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Arun, Richard
(2024).
DOI: https://doi.org/10.21954/ou.ro.00098579
Abstract
LMICs face increasing burden of NCDs, requiring primary prevention, screening and early detection. Cervical cancer (CC) is a major Kenyan public health concern. Medical devices (MDs) are key to health systems’ performance, yet there is limited research literature on their availability, especially for primary and preventive services.
This thesis answers the question: To what extent is poor cervical cancer screening (CCS) service performance attributable to availability and utilization of MDs, and how can CCS performance limitations be improved at facility level?
An explanatory sequential mixed methods design included a Phase I quantitative health facilities survey on availability of MDs and readiness indicators for CC prevention. A qualitative Phase II investigated utilization of MDs and internal working processes for provision of CCS services. Analysis was guided by the dynamic capabilities theoretical framework, to understand inter-facility performance variations.
Survey findings showed high levels of readiness to provide CCS services in the public sector, including availability of most essential MDs, but specific tests and consumables were less available and reported screening numbers showed low and variable performance. Readiness, MDs availability and reported screening numbers were all lower in the civil and private sectors.
Qualitative research confirmed low actual public sector CCS services provision despite potential demand in the form of family planning visits. CCS numbers were mainly driven by referrals and sporadic outreaches. Facilities had failed to sense and seize opportunities to increase CCS services, with none purposively transforming working processes towards a “prevention culture”.
Revision of service availability indicators can improve facility-level information on readiness and ‘actual do.’ Prioritisation of cancer prevention requires a shift of working culture in healthcare through organisational culture change at facility level. The dynamic capabilities framework offers a complementary perspective for health system research to better understand how to promote preventive services at health facility level.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)
