CONTEXT, PROCESS AND CONTENT DIMENSION TO FULL INTEGRATION OF ICT IN DELIVERY OF HEALTH CARE SERVICES IN SELECTED PUBLIC COUNTY HOSPITALS OF MACHAKOS, TURKANA AND NAIROBI COUNTIES IN KENYA

The use of Information and Communication Technologies (ICTs) provide great potential for saving human lives by improving delivery of health care as it provides for easy access to patient medical information on a real-time basis and enables a seamless system of tracking and sharing of patient information from the time of admission, diagnostics, treatment, pharmaceutical and management of patient bills that captures all accruing expenses per patient. Despite heavy investment by the Kenya government in ICT infrastructures in the health care, the efficiency and benefits of ICT has not been achieved because health care system continue to suffer compromised quality of care due to disjointed patient management systems and poor management of health care resources. With such, there is insufficient information on ICT related context, process and content dimensions that influence utilization of ICT. Therefore, the need to establish the barriers to full integration and utilization of ICT in the management of health care facilities in Kenya which is key in the realization of universal health care and sustainable development goal number three in health (SDG#3) as that data would aid in increasing efficiency and ensure evidence based health system management. The broad objective of the study was therefore to determine the ICT Process, Content and Context dimension to full integration of ICT in delivery of health care services in Public County Hospitals of Machakos, Turkana and Nairobi Counties in Kenya. In carrying out the study, a cross-sectional quantitative study was done in Machakos, Nairobi and Turkana counties. The three counties were selected from the 47 counties using simple random sampling with replacement technique from the three clusters (rural, semi urban and urban) with Machakos representing semi urban county, Nairobi an urban county and Turkana a rural county. A total of 172 health facilities were selected using proportionate and simple random sampling with replacement in the three counties from the different level of health facilities (Level 2 to 5). A total of 369 study respondents (health care professionals) were selected across the hospitals in the three counties under study from the various departments using stratified sampling technique and proportionately divided across the counties where the health care workers were randomly selected.A pretested self-administered questionnaire and observation sheet was used to collect data on different variables. Odds ratio at 95% Confidence Interval (CI) was used to describe the association between dependent and independent variables. Data was presented in form of tables and the conclusions drawn from the finding while analysis was done using Statistical Package for Social Sciences (SPSSTM) analytical software version 25 for windows. Univariate analysis was carried out based on frequencies. Testing for association was carried out using bivariate analysis by use of Chi square test at 95% Confidence Interval while determining the strength of the association was done using Phi and Cramers V tests. The dependent variable in this study was ICT utilization. This was indicated by 5 indicators namely: Computer literacy, access to computer at work, presence of ICT policy at the health facility, percentage of routine operation computerized and replacement protocol in case of a breakdown. The study had three independent variables namely context dimension, process dimension and content dimension. Context dimension was indicated by 5 indicators namely: type of previous training undertaken, whether the facility conducts on job training on ICT to staff, types of ICT training sponsorship offered by the facility, whether the institution have an induction training program on ICT and the type of health facility one worked for previously and whether they used ICT platforms during the routine operations. Process dimension was indicated by one construct on whether the participants were involved in the initial set up of ICT in the health facility. The content dimension was indicated by three main indicators namely; purpose of a computer at a health facility, difference in performance with and without ICT and lastly patient outcome when ICT is used and when it is not used. This study demonstrates that content and process dimensions were the most critical success factors associated with ICT utilization in public health facilities. In the rural county, the major limitation in the use of ICT was lack of ICT infrastructure (hardware and software) in the lower level facilities and level 5 facility at 50% and 21.9% respectively with the least challenge being work related factor (overload) at 6.3% and 6.3% respectively in the lower level facilities and the level 5 facility. In the semi urban county, the major limitation in the use of ICT in the lower level facilities was lack of ICT infrastructure (hardware and software) at 33.3% while for the level 5 facility lack of computers was the major limitation at 36.4% while the least limitation was faulty computers, old generation, poor maintenance at 0% in both the lower level facilities and level 5 facility. In the urban county the major limitation in use of ICT in the lower level facilities and level 5 facility was lack of ICT infrastructure (hardware and software) at 46.8% and 30.4% respectively while the least limitation was work related factors (overload) at 4.8% for the lower level facilities and 0% for the level 5 facility. The specific key attributes to ensure utilization of ICT was found to be Strong management involvement in ICT related matters and Availability and implementation of an ICT policy especially among the lower level facilities (Level2 -4) (process dimensions), Presence of an institutional induction training program on ICT (context dimension), Type of ICT support provided and its reliability and Level of services operations computerized (content dimensions).