The 7th East African Health and Scientific Conference

1. The 7th East African Health and Scientific Conference Content, context and process dimensions of information communication technology in public health facilities in Machakos and Nairobi counties- Kenya Chesang’ F*(Amref Health Africa), Kweri J (JKUAT), Kariuki J (KEMRI)

2. Author Profile Name: Faith Chesang Ngorett Country of Origin: Kenya Education: MSc Public Health Work Experience: 7 years in clinical practice and family planning, reproductive, maternal, neonatal & child health programming.

3. Back ground • use of information and communication technology (ICT) – including computers, mobile phones, satellites, software, information systems and digital platforms– to enable, support and deliver services in this case deliver health services to patients and populations • use of ICTs will lead to greater efficiencies in use of resources and greater efficiency in service delivery, WHO World Health Report -20 to 40 per cent of all health spending was wasted due to inefficiencies. Investment in ICT has the potential to reform health systems, extend services to underserved areas, and reduce waste and redundancy.

4. Back ground • Global Observatory for eHealth (GOe) survey -83 per cent of 112 surveyed countries identified at least one ongoing mHealth programme, and 33 per cent identified at least one telemedicine programme within their country. Of the 31 African countries who responded to the survey, SSA nations were least likely to have established, institutionalized eHealth programmes in mHealth, telemedicine or eLearning. When these programmes exist, they are in either the pilot or informal stages of development. • Despite huge investment by the health sector in ICT, there is scanty information on how the different ICT dimensions affect the upscaling of ICT in the health facilities.

5. Back ground Context, Content and Process Dimensions. • Context refers to the social, economic, political, and competitive environments, structure, culture, resources, capabilities, and politics of an organization in which an organization operates. • The content covers the specific areas of the transformation under examination. Covers (both hardware and software), the work processes, and everything related to these (such as social conditions) • The process dimensions are concerned with the processes of change, made up of the plans, actions, reactions, and interactions of the stakeholders, rather than work processes in general.

6. Objectives • To establish the level of ICT related content, context and process dimensions in relation to use of ICT in health care facilities in Nairobi and Machakos counties.

7. Description • Materials & Methods:The study adopted a cross-sectional study design and utilized both quantitative and qualitative techniques. • A total of 73 respondents drawn from levels 4-6 of Machakos and Nairobi counties and key county health facility administrators and ICT personnel. A simple random sampling technique was adopted in selecting the study facilities while the study respondents were selected using cluster sampling technique. • Data was collected using self- administered questionnaires (quantitative tool) and Key- Informant interviews (qualitative tool).

8. Description • Results & Discussion:Presence of institutional induction training program on ICT (contextual factor), presence of ICT policy at facility (Process dimension), and ICT facilities provided (content factor), were the main factors for use of ICT. • Reliability of ICT infrastructure posed the greatest challenge towards use of ICT among the content factors. • Lack of support from hospital top management team (Process factor related challenges) was attributed to low use of ICT. Presence of institutional induction training on ICT (context) affected both level 5 and 6 facilities equally in relation to use of ICT. • 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 and the levels of services operations that have been computerized respectively.

9. Lessons learned • In regard to policy: the ICT training schedules should be revised and enforced to ensure that all the public health facilities benefit fully from the installed ICT facilities. This has the potential to make health workers offer services effectively and efficiently. • All staff members as part of induction process should be inducted in ICT utilization. Health managers in public health facilities should also organize annual trainings in ICT as part of skills capacity development.

10. Lessons learned • In relation to practice: There is need to establish ICT champions who would be able to influence their peers to utilize ICT the workplace. The principal of influence without authority, in this case the use of ICT champions will create a buy-in from their colleagues using minimal effort. • For academic and research purposes: to evaluate whether the behavior of workers in public health facilities solely influence ICT utilization levels, there is need to undertake more of longitudinal studies so as to determine the impact of ICT in relation to health care worker behavior and usage

11. Conclusion • Content and process dimensions were the most critical elements that promote utilization of ICT in public health facilities in Machakos and Nairobi counties. Presence of an institutional induction training program on ICT (context dimension) and strong management involvement in ICT related matters is a critical component in utilization of ICT. Also availability and implementation of an ICT policy especially among level 4 should be enforced to guide the operationalization of ICT in every department (process dimension) •   The context challenges were the majority in all the public health facilities. • The content issues were relatively high in all the facilities visited. The two critical issues relating to content dimension were the type of ICT support provided and its reliability and the level of services operations computerized. This dimensions would help managers create a balance between technology and daily work practice with potential of scaling ICT usage in public health facilities.

12. Acknowledgement • Amref Health Africa in Kenya • The County Governments of Nairobi & Machakos under Department of Health and Department of ICT • Kenya Medical Research Institute (KEMRI) • Jomo Kenyatta University of Agriculture & Technology(JKUAT)