Thesis:

Influence of procurement practices on service delivery in selected public health facilities in Nyeri county, Kenya

Public health facilities are vital in providing healthcare services, offering essential preventive and curative care to communities. It is thus essential for these facilities to efficiently deliver services, as timely access to high-quality healthcare directly impacts public health outcomes. The effectiveness and efficiency of healthcare service delivery are largely dependent on procurement procedures. Public procurement is essential to the effective operation of government agencies, especially the healthcare industry, on a global scale. Purchasing products and services required for the functioning of healthcare facilities, such as prescription drugs, medical equipment, and other healthcare services, is known as procurement in the healthcare industry. To guarantee that healthcare providers can provide timely, high-quality care, efficient procurement procedures are crucial. Poor management, inadequate budget, and bad procurement methods are some of the issues facing the public health system in developing countries. One of the major issues is related to procurement practices, which have led to stock outs of essential medicines and equipment, resulting in delays in treatment and potentially compromising patient care. Despite these insights, there is a paucity of research specifically examining how procurement practices impact service delivery within Nyeri County's public health facilities. Therefore, this study aimed to bridge this knowledge gap by exploring how various aspects of procurement, such as ICT infrastructure, staff training, inventory management, and supplier relationship management, affect service delivery outcomes in selected public health facilities across Nyeri County. The study adopted a descriptive research design and involved 123 staff involved in procurement processes. A researcher-administered questionnaire was used to collect data. Data was coded, cleaned and analyzed using SPSS software version 29 software. Descriptive and inferential analyses, including chi-square tests and logistic regression, were conducted to determine associations between procurement practices and service delivery. The results revealed that ICT availability, staff training, inventory management, supplier relationships, and working duration were significantly associated with service delivery. Facilities with adequate ICT infrastructure were 4.9 times more likely to have good service delivery (AOR = 4.870; CI, 0.859-7.614; P-value = 0.044). Adequate staff training was also a significant determinant, with well-trained staff being 3.2 times more likely to contribute to improved service delivery (AOR = 3.227; CI, 0.576-8.086; Pvalue = 0.033). Additionally, effective inventory management enhanced service delivery, with well-managed facilities being 7.1 times more likely to perform better (AOR = 7.062; CI, 1.741-18.649; P-value = 0.006). A strong supplier relationship was also positively associated with service delivery, with facilities reporting good supplier relationships being 6.1 times more likely to deliver better services (AOR = 6.079; CI, 1.644-12.477; P-value = 0.007). Furthermore, working duration was a key demographic factor, as staff with 5–10 years of experience were less likely to experience poor service delivery compared to those with more than 10 years of experience (AOR = 0.107; CI, 0.026-0.449; P-value = 0.002). The study concludes that procurement practices significantly influence service delivery in public health facilities. Strengthening ICT infrastructure, enhancing staff training, improving inventory management, fostering strong supplier relationships, and optimizing staffing experience can enhance procurement efficiency and service provision. The study recommends increased investment in ICT systems, regular procurement training, and improved supplier engagement strategies to enhance service delivery in public health facilities.