Provision of Public Health Services in Nairobi. An Analysis of Distribution, Location and Utilization.

Attainment of better community health status is a central aim of governments and much international organization. The World health Organization has a declaration that targets “health for all by the year 2000”. However the provision of health services to specific target groups is a problem to many countries. This study provides an in-depth analysis of the level of distribution, accessibility and utilization of public health services in Nairobi. The aim is to examine the extent to which Nairobi residents are served by these public health facilities. The study has a bias on the public health sub-sector, because the public service provision is based on the social welfare rather than a market orientation. Its planning therefore requires more deliberate efforts in order to harmonize the basic objectives of equity, efficiency and geographical accessibility which may not be an overriding factor in market oriented service provision.

The study uses data obtained through stratified random survey. The study area was categorized into administrative units from which the various hierarchies of health facilities were sampled and questionnaires to help official and patients administered. The study analyses information as pertains to patients’ socio-economic characteristics, modes of travel to health visits trips, distance, and the structural effects of distance (Distance decay). Analysis on accessibility shows distance is a major factor in influencing patients’ choice of health facility to seek the medical care. It shows that majority of the patients seek medical care at the nearest health facility but this varies with the kind of treatment being sought. The distance decay gradient seems to obey the hierarchical order of health facilities and the findings of this analysis can be applied in the spatial planning of these facilities and other similar social services. Other forms of accessibility were also found to influence the patient’s decision to seek health services, and the choice of the facilities to visit. The study also analyses the location approach used in the distribution of health facilities in the study area, It was found out that the current planning approach is unable to address effectively to the planning problems of accessibility, equity and efficiency in relation to the distribution and location of health facilities.

Analysis on the utilization shows that the facilities are over utilized. A high population; patient; facility ratio, high bed occupancy rate and high medical personals patient ratios characterize this. This analysis shows that Nairobi is still inadequately served with health facilities.

The make the following proposals. Due to rapid growth of the city there is urgent need to address to the spatial distribution of the health facilities. This is to ensure a fair spatial coverage whereby there is need to decentralize the health planning and the delivery system in the city. Urgent attention should be paid to the acute shortage of medical personals in the study area. The role of the public sector in the delivery of health-care needs to be critically analyzed as regard to availability of crucial human requirement.

This is crucial in respect to the current move of privatization of the economy and the increasing medical costs in the private sector, which may have adverse effects to the majority of the population.

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