Background
Methods
Characteristic | Number |
---|---|
Province:
| |
Central | 18 |
Eastern | 14 |
Sex:
| |
Males | 6 |
Females | 26 |
Profession:
| |
Clinical Officers | 3 |
Registered Nurses | 16 |
Enrolled Nurses | 13 |
Facility Level:
| |
District Hospital | 10 |
Sub-District Level | 11 |
Health Centre | 11 |
Results
Integration models in operation
Operational integration model | Provider(s) client can receive service(s) from in one visit | Room(s) client can receive service(s) from in one visit |
---|---|---|
Provider-level integration
| Client receives all required services from one provider | Client receives required services in one room |
Unit-level integration
| Client receives required services from different specialist providers | Client receives required services in different rooms |
Client may receive more than one service within each specialist unit
| ||
‘Mixed’ integration
| Client receives required services from one provider | Client receives required services in different rooms |
Before integration we used to offer our services in different places but nowadays we offer them all together in the same room, through this we are able to provide our services [better]. (Community Health Nurse, Health Centre, Thika)
Instead of referring clients to another building or health centre, you make sure all the services are close (together) in one place. Sometimes when we are short of staff I have to move from one room to the next to see clients waiting there, but at least it’s just nearby… even for the client to walk. (Clinical Officer, Health Centre, Nyeri)
Here because of shortage of rooms most times I have move with my patient from one examination room to the next where there is equipment. We need more rooms. (Enrolled Nurse, Sub-District Hospital, Kitui)
Benefits of integration
Benefits | Challenges |
---|---|
Increased job satisfaction
:
|
Poor work conditions & support
:
|
•Increased client satisfaction | •Low salaries |
•Personal skills enhanced | •Lack of psychosocial support for occupational stress management |
•Experiential learning | |
•Professional stimulation | |
Improved communication, performance & systems
:
|
Lack of systems adaptation to support integration
:
|
•Improved communication among staff | •Increase in workload per provider |
•Increase in client repeat visits | •Burdensome clinical recording |
•Increase in service uptake | •Long session times |
•No more multiple queues per visit for the client | •Long waiting times for clients |
•Lack of clinical supplies, equipment, room-space, and erratic water & electricity supply | |
•Lack of guidelines on user-fee management | |
•Increase in willingness to take HIV test among clients | |
•Convenience: reduced room-to-room movement by staff during service provision | |
•Decrease in numbers of clients who leave before being attended during a visit | |
•Reduced pressure on under-staffed facilities | |
•Reduced workload per provider |
Increased job satisfaction
I think with integration, you are able to serve the client better and capture each and every detail of a patient (holistically). (The client) will not go home with a certain problem unattended. That is very satisfying. (Enrolled Nurse, Health Centre, Kitui)Clients come praising you, when you meet them outside (the facility). They say that your health service has really improved because you do not keep on sending us here and there causing stigma. (Enrolled Nurse, Hospital, Thika)
I am more competent in the way I offer my services, I have the knowledge in every method, I have the knowledge to administer methods like the IUCD and jadelle which I never knew before, I have been able to treat people under one roof without referring them. (Enrolled Nurse, Sub-District Hospital, Thika)..because I'm able to see more clients than I used to and get more experience… because I'm dealing with different clients with different issues…it is building me as a nurse, profession-wise. So I'm more satisfied. (Registered Nurse, Sub-District Hospital, Kitui)
…where there is no integration there is that boredom because of doing one thing and there is no change. In integration, you are giving this injection now, the next patient will come in with a certain service to be provided so it changes, it keeps on rotating in your mind…and you enjoy the work. It boosts my morale, because the monotony is not there. (Enrolled Nurse, Hospital, Nyeri)
Improved communication, performance and systems
Nowadays we communicate…and that’s been really helpful I think. You don’t feel alone on the job. It never used to happen before. (Enrolled Nurse, Health Centre, Kitui)
Client numbers have definitely gone up… (For example) if you are working in the (child welfare clinic) you can now (expect to) see around 100 children per day… (Enrolled Nurse, Hospital, Thika)More clients are coming back… I think because, when you see a client in one room, and you’re able to give her the services she wanted, she’ll come back. (Registered Nurse, Sub-District Hospital, Kitui)
They started agreeing to be tested, because whenever they go inside, nobody will know the services she is getting inside the room. Before the services were not integrated, they feared. (Registered Nurse, Hospital, Kitui)
Clients…don’t have to queue 3 or 4 times in the same visit now. They are happy now. (Registered Nurse, Hospital, Nyeri)
We are still few staff now, (but because) services are integrated like that, we are able to provide more services and to see all the clients. Not like before. (Registered Nurse, Sub-District Hospital, Kitui)
Before (integration), they used to say MCH is for pregnant mothers, the postnatal mothers (and so on)…But nowadays (clients) can go anywhere. Maybe a client may go (to MCH) for family planning and at the same time the client is sick. It means she will also be treated and everything is finished there; so I might not get a long queue because most of the clients are finished there and they are given the service there and they walk out. (Clinical Officer, Sub-District Hospital, Kitui)
Challenges to effective integration
Poor work conditions and support
[Laughing] Oh my God! I’m not satisfied! You realise that the salary you are getting, although we say that nursing is a calling, at times you may not even (meet) your needs. (Registered Nurse, Hospital, Nyeri)If you compare what you are really doing and the returns, you find that they are not equitable. (Registered Nurse, Hospital, Thika)
Sometimes you meet extreme cases that really leave you crushed…not able to cope. Sometimes the situation (you are dealing with is so severe) you ask yourself how that could happen to a human being… (Registered Nurse, Hospital, Thika)
You are going home, but you are still wearing that coat… You feel you are going home with what you experienced during the day. (Enrolled Nurse, Health Centre, Kitui)
Lack of systems adaptation to support integration
The nurse who is there now has a lot to do, she spends a lot of time with the client because she has to provide (more than one service) to the client. Before, (workload) was less… (Enrolled Nurse, Health Centre, Nyeri)
It is a challenge because you find that you have so many registers, like now you find that you have separate STI register, you have the FP register, you have the post natal register, so it is a challenge to (make entries) in all those books for each client…(Registered Nurse, Hospital, Nyeri)It is tedious for the nurse doing it, patients are there waiting and yet she has to write the reports… (Registered Nurse, Sub-District Hospital, Kitui)
Sometimes people don’t record anything, or they record poorly. (Enrolled Nurse, Health Centre, Kitui)
They complain that we are keeping them (waiting) and yet when you are with a client, you must give that client the integrated service. But…they feel that you are (unnecessarily) keeping them waiting (outside). We are still educating them… (Registered Nurse, Sub-District Hospital, Thika)When a mother comes to my postnatal clinic… If I’m having a client inside and they’re in a hurry, they go. So I don’t get to see most of my postnatal clients. So that is a challenge. (Registered Nurse, Sub-District Hospital, Kitui)
Direct FP outpatients pay 20 Shillings for the (FP service). But clients who come for other services we are supposed to offer them FP as well and we don’t know whether to charge them, so (it means) we have so many other FP clients who get these services for free…which are paid for by few. So…then you wonder, who is supposed to source for this money to purchase the essential commodities to have all these offered services running (smoothly). (Clinical Officer, Health Centre, Kitui)
The challenge there is like when she gets here and she is told that these drugs are not there and yet out there they are told that HIV drugs are free, so (sometimes you) feel for them… they will think that we are (lying to) them. (Enrolled Nurse, Hospital, Thika)