMG, p.7.
-------------------------------. (2016), Master Facility List, Nairobi, pp.32.
------------------------------.(1996), National Report and Plan of Action on Shelter and Human Settlements to Habitat 11 Conference, Ministry of Public Works and Housing, Nairobi.
------------------------------. (1999), National Poverty Eradication Plan 1999-2015 Department of Development Co-ordination, Office of the President, Government Printer, Nairobi.
------------------------------. (2001), 1999 Population and Housing Census Volume I Central Bureau of Statistics Nairobi.
-------------------------------. (2002), Economic Survey Government Printers, Nairobi.
Grant, J. (2001). “class, definition of” In Jones, R. Rout ledge Encyclopedia of International Political Economy: p.161.
Gulliford,M. and J. Figueroa-Munoz, et al. (2002). “What does access to health care mean”? J Health Services and Policy7(3):186-8.
Gummesson, E. (1991). Qualitative Methods in Management Research(Revised edition).
Gwatkin, DR. et al. (2004). Making Health Systems More equitable; 1273-1280.
------------------------ (1999). The Burden Dise4ase Among Global Poor, Lancet, Vol. 354.
Gulliford, M. et al. (2002). What does' access to health care'mean?. Journal of health services research & policy, 7(3), 186-188.
---------------------------- (2002). What does' access to health care'mean?. Journal of Health Services Research & Policy, 7(3), 186-188.
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.
Haynes, R. et al. (2004), Geographical Access to Healthcare, Access to Healthcare, London, Routeledge.
Holmquist, F., & Githinji, M. (2009). The Default Politics of Ethnicity in Kenya. The Brown Journal of World Affairs,16 (1), 101-117.
Kawachi, I. et al. (2004). A glossary for health inequalities. Journal of Epidemiology & Community Health, 56(9), 647-652.
Kitagawa, EM. et al. (1973). Differential Mortality in the United States: A study in Socio-economic Epidemiology, Harvard University Press.
Krieger, N. (2001). A glossary for social epidemiology. Journal of Epidemiology and Community Health, 55 (10), 693-700.
Lynch, JW. et al. (2000). Income inequality and mortality: importance to health of individual income, psychosocial environment or material conditions, BMJ: 320: 1200-1204.
Lindsay, A. et al. (2013). Access and Utilization of Healthcare Services in Massachusetts, United States: a qualitative study of the perspectives and experiences of Brazilian –born immigrant women.