DECLARATION

I submit that this report is my original work and has not been presented in any institution.

Name: Cynthia Aurien Wekhomba

HSM-1-7094-3/2020

Sign............................

Head of institution of attachment

The report has been submitted for review with the management of the Kimili sub county Hospital.

Name...............................................................Sign...........................stamp...............................

Hospital administrator

Kimilili sub county Hospital

Attachment supervisor/Lecturer-Health systems management

This document has been submitted and approved by the attachment supervisor of health systems
management, Kenya Methodist University.

Name......................................................................Sign......................stamp..............................

Chair of health systems management department

This report has been reviewed and approved by the chair of health systems management, Kenya
Methodist University.

Sign............................... stamp..........................

i
 DEDICATION

I dedicate this work to myself for being persistent and my parents for the support they gave me
throughout the attachment.

ii
 ACKNOWLEDGEMENT
My gratitude goes to the kimilili sub county health administrators Mr Dan osuana and Job Tendet
and the human resource manager of Kimilili level 4 hospital for giving me an opportunity to
undertake my attachment in the institution. This has given me an opportunity to get familiarised
with the environment of the health facility. I gained more skills and experience through
engagement in different activities of the health facility. The interaction and support from heads of
departments, and secretary Mary Walucho in the facility gave me more experience. My sincere
thanks goes to my respective lecturers who imparted and shared their knowledge and skills on
health systems management to us. It gave me more confidence in studying the course throughout
my academic years. To my supervisor, Dr Rose Ayikukuei, for assessing me and encouraging me.
To our school Kenya Methodist University, thank you for introducing this course in the curriculum,
it will help in strengthening the health systems to promote and improve health of the community.
To my parent for supporting me throughout the course study. May God bless you All.

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 EXECUTIVE SUMMARY

Kimilili sub county hospital is a level 4 hospital in Bungoma county, kimilili constituency which

was established in 1980 as a small dispensary and has underwent several expansion to meet the

community's health demands. In the attachment study at Kimilili sub county Hospital, the study

aimed at assessing the six building blocks of the health systems management, the main objective

was to identify the strengths and assess the weaknesses of each building block of the health system

management and make recommendations. The six building blocks include; service delivery,

healthcare financing, health workforce, health information, the medical products, vaccines and

technology, leadership and governance as discussed in the World Health Organisation report of

2007. The Kimilili sub county hospital organisation carries all the six building blocks. The

researcher used descriptive cross-sectional study design. The catchment area for the study was the

health workers across Kimilili level 4 and the patients seeking health services in the facility. The

facility offers quality care which is accompanied by good leadership system and the responsible

staff. Data was collected using observation methods and survey interviews from each departmental

heads. The key findings for the study was that the strongest pillar at KSCH was medical products,

vaccines and technology, while the weakest pillar was health financing. Staff motivation through

increased salary will improve the supply of health workers throughout different counties.The study

proposed to develop infrastructure to improve service delivery. Improvement of health

management information system. Recommendations also proposed during the research was

introduction of more training programs for staff development, recruitment and selection of extra

trained staff for healthcare, staff motivation through performance appraisal system, promotion and

increased salary.

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 ABBREVIATIONS
KSCH: Kimilili sub county hospital

HRM: Human Resource Manager

WHO: World Health Organisation

MOH; Ministry of Health

LPO: Local purchase order

DBR: Daily Bed Records

HRIM: Health Records Information Management.

POPC: Paediatric OutPatient Clinic

GOPC: Gynecology OutPatient Clinic

MOPC: Medical OutPatient Clinic

NBU: New Born Unit

HMT: Hospital Management Team

GBV: Gender Based Violence

CCC: Comprehensive Care Clinic

MCH: Maternal Child Health

ENT: Ear Nose Throat

SHA: Social Health Authority

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 TABLE OF CONTENTS

DECLARATION .............................................................................................................................................................................. i

DEDICATION.................................................................................................................................................................................. i

ACKNOWLEDGEMENT ............................................................................................................................................................... ii

EXECUTIVE SUMMARY ............................................................................................................................................................ iv

ABBREVIATIONS ......................................................................................................................................................................... v

TABLE OF CONTENTS................................................................................................................................................................ vi

LIST OF FIGURES.....................................................................................................................................................................viii

CHAPTER ONE ............................................................................................................................ Error! Bookmark not defined.

INTRODUCTION .......................................................................................................................... Error! Bookmark not defined.

1.0 The contribution of the attachment towards strengthening of health systems ...................... Error! Bookmark not defined.

1.1 The Background of the institution of attachment ................................................................. Error! Bookmark not defined.

1.2 ORGANIZATION MISSION, VISION AND VALUES...................................................... Error! Bookmark not defined.

1.3 Organisation structure/Organogram.............................................................................................................................2

1.4 Affiliation to the institution of attachment...................................................................................................................2

1.5 General objective ................................................................................................................ Error! Bookmark not defined.

1.6 Specific objectives .............................................................................................................. Error! Bookmark not defined.

CHAPTER TWO............................................................................................................................ Error! Bookmark not defined.

METHODOLOGY ......................................................................................................................... Error! Bookmark not defined.

2.1 Introduction ......................................................................................................................... Error! Bookmark not defined.

2.2 Attachment area................................................................................................................... Error! Bookmark not defined.

2.3 Study design ........................................................................................................................ Error! Bookmark not defined.

2.4 The target population........................................................................................................... Error! Bookmark not defined.

2.5 Sampling techniques ........................................................................................................... Error! Bookmark not defined.

2.6 inclusion and exclusion area ................................................................................................ Error! Bookmark not defined.

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 2.7 Data collection methods and tools ....................................................................................... Error! Bookmark not defined.

2.8 Data analysis and presentation ............................................................................................ Error! Bookmark not defined.

2.9 Ethical issues and consideration .......................................................................................... Error! Bookmark not defined.

CHAPTER THREE ........................................................................................................................ Error! Bookmark not defined.

FINDINGS AND DISCUSSIONS.................................................................................................. Error! Bookmark not defined.

3.1 Service delivery ................................................................................................................................................................... 22

3.2 Health financing ................................................................................................................... Error! Bookmark not defined.

3.3 Health workforce ................................................................................................................................................................. 19

3.4 Health Information ............................................................................................................... Error! Bookmark not defined.

3.5 Medical products, vaccines and technology .......................................................................... Error! Bookmark not defined.

3.6 Leadership and governance .................................................................................................. Error! Bookmark not defined.

CHAPTER IV ................................................................................................................................ Error! Bookmark not defined.

CONCLUSIONS. RECOMMENDATIONS AND LESSONS LEARNT ....................................... Error! Bookmark not defined.

4.1 Conclusions ......................................................................................................................... Error! Bookmark not defined.

4.2 Recommendations ............................................................................................................... Error! Bookmark not defined.

4.3 Lessons learnt...................................................................................................................... Error! Bookmark not defined.

REFERENCES ............................................................................................................................... Error! Bookmark not defined.

vii
 LIST OF FIGURES

Organogram / organization structure

Swot analysis

viii