An assessment of information communication technology content, context and process dimensions in public health facilities in Machakos and Nairobi Counties, Kenya

Abstract

Objective: To establish the level of ICT related content, context and process dimensions vis- a- vis the upscaling of ICT in health care facilities in Nairobi and Machakos counties.

Design: A cross sectional study

Setting: Machakos and Nairobi counties levels 4-6 hospitals

Subjects: Seventy three (73) respondents drawn from the health facilities were interviewed.

Results: ICT content variables studied were operations computerised, ICT facilities provided and breakdown-replacement protocol. Context variables included on-job ICT trainings, ICT training sponsorships by facility and presence of institutional ICT induction program. The process variables were staff involvement in design of ICT aspects and presence of ICT policy. Among contextual factors, presence of institutional induction training program on ICT was relatively high compared to ICT training on job and ICT training sponsorship offered by facility (χ= 28.15, d.f=2, p<0.001 at 95%CI). Under process dimensions, presence of ICT policy at facility was higher compared to staff involvement in design of ICT aspects (χ =15.03, d.f =2 and p<0.001). Among the content factors, the ICT facilities provided was relatively high in all the facilities compared to levels of services operations computerised and breakdownreplacement protocol (χ=18.4, d.f =6 and p<0.005). Under the challenges, reliability of ICT infrastructure posed the greatest challenge towards up scaling of ICT among the content factors (χ=10.79, d.f. = 4, p-value=0.029). Process factor related challenges also had major impact on up scaling of ICT i.e. less up scaling of ICT that was attributed to lack of support from hospital top management team (χ 9.44, d.f.=4 and p=0.005). Comparing levels 5 and 6 facilities, the context dimension; presence of institutional induction training on ICT was the main factor that affected both facilities equally in relation to up scaling of ICT (p-value=0.021). Comparing level 4 facilities to level 6, process and content dimensions were the main factors that determined ICT uptake specifically availability of ICT policies in the institutions (p=0.011) and the levels of services operations that have been computerized (p=0.010) respectively.

Conclusion: The study findings showed that content and process dimensions were the major aspects that were critical for positive up scaling of ICT in public health facilities. These factors were setting-dependent on the classification of the facility levels, in this study the level 4 facilities had poor up scaling of ICT compared to level 5 and level 6. The specific key attributes included: Strong management involvement in ICT related matters (process dimensions), availability and implementation of an ICT policy especially among level 4(process dimension), presence of an institutional induction training program on ICT (context dimension), type of ICT support provided and its reliability (content dimension) and level of services operations computerized (content). The major challenges that hindered up scaling of ICT were reliability of ICT infrastructure under the content factors and lack of support from hospital top management team under the process related factors.