Influence of Hospital Ownership and Governance structure on Maternal Delivery Services
Year: 2018
Type: dissertation
Study design: Observational Study
Abstract: Background: In Kenya, hospitals are registered by ownership, not by \nfunction making it difficult to assess their performance. Governance theories, \nagency, stewardship and resource dependency have been used to suggest \nideal governance structures for the health sector. Hospitals are critical in \nproviding maternal delivery services, yet how their ownership and governance \nstructures are associated with hospital performance measured by effectiveness \nand equity has been theorized but not examined through a study. \nObjective: The study sought to explore the relationship between \nownership, hospital governance and maternal delivery service outcomes \n(MDS). \nMethodology: A cross sectional, mixed methods study of six primary \nreferral hospitals, differentiated by ownership, was conducted from 10th June \nto 9th October 2015. Six key informant interviews, 40 questionnaire interviews \nwere held with hospital in-charges, board members and management to \ndetermine the governance structure and processes. Hospital and patient data \nabstraction relating to maternal delivery services (MDS) was done to determine \nhospital performance in two dimensions: Effectiveness was measured by \nperinatal and maternal mortality; Equity was measured by the caesarean \nsection rate and payment for services. Qualitative data was analyzed \nthematically. Tests of associations were used to correlate governance and \nhospital performance. \nResults: From the three ownership types, two governance types \nlabelled, public and corporate, were identified. Public governance hospitals had \nlarge boards (>8 members), diverse membership with no fiduciary \nresponsibilities. Corporate governance hospitals had smaller boards (<8 \nmembers) with fiduciary responsibilities. Public governance hospitals were less \neffective with perinatal mortality 2.5 times that of corporate hospitals (31 vs 12 \nper 1,000 births). Having at least 40% of board members registered with the \nMedical Practioners & Dentist Board was associated with reduced perinatal \nmortality (P<0.001,OR= 3.08 95%CI: 2.6879-3.5362). However, in terms of \nequity the picture was mixed, a caesarean section was 1.45 times more likely \nto occur in a corporate hospital (P<0.001 95% CI: 1.3729-1.5410); however, \nthey also charged an average of Kshs 30,818 per delivery (US$304), while \npublic governance hospitals were free. \nConclusions and Recommendations: Governance structure is \nassociated with hospital performance as measured by MDS outcomes of \nperinatal mortality. This study provides a new perspective on measuring \nhospital performance (perinatal mortality), in relation to organizational \ngovernance. No single theory alone explains hospital governance, however \nstewardship theory best describes the best performing hospitals. This study \nprovides a fresh approach to implementing governance theories and therefore \nimproving accountability of hospitals.
Author: Richard Ayah
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2929344261