THE INFLUENCE OF ALTERNATIVE TECHNOLOGY ON ACCESS AND

UTILISATION OF PRIMARY HEALCH CARE SERVICES: A SURVEY OF

CHWELE LOCATION

By

A RESEARCH PROJECT SUBMITTED TO THE SCHOOL OF .. IN

PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF A
. IN

DEPARTMENT OF

. UNIVERSITY

APRIL, 2014

DECLARATION
I declare that this Research report is my original work and has not been presented to any other
examination body. No part of this research should be reproduced either in part or whole without
the consent of the researcher or that of the . University.

NAME:

Sign

Date

Declaration by the Supervisor

This research project has been submitted for examination with my approval as University
Supervisor.
NAME:.

Sign..

Date

ii

DEDICATION
I dedicated this research to my members as well as ...

iii

ACKNOWLEDGEMENT
First and foremost I would like to give praise and honors to the almighty God for giving me
sufficient grace and power to write this research proposal .I would also specifically thank my
supervisor .. for .. commitment and advice not forgetting my friends and my fellow
student for their sincere support and encouragement.

iv

Abstract
Primary Health Care is a basic mechanism that brings healthcare as close as possible to the
people. In Kenya, it is seen as a cost effective means of improving the health of the population. It
is provided free of charge by the government. This service should be accessible to the population
so as to meet the millennium health goals: to establish the alternative technology use to access
PHCSs in Chwele location, to determine primary health care services utilization in Chwele
location, to investigate factors that have bearing on infant mortality in Kenya and to investigate
whether the PHC services are accessible to the communities of Chwele location. Data were
collected at the three Community Health Care centres of Chwele location using self-administered
questionnaires. A document review of the Community Health Care centres records was conducted
to investigate the utilization trends of services. Descriptive statistics were used. The analysis was
based on the information that was elicited from the questionnaires that the people who utilize the
Community Health Care centres of Chwele location provided. The extracted data emanating from
the records from the three centres were also used. The study demonstrated that in terms of
distance, the Community Health Care centres of Chwele location are accessible at a as most
participants lived within 5km. They travelled 30 minutes or less to the clinic. The taxi and
walking was the most common form used to access the clinic. The services were utilized with the
Tuberculosis clinic being the most visited. Generally, people were satisfied with the service and
their health needs are met. The Community Health Care centres of Chwele location are accessible
and utilized effectively although the accessibility rate was very low.

TABLE OF CONTENTS
Declaration...................ii
Dedication....iii
Acknowledgement ...iv
Abstract.....v
Table of Contents.....vi
List of Figures..ix
List of Tables.........x
CHAPTER ONE: INTRODUCTION
1.0 Introduction.1
1.1 Background of the Study.1
1.2 Statement of the Problem7
1.3 Objectives of the Study...8
1.4 Research Questions.8
1.5 Significance of the Study9
1.6 Scope and Limitations of the Study9
1.6.1 Scope of the Study.9
1.6.2 Limitations of the Study..10
1.7 Definitions of Terms.10
1.7.1 Primary Health Care.10
1.7.2 Accessibility.10
1.7.3 Utilization.11
1.8 Conclusion.11
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction...12
2.1 The Concept of Alternative Technology...12
2.1.1 Accessibility of the PHC Services14
2.1.2 Utilization of the PHC Services...15
2.1.3 Gains and Challenges of Motherhood Strategies.17
2.1.4 Risk Factors for Maternal and Newborn Mortality..18
2.1.5 MDG Framework for Global Strategies to Reduce Maternal Mortality..19
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2.2 Theoretical Framework.21

2.3 Empirical Review..23
2.4 Critical Review and Knowledge Gap25
CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY
3.1 Introduction...26
3.1 Research Design26
3.2 The Study Area..26
3.3 Target Population..28
3.4 Sample Size and Sampling Procedure...29
3.5 Data Collection Procedure.29
3.6 Research Instruments29
3.6.1 Questionnaire29
3.6.2 Focused Group Discussion...30
3.7 Data Analysis31
3.8 Research Variables32
3.8.1 Dependent Variable..32
3.8.2 Independent Variables..32
CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND INTERPRETATION
4.0 Introduction...33
4.1 Results and Presentation33
4.1.1 Demographic Distribution of Respondents..34
4.1.1.1 Age against Gender of Participants..34
4.1.1.2 Respondents Marital Status..35
4.1.1.3 Respondents Level of Education..35
4.1.1.4 Chwele Location Residents..36
4.2 Primary Health Care Services Accessibility.37
4.2.1 Accessibility of PHC Materials in the Health Facility.37
4.2.2 Source of Acquiring Information on PHCS.38
4.2.3 Influence of Communicating PHCSs on Chwele Mother and their Newborns39
4.2.4 Chwele Residents Constraints in PHCS Information Access..39
4.2.5 Opinion on Primary Health Care Service Workers' Performance40
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4.3 Utilisation of the PHCSs in Chwele Locality41

4.3.1 Reasons for Visiting Health Care Clinic..41
4.3.2 Immunization42
4.3.3 Family Planning Needs43
4.3.4 Maternal Care Services44
4.3.5 Voluntary Counseling and Testing Needs44
4.3.6 Anti-Retroviral Treatment45
4.4 Alternative Technology for PHCSs...46
4.4.1 The Level of Knowledge and Attitude of PHCS Alternative Technology...46
4.4.2 Distance Travelled46
4.4.3 Respondents Travelling Time..47
4.4.4 Alternative Technology of Modes of Transport...48
CHAPTER FIVE: DISCUSSIONS OF FINDINGS, CONCLUSIONS AND
RECOMMENDATIONS
5.0 Introduction...50
5.1 Discussions of Findings.50
5.2 Conclusions...52
5.3 Recommendations.53
5.4 Suggestions for Further Studies54
References
Appendix I: Sample Questionnaire

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LIST OF FIGURES
Figure 2.1: Model of Maternal and Newborn Health Care
(Bill & Melinda Gates Foundation Theory of Change to Improve
Maternal and Newborn Survival)...13
Figure 2.2: Three Delays Model for Maternal and Newborn Mortality..23
Figure 4.1: Distribution of Immunization Needs among Children Less than 5 yrs43
Figure 4.2: Females Respondents on Family Planning Needs43
Figure 4.3: Females Utilising Maternal Health Care Services44
Figure 4.5: Distribution of Traveling Time.48
Figure 4.4: Cross tabulation of Distance, Gender and Age.47

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LIST OF TABLES
Table 4.1: Distributions Age and Gender of Participants...34
Table 4.2: Respondents Marital Stratus Distribution..35
Table 4.3: Respondents Level of Education35
Table 4.4: Distributions of Respondents Locality, Age against Gender.36
Table 4.5: Accessibility of PHC Materials in the Health Facility...37
Table 4.6: Distribution of Respondents Source of Acquiring Information on PHCS.38
Table 4.7: Influence of Communicating PHCSs on Chwele Mother and their Newborns.39
Table 4.8: Chwele Residents Constraints in PHCS Information Access40
Table 4.9: Respondents Opinion on Primary Health Care Service
Workers' Performance.40
Table 4.10: Distribution of Utilization of Chronic Disease Services by Respondents...42
Table 4.11: Distribution of Age, Gender and VCT.45
Table 4.12: Distribution of Respondents Age Gender ARV Cross tabulation45
Table 4.13: Percentage of Respondents with Increased
Knowledge and Attitude on PHCS Alternative Technology.46
Table 4.14: Distribution of Age and Gender by Transport.49