Andrew YitambeGoretti OfafaKiura, Daniel Munyi2021-10-152021-10-152020http://ir-library.ku.ac.ke/handle/123456789/22780A Research Thesis Submitted in Fulfillment of the Requirements for the Award of the Degree of Master of Science (Health Management) in the School of Public Health and Applied Human Sciences of Kenyatta University, April 2020.Human Resources for Health is a key pillar of healthcare provision necessitating prudent staffing norms to meet workload demands of health facilities. Uniform staffing norms across health systems based solely on policy guidelines can no longer be used at facility level without adjusting for facility specific trends of workload determinants such as occupancy the omission of which results in poor outcomes or wasted resources due to inadequate staffing mix. The study utilized a cross sectional design & sought to confirm or disapprove the correlation between bed occupancy and patient care activity time with clinician workload at paediatric wards of selected public & private hospitals in Nairobi County, Kenya and drive for determinant informed application of staffing norms in the different settings of the health sector. A validated staffing standardization model was used to estimate Clinician Workload. The different types of activities that clinicians carry out in their daily work were determined through key informant interviews. Results of the interviews helped design a work sampling data collection tool through which observations were made on the frequency of patient care activities carried out by the clinicians and thus established activity times. Activity time data collected from the survey was analyzed using Statistical Package for Social Sciences (SPSS) version 22 and factored into the validated model so as to derive workload and the corresponding clinician staffing level. Multivariate linear regression analysis was used to correlate the various independent variables and clinician workload followed by test of significance for each variable. A sample of 6188 observations were made among 115 clinicians with a distribution of 4,890 (79.0 %) observations for direct patient care activities, 771(12.5 %) observations for indirect patient care activities and 527(8.5%) observations on allowance activities. Differences were observed between public & private facilities in average bed occupancy (2= -0.505, df= 53, p = 0.000) and proportion of time spent by clinicians in direct patient care activities (2= -10.995, df=53 p = < 0.05) but no significant difference in workload required (t=- 1.415, df=53, p= 0.163). There was varied but significant correlation between various variables and workload including direct patient activities (r=.743, P< .000), indirect patient activities (r=-.311, P< .021) and bed occupancy (r=.314, P< .020). The study concluded that workload increases by one unit with every 8.8% change in direct patient care activities volume, every 5% change in indirect patient care activities and 14.3% change in bed occupancy with the three factors accounting for 54.4%, 9.7%, and 9.8% of the determinants of workload respectively. Multivariate regression of the combined factors of patient care activities, allowance activity, ward occupancy and facility owner found these factors to account for 85.9% of the variation in clinician workload (p-value <0.001). The study recommends that the magnitude of direct patient care activities should be considered when determining clinician workload, that strategies of reducing the effect of indirect patient care activities on clinician workload should be devised and that bed occupancy trends should be studied and factored into workload determination derivation of staffing norms.enClinician Workload DeterminantsPaediatric WardsPrivate hospitalsPublic hospitalsThesis