Factors Influencing Choice of Delivery Place among Mothers in Rukungiri and Kanungu Districts, South Western Uganda: A Cross Sectional Study

2020 ◽  
Author(s):  
Richard Mugambe ◽  
Habib Yakubu ◽  
Solomon Wafula ◽  
Tonny Ssekamatte ◽  
Simon Kasasa ◽  
...  
Keyword(s):  
Health Facility ◽  
Rural Areas ◽  
Health Workers ◽  
Public Health Facility ◽  
Facility Delivery ◽  
Health Facilities ◽  
Public Facility ◽  
Cross Sectional ◽  
Western Uganda ◽  
Delivery Place

Abstract Background: Child birth in health facilities is generally associated with lower risk of maternal and neonatal mortality. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we examined the determinants of mothers’ decision of the choice of child delivery place in Western Uganda.Methods: Cross-sectional data was collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data was collected on the place of delivery for the most recent child, mothers’ sociodemographic characteristics, health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of mothers’ choice of delivery place as well as determinants for the choice of private versus public facility for delivery at 95% confidence intervals. Results: Majority of mothers (90.2%) delivered in health facilities. Non-facility deliveries were attributed to fast progression of labour (77.3%), lack of transport (31.8%) and high cost of hospital delivery (12.5%). Being engaged in business as an occupation [APR = 1.06, 95% CI (1.01 – 1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02 – 1.17)] favoured facility delivery while higher parity of 3 – 4 [APR = 0.93, 95% CI (0.88 – 0.99)] was inversely associated with facility delivery as compared to parity of 1-2. Choice of private facility over public facility was influenced by how mothers valued factors such as high skilled health workers [APR = 1.15, 95% CI (1.05 – 1.26)], higher quality of WASH services [APR = 1.11, 95% CI (1.04 – 1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78 – 0.92)] and availability of caesarean services [APR = 1.13, 95% CI (1.08 – 1.19)].Conclusion: Utilization of health facility child delivery services was high. Health facility delivery service utilization was influenced by engaging in business, belonging to wealthiest quintile and being multiparous. Choice of private versus public health facility for child delivery was influenced by health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

scholarly journals Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard K. Mugambe ◽  
Habib Yakubu ◽  
Solomon T. Wafula ◽  
Tonny Ssekamatte ◽  
Simon Kasasa ◽  
...  
Keyword(s):  
Health Facility ◽  
Rural Areas ◽  
Health Workers ◽  
Facility Delivery ◽  
Health Facilities ◽  
Public Facility ◽  
Health Facility Delivery ◽  
Cross Sectional ◽  
Factors Associated ◽  
Catchment Areas

Abstract Background Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. Methods Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers’ sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. Results The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01–1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02–1.17)] favoured facility delivery while a higher parity of 3–4 [APR = 0.93, 95% CI (0.88–0.99)] was inversely associated with health facility delivery as compared to parity of 1–2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05–1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04–1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78–0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08–1.19)]. Conclusion Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

scholarly journals Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicholas Kwikiriza Magambo ◽  
Francis Bajunirwe ◽  
Fred Bagenda
Keyword(s):  
Health Facility ◽  
Urban Areas ◽  
Health Workers ◽  
Geographic Location ◽  
Health Facilities ◽  
Urban Setting ◽  
World Health ◽  
Program Performance ◽  
Immunization Program ◽  
Western Uganda

Abstract Background Globally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p < 0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

scholarly journals Geographic location of health facility and immunization program performance in Hoima district, western Uganda: A health facility level assessment

2020 ◽  
Author(s):  
Nicholas Magambo Kwikiriza ◽  
Francis Bajunirwe ◽  
Fred Bagenda
Keyword(s):  
Health Facility ◽  
Urban Areas ◽  
Health Workers ◽  
Geographic Location ◽  
Health Facilities ◽  
Urban Setting ◽  
World Health ◽  
Program Performance ◽  
Immunization Program ◽  
Western Uganda

Abstract Background: Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of health facility may influence performance of their immunization programs. Therefore, the purpose of this study was to examine whether geographical location of health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods: We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results: We collected data at 49 health facilities. Most of the health units (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.Conclusions: Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

scholarly journals Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a Health Facility level assessment

2020 ◽  
Author(s):  
Nicholas Magambo Kwikiriza ◽  
Francis Bajunirwe ◽  
Fred Bagenda
Keyword(s):  
Health Facility ◽  
Urban Areas ◽  
Health Workers ◽  
Geographic Location ◽  
Health Facilities ◽  
Urban Setting ◽  
World Health ◽  
Program Performance ◽  
Immunization Program ◽  
Western Uganda

Abstract Background: Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods: We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results: We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.Conclusions: Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

scholarly journals Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
James S. Miller ◽  
Palka Patel ◽  
Sara Mian-McCarthy ◽  
Andrew Christopher Wesuta ◽  
Michael Matte ◽  
...  
Keyword(s):  
Case Management ◽  
Health Facility ◽  
Health Workers ◽  
Initial Assessment ◽  
Community Case Management ◽  
Cross Sectional Survey ◽  
Integrated Community Case Management ◽  
Cross Sectional ◽  
Western Uganda ◽  
Children Under 5

Abstract Background In some areas of Uganda, village health workers (VHW) deliver Integrated Community Case Management (iCCM) care, providing initial assessment of children under 5 years of age as well as protocol-based treatment of malaria, pneumonia, and diarrhoea for eligible patients. Little is known about community perspectives on or satisfaction with iCCM care. This study examines usage of and satisfaction with iCCM care as well as potential associations between these outcomes and time required to travel to the household’s preferred health facility. Methods A cross-sectional household survey was administered in a rural subcounty in western Uganda during December 2016, using a stratified random sampling approach in villages where iCCM care was available. Households were eligible if the household contained one or more children under 5 years of age. Results A total of 271 households across 8 villages were included in the final sample. Of these, 39% reported that it took over an hour to reach their preferred health facility, and 73% reported walking to the health facility; 92% stated they had seen a VHW for iCCM care in the past, and 55% had seen a VHW in the month prior to the survey. Of respondents whose households had sought iCCM care, 60% rated their overall experience as “very good” or “excellent,” 97% stated they would seek iCCM care in the future, and 92% stated they were “confident” or “very confident” in the VHW’s overall abilities. Longer travel time to the household’s preferred health facility did not appear to be associated with higher propensity to seek iCCM care or higher overall satisfaction with iCCM care. Conclusions In this setting, community usage of and satisfaction with iCCM care for malaria, pneumonia, and diarrhoea appears high overall. Ease of access to facility-based care did not appear to impact the choice to access iCCM care or satisfaction with iCCM care.

scholarly journals Examining Health Facility Financing in Kenya in the Context of Devolution

2021 ◽  
Author(s):  
Angela Kairu ◽  
Stacey Orangi ◽  
Boniface Mbuthia ◽  
Joanne Ondera ◽  
Nirmala Ravishankar ◽  
...  
Keyword(s):  
Health System ◽  
Health Facility ◽  
Descriptive Analysis ◽  
Health Facilities ◽  
Public Hospitals ◽  
Health Centers ◽  
User Fees ◽  
Public Facility ◽  
Cross Sectional ◽  
Financial Autonomy

Abstract Background: How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system.Methods: We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no=20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data.Results: Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion: The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.

scholarly journals Gambaran Kesadaran Masyarakat terhadap Kawasan Tanpa Rokok di Indonesia

2019 ◽  
pp. 123-130
Author(s):  
Ingan Ukur Tarigan ◽  
Anni Yulianti
Keyword(s):  
Smoking Cessation ◽  
Tobacco Control ◽  
Public Transportation ◽  
Rural Areas ◽  
Local Governments ◽  
Health Workers ◽  
Age Groups ◽  
Health Facilities ◽  
Cross Sectional ◽  
Public Places

Abstrak Merokok merupakan salah satu faktor risiko terhadap penyakit yang membahayakan, seperti jantung, stroke, kanker, dan lain sebagainya. Perilaku masyarakat khususnya perokok aktif yang merokok di sembarangan tempat masih cukup memprihatinkan. Perokok membebankan risiko merokok bukan hanya pada diri sendiri tetapi juga kepada orang lain yang ada di sekitarnya. Analisis dilakukan dengan menggunakan data GATS (Global Adult Tobacco Survey) 2011, dimana desain penelitian adalah cross sectional. Pemilihan sampel menggunakan teknik sampling proportional probabilitas to size (PPS). Hasil dari analisis antara lain: masyarakat yang terpapar rokok di dalam rumah lebih banyak pada kelompok laki-laki dibandingkan perempuan, yang terbanyak pada kelompok umur 45-64 tahun dengan pendidikan tidak tamat SD, tempat tinggal di pedesaan, dan pekerjaan wiraswasta. Kebijakan keluarga yang mengizinkan merokok dalam rumah sebesar 46,9%, dan seseorang yang merokok dalam rumah setiap hari mencapai 62,5%. Masyarakat yang terpapar rokok di ruang kerja sebesar 51,4%, dan kantor yang mengizinkan merokok dalam ruang kerja sebesar 38,4% dan yang tidak ada kebijakan sebesar 19,8%. Terpapar rokok di kantor pemerintahan 66,4%, di universitas 55,3%, di sekolah atau fasilitas pendidikan lainnya 40,3%, di fasilitas keagamaan 17,9%, di fasilitas kesehatan 18,4%, di bar atau klub 91,8%, dan transportasi umum 70,8%. Hasil ini dapat menjadi data dasar untuk mengembangkan intervensi program pengendalian tembakau yang efektif, termasuk menyediakan layanan berhenti merokok, terutama di fasilitas kesehatan. Pemerintah pusat dan daerah perlu meningkatkan sosialisasi tentang bahaya merokok di tempat-tempat umum dan dampaknya terhadap masyarakat khususnya yang bukan perokok; yaitu dengan membuat peraturan yang jelas dan tegas tentang pelarangan merokok di tempat-tempat umum dan memberikan sangsi yang tegas terhadap yang melanggar peraturan tersebut. Upaya layanan berhenti merokok dapat dilaksanakan dengan meningkatkan kegiatan promosi oleh tenaga kesehatan, sosialisasi ‘Quitline’ Kementerian Kesehatan, skrining CO2, bantuan konseling dan mengembangkan metode terapi berhenti merokok bagi para perokok aktif di berbagai fasilitas kesehatan yang tersedia. Kata kunci: rokok, perokok pasif, pengendalian tembakau Abstract Smoking is one of the risk factors for severe diseases, such as heart disease, stroke, cancer, and so on. The behavior of active smokers who smoke arbitrarily at many public places is still quite alarming. Smokers impose the risk of smoking not only on themselves but also to others around them. The analysis was performed using GATS (Global Adult Tobacco Survey) 2011 data, where the research design was cross-sectional. The sample selection uses a proportional probability to size (PPS) sampling technique. The results of the analysis show people who are exposed to cigarettes in the house are mostly males than females with the characteristics were at age groups 45-64 years old, educational level was not completed elementary school, living in rural areas, and self-employee. Family policies that allow smoking in the home were 46.9%, and someone who smokes in the house every day reaches 62.5%. People who are exposed to cigarettes in the workspace were 51.4% and offices that allow smoking in the workspace were 38.4% and those without any ‘free smoking area’ policy were 19.8%. Exposure to cigarettes was 66.4% in government offices, 55.3% in universities, 40.3% in schools or other educational facilities, 17.9% in religious facilities, 18.4% in health facilities, 91.8% in bars or clubs, and 70.8% in public transportation. These results could be a reference or base evidence in developing an effective tobacco control program, including providing smoking cessation services. Central and local governments need to increase awareness about the risk of smoking in public places and their impact on public health, especially for non-smokers, by issuing a strict regulation on free smoking areas in public places and enforce punishment to people who violate these regulations. The efforts to stop smoking services can be implemented by increasing promotion activities by health workers, socialization of the Ministry of Health 'Quitline', CO2 screening, counseling assistance and developing methods of smoking cessation therapy for active smokers in existing health facilities. Keywords: cigarette exposure, passive smokers, tobacco control

scholarly journals Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment

2020 ◽  
Author(s):  
Nicholas Magambo Kwikiriza ◽  
Francis Bajunirwe ◽  
Fred Bagenda
Keyword(s):  
Health Facility ◽  
Urban Areas ◽  
Health Workers ◽  
Geographic Location ◽  
Health Facilities ◽  
Urban Setting ◽  
World Health ◽  
Program Performance ◽  
Immunization Program ◽  
Western Uganda

Abstract Background Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of health facility may influence performance of their immunization programs. Therefore, the purpose of this study was to examine whether geographical location of health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of the health units (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

scholarly journals Geographic location of health facility and immunization program performance in Hoima district, western Uganda: A health facility level assessment

2020 ◽  
Author(s):  
Nicholas Magambo Kwikiriza ◽  
Francis Bajunirwe ◽  
Fred Bagenda
Keyword(s):  
Health Facility ◽  
Urban Areas ◽  
Health Workers ◽  
Geographic Location ◽  
Health Facilities ◽  
Urban Setting ◽  
World Health ◽  
Program Performance ◽  
Immunization Program ◽  
Western Uganda

Abstract Background: Globally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods: We conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results: We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.Conclusions: Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

scholarly journals Examining health facility financing in Kenya in the context of devolution

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angela Kairu ◽  
Stacey Orangi ◽  
Boniface Mbuthia ◽  
Joanne Ondera ◽  
Nirmala Ravishankar ◽  
...  
Keyword(s):  
Health System ◽  
Health Facility ◽  
Descriptive Analysis ◽  
Health Facilities ◽  
Public Hospitals ◽  
Health Centers ◽  
User Fees ◽  
Public Facility ◽  
Cross Sectional ◽  
Financial Autonomy

Abstract Background How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. Methods We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data. Results Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.

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