| Resource scarcity (commodity stock-outs, breakdown or lack of fuel in ambulances) |
Borrowing drugs from other facilities and obtaining credit from suppliers. PHC facility managers also had a WhatsApp group where they shared information about drug availability. The hospital pharmacy kept buffer stock that PHC facilities could borrow and, when exhausted, the PHC facilities borrowed from each other Seeking credit from suppliers
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Spending at source: This entails spending small amounts of money from hospital collections before banking. This contravenes the law requiring that all collected user fees are banked before spending. Managers keep a record of what the money has been spent on for accounting and audit purposes Re-introduction of user fees in peripheral facilities
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Drafting of the FIF bill, which became law in 2016. The bill seeks to restore some autonomy to hospitals by providing a mechanism for the management of hospital funds. New structures were set up, e.g. hospital boards, a county board, collecting accounts for all the hospitals |
Borrowing, re-introduction of user fees and spending at source enabled service delivery to continue especially in emergency situations Inherent risks of abuse, legal and reputational consequences for the hospitals (spending at source) Re-introduction of user fees may have reduced access to care for poor patients
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| Resource scarcity-understaffing |
Reorganization of staff shifts and work allocation:
Recalling staff from annual leave Staff were transferred from existing departments to other newly opened departments to deal with understaffing. This response was met with resistance by the nursing staff who felt overburdened by having few staff already. The HMT listened to the grievances of the staff but urged them to continue working as the managers made efforts to have more staff employed
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Employment of staff on contract basis following requests, meetings and lobbying by hospital managers and representatives of a community organization that was concerned about poor service delivery in Hospital C Task shifting non-technical duties to support staff Extending work hours to include weekends and late evenings Merging departments so that fewer doctors can see more clients across different departments
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Reorganization without increasing HCW numbers risked fatigue and burnout among HCWs due to high workload, extended work hours, which could undermine the quality of care offered Employment on contract basis eased workload of existing staff and helped to continue service delivery
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| HR management challenges—lack of induction that managers perceived to contribute to staff discipline issues, such as lateness, absenteeism |
Hospital C HMT invited senior managers from the county level to participate in a staff meeting regarding staff discipline (lateness, absenteeism) and expectations of an employee. This was after the EEC had held frequent meetings with staff from various departments and felt that they needed the support of the CHMT Hospital C HMT made copies of the COR for staff to read. These copies were shared with the various hospital departments for staff to read, to serve as reference material that could guide staff behaviour
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The HMT agreed informally that all its members would be expected to correct staff misconduct rather than waiting for the direct cadre manager of the affected staff to handle the issue. This was aimed at ensuring staff behaviour did not affect patient care negatively |
Set-up of HR advisory committee to advise on promotion and training needs. The committee meets yearly to identify staff eligible for promotions and then forwards their names to the HR advisory committee at county level. During the 5-month-long nurses’ strike, promotions for staff were fast-tracked and completed in the early weeks of the strike |
Getting the support of the CHMT empowered the HMT and reinforced the norms of the organization and was useful for organization strengthening at facility level as it streamlined organizational behaviour by providing boundaries within the COR. The COR could also be used to support facilitative leadership and management Organizational strengthening resulting from shared collective duty by HMT for upholding organization norms Introduction of the HR committee changed processes and helped to break down organizational barriers that slowed down HR processes
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