HEALTH FACILITY-BASED INTELLECTUAL CAPITAL AND PROVISION OF PRECONCEPTION CARE IN KISUMU COUNTY-KENYA

Abstract

‘Preconception care’ (PCC) is the provision of biomedical, behavioral and social health interventions to women and couples before conception occurs. The PCC, is valuable and key in preventing and controlling non-communicable diseases. Health providers’ personal and patient factors pertaining to a health care organization and the broader environment affect the delivery of health care services including preconception care. PCC is an intangible product of a health care system and thus is critical to assess its implementation regularly. The key constraint limiting progress is the gap between what is needed and what exists in terms of skills and availability of human resources & infrastructures in the face of increased demand; ineffective referral and weak management systems. This gap is yet to be measured in Kenya more so in Kisumu County. This lack of information threatens success and sustainability of new initiatives like preconception care thus stagnation in reduction of neonatal and maternal indicators. Assessing the strengths and weaknesses of the preconception care system in a place contributes to the preconception care implementation strategy for action in each country as recommended by World Health Organization (WHO). Using a cross-sectional design, this study quantitatively and qualitatively explored preconception care service delivery and how it is influenced by the intellectual capital in health facilities in Kisumu County of Kenya. It specifically sought to determine the level of implementation of PCC and to illustrate how it is influenced by health provider characteristics, facilities and the external environment. Structured interviews were conducted on health providers n=476 and clients n=560 to ascertain their knowledge, perceptions and practice on preconception care respectively. A checklist was used to assess the procedures, processes and resources available for PCC in facilities n=28. Focused group discussions were done to establish the opinions of certain cadres of health providers. The significance in the differences in proportions was determined by the chi square statistic at P≤0.05. The student t-test and linear regression were used to show the relationship between the factors and preconception care provision rate. The rate of provision was 39% (n=28). There was a significant difference in the mean for cadres, {nurses (M=70.04, SD=8.951) and non-nurses (M=71.90, SD=8.732); t (473) =-2.23, P = 0.026)} & years of experience up to 5 years (M=72.04, SD=8.417) and more than 5 years (M=69.89, SD=9.283); t (465) =2.63, P = 0.009. PCC inclusion in HMIS reporting was a significant predictor (b= 0.6, t (26) =8.64, P<0.001, 95% CI 0.46-0.74) of provision. The mean provision per KEPH levels (M=60.21, SD=4.902); t (26) =-5.06, P<0.001 and types of services (M=69.36, SD=4.924); t (26) =4.63, P<0.001 were significantly different. Those who resided in rural areas (OR=1.641, P=0.014), had a higher level of education (OR=2.42, P<0.001), had had previous pregnancies (OR=2.45, P=0.003), were married (OR=1.71, P=0.045) and have ever heard of preconception care (OR=5.58, P<0.001) were likely to express their intention to accept care if offered. Investing in on-job training for health providers especially nurses, establishing a reporting system for PCC activities, creating awareness on PCC and providing care in primary health facilities in rural areas can improve PCC service delivery. The results will inform programs targeting to improve delivery of PCC services so as to improve obstetric outcomes and thus reduce the maternal and neonatal health indicators.