FACTORS AFFECTING THE ADOPTION OF HEALTH MANAGEMENT

INFORMATION SYSTEM AMONGEST HEALTH CARE PROVIDERS AT WAJIR

COUNTY REFERRAL HOSPITAL WAJIR COUNTY, KENYA.

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DECLARATION
This proposal is my original work and has not been present in any other institution for academic
awarding.

Approval
This proposal has been submitted with my approval as the polytechnic supervisor.

Madam Laureen Agit

Signature …………….

DATE …………………………………………………………

ii
DEDICATION
I dedicate this project to my wonderful parents, my lectures, my classmates and friends for their
support and encouragement throughout this project.
May God bless you all.

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ACKNOWLEDGEMENT
I thank Allah for taking good care of me since I commenced my research till now. To him be
glory. I also thank for guidance she has shown me indeed she has play an important role in
making this project be success. Likewise, I thank my good people who respond in my
questionnaire and may our almighty God bless you abundantly.

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TABLE OF CONTENTS
DECLARATION ............................................................................................................................................. ii
DEDICATION ................................................................................................................................................iii
ACKNOWLEDGEMENT.................................................................................................................................iv
LIST OF TABLES .......................................................................................................................................... vii
LIST OF FIGURE.......................................................................................................................................... vii
OPERATIONAL DEFINATION ...................................................................................................................... viii
LIST OF ABBREVIATION ............................................................................................................................... ix
ABSTRACT ....................................................................................................................................................x
CHAPTER ONE ............................................................................................................................................. 1
I.0 INTRODUCTION ...................................................................................................................................... 1
I.I Background of the study ..................................................................................................................... 1
1.2 Statement of the problem ................................................................................................................ 2
1.3 JUSTIFICATIONS .................................................................................................................................... 3
1.5Purpose of the study .......................................................................................................................... 4
1.6 Objectives of the study ..................................................................................................................... 4
1.7 Significances of the study .................................................................................................................. 5
1.8 Scope of the study ............................................................................................................................ 5
1.9 CONCEPTUAL FRAMEWORK ................................................................................................................. 6
CHAPTER TWO (2) ....................................................................................................................................... 7
2.2 Health management information system ......................................................................................... 7
2.3.0 Infrastructure Barriers ................................................................................................................... 9
2.3.1 Internet ...................................................................................................................................... 9
2.3.2 Computer hardware and software ........................................................................................... 10
2.3.3 Information system professionals ............................................................................................ 11
2.4 Skills and perception toward health management information system ......................................... 13
2.5 Hospital management ..................................................................................................................... 14
CHAPTER THREE ........................................................................................................................................ 16
3.0 RESEACHER METHODOLOGY............................................................................................................... 16
3.1 INRTODUCTION ................................................................................................................................... 16
3.2 Research design .............................................................................................................................. 16
3.3 Study Area ....................................................................................................................................... 16
3.4 Population of the study ................................................................................................................... 17
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 3.5 SAMPLING PROCEDURE .................................................................................................................. 17
3.6 SAMPLING SIZE ............................................................................................................................... 18
3.5 Data collection technique ............................................................................................................... 20
3.6 Data Analysis ................................................................................................................................... 21
3.7 Ethical consideration ....................................................................................................................... 21
CHAPTER FOUR ......................................................................................................................................... 22
4.0 INTRODUCTION ............................................................................................................................... 22
4.1 SAMPLE CHARACTERISTICS ............................................................................................................. 22
4.1.1RESPONDENT’S RESPONSE RATE ................................................................................................... 22
4.1.2 RESPONSE RATE BY GENDER ........................................................................................................ 23
4.1.3 PROFESSIONAL EXPERTISE ........................................................................................................... 24
4.1.4 WORKING EXPERIENCE ................................................................................................................ 25
4.2 ICT INFRASTRUCTURE AT WAJIR COUNTY REFERRAL HOSPITAL. .................................................... 26
4.2.1 COMPUTER HARDWARE .............................................................................................................. 26
2.2 INTERNET ACCESS ........................................................................................................................... 27
4.2.3 TECHNICAL INFRASTRUCTURE...................................................................................................... 29
4.3 HOSPITAL STAFF SKILLS ON HMIS ................................................................................................... 30
.4.3.1 PERCEPTION OF HEALTH CARE WORKERS TOWARDS HMIS. ....................................................... 32
4 RESOURCE ALLOCATION TOWARDS HMIS. ........................................................................................ 32
4.5 HOSPITAL ADMINISTRATION ON MANAGING HMIS ADOPTION. .................................................... 33
CHAPTER 5 ................................................................................................................................................ 34
5.0 INTRODUCTION ............................................................................................................................... 34
5.1 SUMMARY OF THE FINDINGS .......................................................................................................... 34
5.2: CONCLUSION.................................................................................................................................. 35
RECOMMENDATION. ................................................................................................................................ 36
REFERENCES.............................................................................................................................................. 37
APPENDIX I QUESTIONNAIRE ................................................................................................................ 40

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 LIST OF TABLES

Table 3.1. Sample frame..................................................................................................21

Table 4.1. Response rate of respondent.........................................................................24

Table 4.2 Professionals expertise....................................................................................26

Table 4.3 Working experience of respondents............................................................28

Table 4.4 Reliability of internet challenges..................................................................31

Table 4.5 Infrastructure influence HMIS adoption...................................................... 33

Table 4.6. Hospital on how to use HIMS.........................................................................34

Table 4.7 Hospital administration on managing HMIS adoption............................40

LIST OF FIGURE

Figure 4.1 pie chart showing response rate............................................................................................25

Figure 4.2 Stacked bar showing sufficient of computer hardware among the departments...29

Figure 4.3 Perception of health workers ..................................................................................................35

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OPERATIONAL DEFINATION
I. ADOPTION-transfer between an old system to another.

ii. IMPLEMENTATION –installation of new hardware and systems software.

Iii INFORMATION SYSTEM- an integrated set of components for collecting, storing and
processing data and for providing information, knowledge and digital product.
iv. ELECTRONIC MEDICAL RECORD – systematize collect patient and population health
information, electronically store in digital form.
V. SYSTEM INTERGRATION – the process of operationally connecting separate computer
system or software application into single larger system allowing each solution to functionally
work together.
vi. ICT INFRASTRUCTURE – the information and communication technology infrastructure
and systems including software, hardware, firmware, networks and the company websites that
are used in the business.

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LIST OF ABBREVIATION
I.HMIS-Health management information system.
ii. WCRH- Wajir county referral hospital.
iii.IT- Information technology.
iv. HRIOs-Health records and information officer.
v. IS- Information system.
Vi ICT- Information Communication Technology

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ABSTRACT
Health management information system is vital for acquisition of data for planning, monitoring,

evaluation and effectives decision making. Health worker collect and report data routinely on all

their activities. Studies on developing countries have shown that there are challenges which

constrain the adoption and use of health management information system at various health care

facilities. This study examines the factors influencing the adoption of health management

information system amongst healthcare providers at Wajir County Referral Hospital, Kenya. The

study adopts acrossectional research design. The target population was 66 health care workers

using health management information system at Wajir Couty Referral Hospital. Questionnaire

were distributing to a sample size of 66 respondents of which 42 were responded to and return.

Data analysis is done after data cleanup of all questionnaire. The result was present in tables and

charts. The findings revealed that both technological factors and resource allocation by

management towards HMIS influence its adoption at Wajir County Referral hospital.

Technological factors include computer hardware and internet access. The hospital has limit

number of computer hardware due to high cost of acquisition and maintenance, poor resource

allocation is found to be a significant factor affecting HMIS. The study therefore recommended

acquisition of more computer hardware, improvement of both WI-FI and internet connection,

employment of more ICT Staff and appropriate allocation towards Health management

information systems.

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 CHAPTER ONE

I.0 INTRODUCTION
I.I Background of the study
Traditionally, paper filling systems are used to keep track of each patient’s health record, which

include demographic information, medical history, test requested, diagnosis reached, prescription

drugs and any other treatments conducted. Because of technological advancements, health

information is now collected and stored in digital format, commonly known as electronic

medical records. Various health- care organization have used electronic healthcare systems based

on information communication technology to help with health care delivery. For healthcare

management a health management information system is a comprehensive system with an

electronic medical record. Care soft HIMS, a web- based system, is introduce in May 2018 at

Wajir County Referral Hospital to provide efficient and better health delivery in the facility by

simplifying clinical, financial and administrative processes. The factor affecting the acceptability

and usage of the health information technologies must be investigating in order for them to be

successfully implemented (Kamal et al., 2020). A detailed examination of the facilitators and

barriers to EHR adoption provides continued support for EHR deployment across diverse health-

care organization, perhaps resulting in lower association economic expenses (Tsai et al, 2020).

In high-come countries, such as the united State of nation, putting electronic health systems in

place is a difficult task. In low-income countries like Kenya, however, open source software may
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provide some relief (MEIGaN et al, 2018). Many issues have influences and will continue to

influence the deployment and transition of hospital information systems that are outside the

scope of the report (Kruse, Beaned 2018). The lack of fit between technical, human and

organization variables has been blamed for a slew of HIS adoption issues, according to studies

(Pandya et.al,2022).

It is possible to examine the factors that influence the adoption of health information technology

(Ali et al,2020). It is critical to understand the adoption process and access the system’s

capabilities as health care institutions in low and middle income nations embrace digital health

systems to improve hospital and administrative patient care (Garg et.al, 2020). Investigation of

adoption and use by users is one of the most effective components in the implementation of

health information technology, particularly electronic medical record (quarrelsome et, al, 2019).

In terms of health information systems, the situation is not much better. Many health information

system deployments fall short of perfection (Sacks and Picas 2020).

1.2 Statement of the problem

A move from paper- based records management to the use of information technology is one of

the many transformations that health care was undergoing. Improving clinical outcomes, easing

care coordination, minimizing human medical mistakes and enabling data monitoring through

time are just a few of the benefit of the information system. Health management information

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system(HMIS), for example are essential ICT tool for improving the value of the health care

delivery and lowering healthcare cost (Shangala,2020). With the advancement of information

technology, hospitals are increasingly using HMIS. Kenya is one of the country that is promoting

the usage of health information management systems. As a result, the government is growing

increasingly critical of the country use of information technologies.

Implementing HMIS in health care institutions, according to (Dolerite and Memo 2019), looks to

be challenging. Various health care facilities in Kenya are confronting a number of issues as they

implementing HMIS. Three factors (infrastructural constraints, hospital staff skills and

perceptions of HMIS and hospital management) were investigate in the study to see if they

influencing HMIS adoption at Wajir County Referral Hospital in Kenya

1.3 JUSTIFICATIONS
Securely of sharing health management information system with patients and other clinicians.

Healthcare providers are more efficient diagnosis patients reduces medical errors and provide

safe care also improving patient health care providers interaction and communication as well

as health care convenience.

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1.4 Research Questions

i) what are the state of ICT infrastructure at Wajir County Referral Hospital?

ii) What are the skills level and perception toward HMIS amongst health care workers at Wajir

County Referral Hospital?

iii )Do hospital management influences Wajir County Referral Hospital adoption?

1.5Purpose of the study

The goal of this is to investigate the difficulties encounter during the implementation of a health

management information system at Wajir County Referral Hospital in Kenya.

1.6 Objectives of the study

The primary goal of this study is to gather perspective from health care practitioners who have

use a health management information system in order to determine the problem encounter during

implementation of HMIS at Wajir County Referral Hospital in Kenya, the following are

particular goals:

I)A review of the health-care facility in ICT infrastructure.

ii) To assess the degree of knowledge and attitudes concerning HMIS among health care workers

who utilize it.

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iii) To find out how hospital management influences health management information system.

1.7 Significances of the study

The study goal was to look at the issues that WCRH face when implementing a health

management information system. Several challenges to implementing and adoption of the health

management information system have been identifying in previous research studies, but there

was no knowledge or experience of the constraints of health management information system

adoption from health care providers who have use HMIS at WCRH. Patients, hospital employees

and management, other health- care institutions, both international and local funders and chiefs

of health at the sub- county and national level will benefit from the study findings.

The administration, health-care employee and other health-care institutions benefit from being

aware of the numerous problem encounter during HMIS adoption so that suitable interventions

may be developed to guarantee the effective adoption and operation of health management

information system at the facility. The government, foreign and local partners will be able to

comprehensive the assistance required to guarantee that HMIS is use efficiently and effectively

in health care institutions. Patients benefit in the long run because the quality is enhancing.

1.8 Scope of the study

The study focused on health care practitioners that use a HMIS at WCRH in Kenya, with the

goal of identifying challenges encounter during health management information system

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 implementation. Infrastructure, skill and perception of the health care employee regarding health

management information system and hospital administration were all considerations in this

study. The data is gather during a three – month period. Following the end of the data gather,

analysis and presentation were carried out.

1.9 CONCEPTUAL FRAMEWORK

Independent. Variable
Infrastructure barrier

• internet connectivity

• computer hardware and

software

• information

Skills and perception

.
• Specialized knowledge

• Hiring cost for competent HMIS

work ADOPTION
• Training • attitude

Hospital management

• Allocation of resources

• Change management

•Dedicated hospital
administration

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 CHAPTER TWO (2)

LITERATURE REVIEW

2.0 INTRODUCTION

This systematic identification, location and analysis of documents containing information related

to research problem being investigate, the chapter also discusses the conceptual framework as a

review of the previous on the adoption of HMIS.

2.2 Health management information system

A planning system for collecting, processing, storing disseminating and using health related

information to carry out function of management. It consists of people, tools (paper based and

electronic) and procedure to gather, sort and distribute timely, accurate information to decision

makers (kuyo and MuriKr et al, 2018). Growth of health information system has given rise to

hospital management software, which aims to assist administrators in assessing the quality of

service render by the hospital staff and in performing important tasks with regard to

management. A health management information system was a system that records, stores,

retrieves and processing health data in order to enhances decision making (Endian et al, 2019).

Ethiopia health system was dived into three levels: Primary, Secondary and tertiary. Health post,
7
health clinics and primary hospitals make up the primary health care unit. A connection

connects health centers and health posts, with one health center and health post, with one health

center accountable for around five health posts. General hospital was found at the secondary

level, whereas teaching and referral hospital are found at the tertiary level. Ethiopia has been

adopting health management information system at all level of the health care system to

guarantee that information was available for evidence- based health planning and decision-

making, with an emphasis on rationalizing and standardizing the systems and information system

(Endriyas, M.Alano, A mekonnen, at al, 2019). Hospital operations are streamlined,

administration and control are better, patient care is improving and profitability is increase thank

to healthcare software. Health information systems according to the WHO, offer the foundations

for decision making and have four major function: Data creation, compilation, analysis and

synthesis, communication, and usage. From the medical system to the administrative system,

hospital will gain substantially from the use of Information Technology (IT) application such

HMIS (Esfahan et al, 2018). According to research conducted by Flower, just 28% of

information system work well (Nashi et al, 2016) HMIS is a hospital management information

system that automates financial, administrative and patient care tasks, generates management

reports and operation data and include a strong query module. Although the phrases hospital

management and information systems, patient information systems, medical information system,

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health information systems, clinical information system and hospital information systems have

slightly distinct definitions, they are frequently used interchangeably (Payne et.al, 2019).

2.3.0 Infrastructure Barriers

2.3.1 Internet

According to the world Health Organization, health information systems provide the foundation

for decision making and perform four key functions: data production, compilation, analysis and

synthesis, communication and consumption. Hospital will benefit significantly from the adoption

of Information Technology (IT) application such HMIS, from the medical system to the

administrative system (Esfahan et al, 2018) according to flower’s research, just 28% of

information system function well (Russo et al, 2018) health management information systems is

a hospital management information system that automates financial, administrative and patient

care processes, creates management reports and operational data and has a powerful query

modules. Despite the fact that the terms hospital management and information systems, patient

information systems, medical information systems, health information systems and clinical

information systems. As a result of their inability to handle online health data, health care

practitioners waste too much time doing to (Tsakitzidis et al, 2020). Sluggish internet use among

doctors in Pakistan (Khan, 2019), is owing to a lack of suitable technology and computer

training. Doctors have internet access but do not utilize it because they believe the information

accessible on the internet is untrustworthy and of poor quality, resulting in sluggish utilization.
9
Doctors performances is harm by their misunderstandings regarding the dependability and

quality of information on the internet. Organizational Doctors performances is harm by doctor’s

misconception about the authenticity of information found on the internet (Khanna and Dab

2021).

2.3.2 Computer hardware and software

For the effectives installation of E- health systems, sufficient hardware is required. To avoid

user- related issues, essential hardware must be identifying, determine and install before the e-

project may be launch. User frequently complain that information systems and interface design

are not user pleasant (Inala and Hacalogulu, 2019), Therefore at the start of an e-project,

currently existing hardware must be recognizing. One of the major challenges face by users is

that information systems and technology in health care facilities lack flexibility and adaptation.

Doctors must be given the opportunity to collaborate with information technology employee to

set out their unique requirement influencing their activities in order for e-health apps to be

successful. Users (doctors) must have an opportunity to participate in the creation and adaptation

of technology. Doctors in low-income countries argue that the software contents and language

are not appropriate for their native context, that proper language is usually overlook information

systems and that there is little material accessible in local language for e-health initiatives

(Bhandari et al.2021). doctor and physicians from all sections of a hospital should consider when

designing an Information System for successful e-health applications because it improves the
10
quality of the Information System (IS) because physicians from different sections of a healthcare

institution can provide complete requirements and thus unnecessary features of an IS can be

avoided. (Adam ski et al,2018) believes that all healthcare practitioners should be involve

planning, development and implementation.

2.3.3 Information system professionals

When workers have the still to utilize and maintain ICTs, it has an influences on organization

work practices. It is highly usual for information system workforce in developing country

hospital to have insufficient computer abilities, as well as a lack of motivation to learn and apply

IT- related skill while doing their jobs. This might be as a result of unfavorable working

condition and scarcity of training resources and programs. Due to a shortage of qualified

information system workers and their understanding of e-applications the failure rate of e-health

initiatives in developing nation is greater than industrialize one (Mosud,2020). According to

(Harahan, 2022). A lack of training and education for IT expert in healthcare companies forces

IT- workforce to avoid using e-health systems, resulting in lost resources and little gain from

information systems application in the health sector. The majority of healthcare institution in

poor nation have a lot of data, but they lack the ability to manage and analyze it using

information communication technology to make decisions. ICTs are beneficial for healthcare

sectors in developing countries to effectively plan, control ancounty referral unicate health-

related information and decisions more effectively across all the different section of a hospital,
11
according to (Salmon and Abdu 2019) information technology professionals need training to

effectively use all e-health applications according to (Amon Kona et al, 2021). Qualify IT

experts are a critical component for efficient ICT use in health (Chowder et al, 2018). The health

sector in developing countries has several challenges in establishing and promoting a health

information system. These constraints include a lack of infrastructure, expense, technical

complexity, competent, human resources and medical personnel who are not ready (Paul et

al,2020). Factor influencing the long term adoption of e-health technologies in developing

countries. A study of Nigerian hospital from the perceive usefulness, belief, willingness and

attitude. Low literacy and familiarity with e-health technology application, as well as a lack of

desire and bad organizational and management practices, are all key problems. (A Kenyan case

study on electronic health records) AfyaEHMS, a new open MRS based system is being

implemented in Kenya (Paton, C and Muinga, N 2018). Afya EHMS is originally adopted in

Machakos County, Kenya and has since been expand to other levels of health care institutions in

other counties. At Kenya Machakos county this system is deploy in 250 health institutions.

Inadequate infrastructure, such as power and a reliable network, factor relating to user training

and attitudes, stakeholder engagement, harnessing local talent in system development, system

integration and a large system are among the key challenges identify that influence

implementation.

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2.4 Skills and perception toward health management information system

Many developing countries face a lack of resource to equip health institutions agrees at fail to

address short and long term needs (Check 2018) limit budge allocate to the health sector

(Dolerite 2019), and a lack of information and communication skills and knowledge (Claro et

al,2018). Infrastructure is not only costly to build, but it also necessitates ICT skills and expertise

for successful implementation of e-project (Fuse and Coleman 2018). According to findings of a

Tanzania research on bridging the gaps in health management information system in the context

of changing health sector (2010), 75% of the health professionals has never been educate in

HMIS, and 60% did not adequate define it.85% of people has a favorable view regarding the

system. Internal and external variables impact the application of the health by medical

professionals, according to research conduct in Zimbabwe. Internal influences include ICT skills

and knowledge (Forsa and Coleman 2018). Health management information system

implementation is hampered by a lack of knowledge and skill among health care personnel who

use it. Medical practitioners must be educating and training to utilize e-health effectively in

korder for acceptances and implementation to be successful Forsa and Coleman 2018). The

obstacle mention in research conduct in Kenya on implementing an open source electronic health

record system in Kenya health care facilities include expensive software license cost, clinical and

administrative buy-in and a lack of proper user training. Fear of technological failure (paper

systems are thought to be more dependable), more infrastructure needs and lack of understanding

13
of HIS benefit are the hurdle to its implementation. The administration and medical staff

aversion to using health information system is exacerbating the problem.

2.5 Hospital management

The distribution of resource by the hospital administration has an impact on health management

information adoption. Adoption of the system is facilitating by allocating sufficient project

resource to HMIS. It is implementation is hamper by a lack of resources. Project manager with

extensive expertise and the ability to build a realistic project plan to enable Health management

information system adoption are required. Adoption of HMIS is hamper by lack of managerial

support. A figurehead position should be display in order for it to be adopted. An equally

overwhelming majority (65-75%) agreed that anxiety about adopting new technology, a lack of

qualify specialist are major deterrents to HIS implementation, according to a study conduct in

India in November 2016.

How hospital administrators handle change opposition has a big impact on HMIS adoption. Not

everyone on staff is on board with technology. There are certain health care professionals that are

hesitant to employ HMIS. While establishing the hospital, the hospital management faces

considerable challenges and large expenditure are made in terms of infrastructure and use of

integrate information systems such as health information (Herryawan and Murphi, 2021). Lack

of funding, resource and infrastructure have all been identifying as key roadblocks to the

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implementation of hospital information systems (When and AL Momani, 2019). Physical

limitations, limited computer skill, a lack of technical expertise, lack of standardization and a

low incidence of computer literacy are all cognitive hurdles that need be address before using

HIS (Robins 2019). To large degree, develop nation are adopting modern health technology.

However poor nation continues to struggle for it, owing to a variety of obstacles like as

insufficient infrastructure, a paucity of resources, a lack of qualify labor and management

unwillingness to invest in health information system (Zhou et al, 2011).

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 CHAPTER THREE

3.0 RESEACHER METHODOLOGY

3.1 INRTODUCTION

This chapter describes the method applied in investigating the subject matter. It presents the

approach which is employee to carry out the study by explaining the research design, study area,

population, sample producer, data collection technique, data analysis and ethical consideration

3.2 Research design

A cross-section research approach was used in this study. Data was collect from respondents at a

single moment in time from various age group at various stage of development. A crossectional

study according to (Laurent Thomas 2020), is a sort of research design in which data is collect

from a large number of people at one time

3.3 Study Area

Wajir county referral hospital in wajir central, Kenya was the site of teaching and research. Wajir

county referral hospital is level 5 hospital with a bed capacity of 220 that provide both outpatient

and inpatient medical services. It has a health management information systconnecti was used by

numerous departments.

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3.4 Population of the study

The target population for a research is referred to as the population (Majid, 2018) Population is

defined by (Pandey, 2021) as a whole collection of persons, events, or things with a common

observable attribute, i.e. the sum of all that complies to a particular definition. According to

(Aspers and Corte2019,), the population refers to the possible subjects who have the

characteristics that the researcher is looking for. All members of an actual or hypothetical group

of people, events, or objects to which an investigator seeks to generalize the findings of a

research study are referred to as the target population (Pandey, 2021). Typically, researchers

make findings about big groups by selecting a subset of the population to represent the entire

population (Fumari, 2021).

The study's target respondents were health-care workers at Wajir County Referral Hospital in

Wajir County, Kenya, who used HMIS. Clinical officers, nurses, lab technicians, pharmacists,

HRIOs, and IT personnel all use HMIS in the course of their daily duties at the health care

facility.

3.5 SAMPLING PROCEDURE

The practice of selecting an acceptable number of participants from a specific population was

known as sampling (Johnson etal., 2020). Systematic sampling and simple random sampling

were utilized as sampling procedures. Only health care employees who used HMIS at the

17
healthcare facility were asked to participate in this study. They had an equal and independent

probability of participating in the research.

3.6 SAMPLING SIZE

The sampling size that was involved in this study was determined using Andrew Fishers et al

(1998) formula.

n = (z2pq) / (d2)

n -desired sample size if target population is greater than 10000.

Z -The standard normal deviation at the required confidence interval.

Confidence level z –score

90% 1.645

95% 1.96

99% 2.576

p-the estimated proportion in the target population estimated to have characteristics of interest to

the researcher.

q= 1-p

d -error margin to be tolerated.

P=50% or 0.5
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z=1.96

q=1- 0.5

d=0.05

Thus (1.962) ×0.5 ×0.5 / (0.052) = 384.16

nf =n/ 1 + (n/N)

nf = Desired sample size when population is less than 10,000.

n =Desired sample when population is more than 10,000.

N = Estimated population size of the study area.

N- Estimated healthcare providers at Wajir ounty referral hospital, Kenya=80.

384 / (1+ 384/ 80) = 66.20

= 66 respondents.

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Table below presents the sampling frame

Table 3.1: sampling frame

Population category Target population

clinical officers 10

Nurses 18

Lab technician 10

Pharmacists 12

Hrios 10

It staff 6

total 66

3.5 Data collection technique

The data collection tool that was use a questionnaire. Respondents were required to provide data

or information through closed ended structure questionnaire using five point Likert scale where

the respondents were to indicate the extent to which they agree a variable in regard to health

management directly to respondents. Observation is also use as a technique for data collection.

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3.6 Data Analysis

After the data gathering is complete, the data is analyzing. The researcher’s employee both

qualitative and quantitative methodologies. Responses to open ended questions were analyze

using qualitative content analysis. To ensure that data is summarize and structure in a logical

manner, data analysis tools such as Microsoft Excel and Microsoft Word are use. Data is present

in tables, graph and charts. Open-ended question responses are tallied to produce proportion that

were close to those given by narrative.

3.7 Ethical consideration

Ethical practices that are put into consideration included:

I)Data and information acquired from the research project are handle with integrity.

ii) Respondent confidentiality

iii) plagiarism and fraud in research were completely avoided.

iv) There is no restriction on freedom of expression.

v) Transparency is disclosing study result.

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 CHAPTER FOUR
4.0 INTRODUCTION
The findings of the research, data analysis, interpretation, and discussion of individual objective

results based on the research objectives are summarized in this chapter. The goal of the study

was to gather feedback from health care providers who use HMIS in their regular activities at

Wajir Referral County Hospital in order to identify problems encountered in HMIS

implementation. To do this, the study focused on three specific goals: assessing the health care

facility's ICT infrastructure, assessing healthcare staff's capabilities and perceptions of HMIS,

and determining whether and how hospital management influences HMIS adoption. As a result,

data from primary sources is provided in accordance with the study's three objectives and

research questions.

4.1 SAMPLE CHARACTERISTICS

4.1.1RESPONDENT’S RESPONSE RATE
The hospital's 66 healthcare staff were the subjects of the study. The study included 66

questionnaires, with 42 of them being returned and answered. Six clinical officers, twelve nurses,

six laboratory technicians, four pharmacists, eight HRIOs, and six IT workers were among the 42

people who answered to the questionnaire. They're all departments that use HMIS. The overall

response rate was 63.64 percent, which was sufficient for data analysis.

According to (, a response rate of 50% is satisfactory, 60% and above is good, and 70% is very

good. According to (Daikeler et al., 2020), a response rate of 50 percent is satisfactory, whereas

22
a rate of more than 70 percent is excellent. This suggests that the study's overall response rate

was good and adequate for the data analysis.

The good response rate was as a result of data collection technique, approach used on the

respondents and willingness of the respondents to participate in the study.

Table 4.1: Response rate of respondent

Distribution Frequency %

clinical officers 6 14.28

Nurses 12 28.57

lab technician 6 14.28

pharmacists 4 9.52

Hrios 8 19.52

IT STAFF 6 14.28

TOTAL 42 100

4.1.2 RESPONSE RATE BY GENDER

The study sought data on whether the respondents were male or female so as to establish gender

distribution of respondents. Majority were female 23 at 54.76% while male were 19 which

equals to 45.24% of the total respondents .This had no influence on factors influencing HMIS

adoption

23
Figure 4

RESPONDENT

MALE
45%
FEMALE
55%

4.1.3 PROFESSIONAL EXPERTISE

The study through the questionnaire acquired aspect on job title of respondents so as to ascertain

the ability of respondents to answer questions regarding HMIS .This was also important as it

showed respondents are fairly educated to know their systems and how they operate.

The findings showed nurses at 28.57% making the highest, Cos 14.28%, lab technicians 14.28

%, HRIOs 19.05% ,IT staff at 14.28% and pharmacists at 9.52%.

24
Table 4.2: professional expertise

professional expertise Frequency %

Clinical officers 6 14.28

Nurses 12 28.57

Lab technician 6 14.28

Pharmacists 4 9.52

Hrios 8 19.05

It staff 6 14.28

Total 42 100

4.1.4 WORKING EXPERIENCE

A high number of health care workers at Wajr county hospital have worked for less than 5 years

at the health care facility, with a percentage of (61.90%).those who have worked for between 6-

10 years had a percentage of (23.81%), between 11-20 years (14.29%) which was the lowest.

25
Table 4.2: working experience of respondents.

Experience ( years) Frequency %

<5 26 61.90

6-10 10 23.81

11-20 6 14.29

Total 42 100

4.2 ICT INFRASTRUCTURE AT WAJIR COUNTY REFERRAL HOSPITAL.

4.2.1 COMPUTER HARDWARE
Wajir County referral Hospital has a total of 58 computers spread out across its numerous

departments. They are vital in the implementation of HMIS. The majority of the computers are

connected to a UPS, but not all of them are, resulting in disruptions when power surges or

outages occur.

One of the queries wanted to know if each department had enough computer hardware.

According to the study, 42.86 percent of respondents agreed, 35.71 percent said they were

neutral, and 9.52 percent said they strongly agreed. This indicates that the hospital has

computers, but not the necessary quantity for a seamless HMIS implementation. The following

graph depicts the results:

26
Figure 4.2: The sufficiency of computer hardware among the departments

45

40

35

30

25 Series 3
Series 2
20
Series 1
15

10

0
Strongly agreed neutro disagree strongly
agreed disagree

2.2 INTERNET ACCESS

Departments at wajir county referral hospital use both Wi-Fi –connection and Ethernet

connections. Wi-Fi connection transmits data via wireless signals whereas Ethernet connection

transmit data over cables. Ethernet connection at the facility is faster thus reliable and more

secure. The wireless network is constantly bombarded by multiple devices mostly health care

staff devices all for different uses making demands on Wi-Fi immense thus slow and unreliable

at the health care facility.

At times Ethernet connection at the health care facility is slow. Also due to constant delayed

payments for internet bill after expiration date, it takes 3 to 5 days of a week for Wi-Fi

27
connection to be restored at the health care facility. All this hinders and constrain smooth HMIS

adoption.

The respondents were asked whether all staff have stations with reliable internet access (57.14%)

agreed, (19.05%) strongly agreed, (14.29%) neutral and (9.52%) disagreed. This implies the

hospital has internet access but not that reliable. The finding are tabulated below

Table 4.4: Reliability of internet access

Experience ( years) Frequency %

Strongly agree 8 19.05

Agree 24 57.14

Neutral 6 14.29

Disagreed 4 9.52

Strongly disagree 0 0

Total 42 100

28
4.2.3 TECHNICAL INFRASTRUCTURE
The study sought to find out whether the hospital has dedicated ICT department and ICT team.

The results reveal that (42.86%) strongly agreed, (40.48%) agreed and (2.28%) strongly

disagreed which was the lowest. This implies that indeed the hospital has dedicated ICT

department, responsible for maintaining all network and computer related issues, security for all

systems and data also monitoring performance of computer parameters to provide first response

in case of necessary assistance required. From the findings technical infrastructure does not

affect or constrain HMIS adoption at Wajir county referral hospital.

Figure

4.2.4 INFRASTRUCTURE INFLUENCE ON HMIS ADOPTION AT THE HEALTH CARE

FACILITY

The study sought to find out from the general respondents whether infrastructure influence

HMIS adoption and the findings indicate that (28.57%) respondents strongly agreed, (26.19%)

disagree,(19.05%) neutral, (16.67%) agree and (9.52%) strongly disagreed. This implies

infrastructure influence HMIS adoption at Wajircounty referral hospital

29
Table4.5: Infrastructure influence HMIS adoption

Experience (years) Frequency %

Strongly agreed 12 28.57

Agreed 7 16.67

Neutral 8 19.05

Disagreed 11 26.19

Strongly disagree 4 9.52

Total 42 100

4.3 HOSPITAL STAFF SKILLS ON HMIS

The respondents were asked whether some hospital staff lacks skills on the use of HMIS. The

purpose of the question was to find out skill level of staff on HMIS and to determine whether it

affect its adoption. From the total respondents (42.86)which was the highest disagreed, (26.19%)

were neutral, (19.05%) agreed, s(7.14%) strongly disagreed and (4.76%) strongly agreed. From

the overall results it implies that skills level on staff on HMIS does not influence HMIS adoption

at Wajir county referral hospital. The findings are tabulated below

30
4.6 Table Hospital staff skills on how to use HMIS

Experience (years) Frequency Percent

Strongly agree 3 40.66

Agree 10 28.25

Neutral 11 16.05

Disagree 16 12.44

Strongly disagree 6 8.0

Total 4 100

At Wajir county referral hospital CMEs are normally conducted at intervals. Different topics are

discussed at different times. The audience are normally health care workers at Wajir county

referral hospital from various departments. The speakers can be experts invited or one chosen

from the hospital staff. At times staff are educated on HMIS use, its importance and impact on

provision of health care services.

31
.4.3.1 PERCEPTION OF HEALTH CARE WORKERS TOWARDS HMIS.
All the respondents are overwhelmingly satisfied with the use of HMIS at the health care

facility.one of the questions sought to find out whether staff are satisfied with the use of HMIS at

wajir county referral hospital. From the total respondents (95.24%) said yes and (4.76%) no.

The results are presented below:

perception of healthcare workers

no
5%

yes
95%

4 RESOURCE ALLOCATION TOWARDS HMIS.

One of the questions sought to find resource allocation by the hospital administration towards

HMIS. This would determine whether there is poor resource allocation by hospital management

constraining HMIS adoption. Resources are in terms of computer hardware and software,

internet, technical team for maintenance and employment of qualified personnel with skills on

HMIS (3 of the total respondents strongly agreed, (24.20%) neutral and (22.35%)

32
disagreeresourced. This implies that poor allocation towards HMIS by hospital administration

influence HMIS adoption at Wajir county referral hospital.

4.5 HOSPITAL ADMINISTRATION ON MANAGING HMIS ADOPTION.

The study sought to find out how the hospital is managing the adoption of HMIS at Wajir

County referral hospital .The purpose was to determine whether the administration is committed

on HMIS adoption and dealing with resistance to change brought by HMIS effectively. The

results are tabulated below

Experience (years) Frequency Percent

Excellent 5 11.90

Very good 20 47.62

Good 14 33.33

Fair 2 7.14

Total 42 100

33
 CHAPTER 5
5.0 INTRODUCTION
This chapter comprise of summary of the result findings, conclusions and recommendation.

5.1 SUMMARY OF THE FINDINGS

The study investigated factors influencing the adoption of HMIS among health care providers at wajir
county referral hospital. A total of 66 questionnaire were used on the respondents. Response rate by
gender majority were female (54.76%) and male at (45.24%). The overall return rate was (63.64%) which
was adequate and good for data analysis. The excellent response rate shows high level of motivation
amongst respondents to complete the survey. Also implies that effective methods were used to attain
the above response rate.

The study obtained information from respondents on their professional expertise and working
experience. This was important for effectiveness of the study as it helps to understand the level of
experience the respondents answered the questions from.

Nurses made the highest professional expertise at (28.57%). This implies that they make the highest
number of health care staff at wajir county referral hospital also they were ready and willing to
participate in the study.

A high number of respondents had a working experience of <5 years(61.90%). 6- 10 years (23.81%) and
11- 20 years ( 14.29%).This shows that wajir county referral county hospital has more staff who have a
working experience at the health care facility of less than five years.

The study findings reveal (42.86%) of respondents agreed that each department has sufficient computer
hardware with computer components at the health care facility .This implies that the hospital does not
have the required number of computers for smooth and effective adoption of health management
information system. Hardware is important for effectiveness of information system because most soft
wares are assessed from hardware. Efficient information systems is constituted of the best components
that work together to give the best outcomes.

The study revealed that (57.14%) of the respondents agreed that staff have stations with reliable
internet access. From observation wajir county referral hospital has both Wi-Fi connection and Ethernet
connections, the latter is more reliable for use at the health care facility though at times slow hindering
adoption of HMIS thus no quality assured internet at wajir county referral hospital. Fast reliable internet
connection is essential to keeping HMIS running smoothly.

The study revealed that (42.86%) strongly agree that the hospital has dedicated ICT department
(technical infrastructure).They are responsible for monitoring performance of HMIS and providing

34
assistance where needed. (57.14%) of respondents agreed that infrastructure influence HMIS adoption
at wajir county referral hospital.

Skills on HMIS does not influence HMIS adoption at wajir county hospital.(42.86%) of respondents which
was the highest disagreed that some hospital staff lacks skills on how to use HMIS. CMEs has helped
boost staff skills on HMIS.

(95.24%) of health care staff are satisfied with the use of HMIS at WCRH. Most perceive it to have
promoted work delivery and ensured quality health care services.

On resource allocation (35.71%) of the respondents strongly agreed that there is poor resource
allocation toward HMIS hindering its adoption. The study also found out that (47.62%) recommend the
administration in terms of dealing with the adoption of HMIS as very good, (33.33%) good and (11.90%)
excellent. This implies the hospital administration is dealing effectively with resistance to change
brought by HMIS effectively through various motivation and educative programs.

5.2: CONCLUSION
HMIS aim to reduce medical errors, reduce cost of health care, improve clinical processes and

generally improve the quality of health care services. Realization of the above is difficult due to

constraining factors during its adoption. Majority of respondents agreed that computer hardware

in terms of its cost of installation and maintenance which was high influence HMIS adoption at

Wajir referral county hospital. Unreliable internet access affect HMIS adoption. Management

support also in terms of resource allocation was a significant factor constraining HMIS adoption.

All this influence the aim of HMIS. Addressing constrains towards HMIS adoption effectively

will enhance provision of quality health care services to patients and HMIS achieving its aim.5.3:

35
RECOMMENDATION.
From the study findings the following recommendations are made:

i) Appropriate resource allocation towards HMIS

ii). Get more computer hardware

ii). Improving on both Wi-Fi and Ethernet connection.

36
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employee engagement and its impact on organizational effectiveness: a systematic literature

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APPENDIX I QUESTIONNAIRE
I am a student from Kabete National Polytechnic and carrying out a research on THE

ADOPTION OF HEALTH MANAGEMENT INFORMATION SYSTEM AMONGST

HEALTHCARE PROVIDERS AT WAJIR COUNTY REFERRAL HOSPITAL, WAJIR

County, Kenya. You have been identified as one of the persons to be included in the research

thus you are requested to give information as per the questionnaire. The information collected

will help to identify challenges towards HMIS adoption so as to inform necessary interventions

to ensure smooth adoption of HMIS at the health care facility. Confidentiality of all information

provided is guaranteed.

SECTION A: BACKGROUND INFORMATION

i). Gender: male [ ] Female [ ]

ii). Age: 19-25years [ ] 26-35years [ ] 36-45years [ ] 46-55 years [ ] above 55years [ ]

iii) .Profession expertise: clinical officer [ ] HRIO [ ] Nurse [ ] Lab Technician [ ] IT Staff [ ]

Pharmacist [ ]

40
iv).Years of service at the hospital: ≤ 5years [ ] 6-10 years [ ] 11- 20 years [ ] 21- 30 years 31-

40 years [ ]

SECTION B: INFRASTRUCTURAL BARRIERS

The following factors are infrastructural barriers which influence HMIS adoption, to what extent

do you agree with the following statements using a scale of 1- 5 where, 1: strongly agree 2:

Agree 3: Neutral 4: Disagree 5: Strongly disagree.I

INFRASTRUCTURAL BARRIERS 1 2 3 4 5

A. All staff have stations with reliable internet access

B.Each department has sufficient computer hardware

C. Hospital has dedicated ICT department (Technical

infrastructure)

D. Internet is important for effective use of HMIS.

E. Infrastructure influence HMIS adoption at the health care

facility.

41
SECTION C: SKILLS AND PERCEPTION TOWARDS HMIS.

To what extent do you agree with the following statements as a barrier towards HMIS adoption?

1: strongly agree 2: Agree 3: Neutral 4: Disagree 5: Strongly disagree.

SKILL 1 2 3 4 5

A. Some hospital staff lack skills on how to use HMIS

B. High cost of hiring skilled personnel influence HMIS

adoption.

C. Lack of adequate training on use of HMIS influence

its adoption.

D. Lack of knowledge on technology affect HMIS

adoption

Are you satisfied with the use of HMIS at the health care facility? Yes [ ] .No [ ] .

What is the perception of ealth care workers towards HMIS? ....................................................

............................................................................................................................................................

............................................................................................................................................................

............................................................................................................................................................

....................
42
SECTION D: HOSPITAL ADMINISTRATION

The following hospital administration activities act as a barrier towards HMIS adoption. To what

extent do you agree? Use a scale of 1-5. 1: strongly agree 2: Agree 3: Neutral 4: Disagree 5:

Strongly disagree.

Hospital administration activities 1 2 3 4 5

A. Poor resource allocation towards HMIS

B. Hospital administration is committed on HMIS use

(figure head role)

C. Hospital administration is dealing with resistance to

change brought by HMIS effectively.

How do you rate the way the hospital administration is managing the adoption of HMIS?

A .Excellent [ ] B. Very good [ ] C. Good [ ] D. Fair [ ]

43
APPENDIX II TIME FRAME

Years 2022 2023

Month Sept Oct Nov Jan-mar May -jun Nov-Dec

Problem identification

Literature review

Research methodology

Proposal submission

Data collection

Data analysis

Research project submission

44
APPENDIX III RESEARCH BUDJET

Items Cost

Proposal printing 130

Project printing 270

Binding 100

Transport 1000

Questionnaire 990

Stationery 200

Miscellaneous expense 1000

Total 3690

45