000			03136nam a22001937a 4500
008			210129b ||||| |||| 00| 0 eng d
050			_aRA393W366 2019
100			_aWanjohi Eric
245			_aEffect of devolution of health services on availability of medicines for Non-Communicable Diseases _ba case study of the Makueni County Referral Hospital _cEric Wanjohi
260			_aNairobi; _bStrathmore University _c2019
300			_axii, 66pg
520			_aKenya has witnessed a rapid epidemiological shift, with a surge in non-communicable diseases (NCDs) like diabetes and cardiovascular diseases, which often require lifelong treatment and can lead to impoverishment. One driver of excessive expenditure is medicines and related products. To prevent impoverishment from NCDs, counties must strengthen the management of commodities. However, frequent stock-outs at public facilities suggest weaknesses in supply chain management. This study sought to establish the effect of devolution of health services on the availability of medicines for NCDs at the Makueni County Referral Hospital in Makueni County. To achieve this, the study employed a mixed methods approach. First, the availability of selected medicines for NCDs was described before and after devolution (2011-2012 and 2017-2018). Then, the reasons underlying observed patterns, and staff perception on factors that may have influenced availability, both examined through in-depth interviews. The study found that three cardiovascular products, nifedipine, enalapril and hydrochlorothiazide were mostly unavailable pre-devolution. Post devolution, availability of nifedipine and hydrochlorothiazide improved substantially with enalapril availability remaining a challenge post devolution. Tracer diabetes medicines, metformin and glibenclamide had steady availability pre and post-devolution period. However, Insulin had good availability post devolution. Asthma drugs (salbutamol inhaler, salbutamol nebulising solution and budesonide inhaler) had higher stock out post-devolution.The relatively affordable amoxicillin, paracetamol and ibuprofen had good pre- and post-devolution availabilities, with ceftriaxone, a much more costly antibiotic, only having good availability post-devolution. Reasons for the increased availability included increased funding, better structured quarterly orders, better collaboration across actors, better public participation and an overall increase staff numbers. The study recommends that other health financing avenues be sought and that the county government reviews medicines budgets frequently. The study also recommends that county government should encourage public participation so as to know areas that need improvement
521			_aA thesis submitted in partial fulfillment of the requirements for the Degree of Master of Business Administration in Healthcare Management at Strathmore Business School
700			_aFrancis Wafula _cDr. _eSupervisor
700			_aRuth Kiraka _cProf. _eDean
700			_aGeorge Njenga _cDr. _eDean
856			_uhttps://su-plus.strathmore.edu/handle/11071/6732
942			_2lcc _cTH _uNI _zMBA-HCM
999			_c314918 _d286173