Assessment of the Influence of Citizen Service Charter on Health Service Delivery at Mbagathi Hospital

Abstract

The problem of ineffective service delivery in public hospitals remains a persistent challenge. The main objective of the study was to assess the citizen service charter and its implications for health service delivery in Mbagathi Hospital. Specifically, the study sought to assess the influence of service standards on health service delivery, to determine the influence of procedural clarity on health service delivery, to examine the influence of grievance redressal mechanisms on health service delivery at Mbagathi Hospital and to assess the influence of patients’ awareness of rights and responsibilities on health service delivery at Mbagathi Hospital. The study was guided by new public management (NPM) theory and public service motivation theory (PSMT). The study adopted a descriptive research design. The study site was Mbagathi Hospital. The study targeted 1208 daily outpatients at Mbagathi Hospital from whom data were collected using questionnaires and 19 key informants including hospital management staff for interviews. Hence, the sampling frame was 1227, which included both outpatients and hospital management staff. From the sampling frame, the sample size of 189 was selected using both the stratified proportionate random sampling method and purposive sampling. Primary data were obtained using respondent-administered 5-point Likert scale questionnaires and an interview guide. The pilot study was conducted in Mama Lucy Kibaki Hospital to assess the reliability and validity of the research tools. The questionnaires were administered to the outpatients in Mbagathi Hospital. The researcher used a drop-and-pick-up later approach for distributing the questionnaires. The researcher conducted key informant interviews with the help of trained research assistants. The researcher observed different legal and ethical considerations when conducting the study including obtaining informed consent from every participant before the collection of data and informing the participants that they retained the right to rescind participation in the process of data collection. Qualitative data from the open-ended questions and interviews were analyzed through content analysis. Quantitative data were analyzed through descriptive statistics: frequency, percentage, mean and standard deviation. Presentation of the findings was in the form of tables and figures like pie charts and bar graphs. The study established that the R2 was 0.733, which implies that 73.3% of the variations in health service delivery could be explained by service standards, procedural clarity, grievance redressal mechanisms, patients’ awareness of rights and responsibilities in the citizen service charter. Findings showed that service standards (β=0.764; p=0.001), procedural clarity (β=0.643; p=0.000), grievance redressal mechanisms (β=0.712; p=0.011), and patients’ awareness of rights and responsibilities (β=0.558; p=0.000) had a significant influence on health service delivery in Mbagathi Hospital. From the interviews, the study established that the citizen service charter is implemented by ensuring it is accessible to everyone within the hospital. This is done by displaying it in key areas such as reception desks, waiting bays and outpatient departments where patients can easily access information. The study concluded that the citizen service charter significantly influenced the health service delivery in Mbagathi Hospital. The study recommended that management in Mbagathi Hospital should strengthen operational efficiency by introducing clear internal performance targets aligned with the charter.