According to World Health Organization (WHO), a vast majority of people in Africa and Asia rely on herbal medicine for their primary health care needs. The concomitant use of traditional and biomedical systems of care is common in both rural and urban areas in Africa. Use of herbal medicine and traditional systems of care by expectant mothers as well as lack of disclosure to healthcare practitioner has an influence on both health-seeking behavior and outcomes of care. The broad objective of this study was to assess the utilization of herbal medicine among women in Embu Provincial General Hospital .The specific objectives of the study were: a) to determine the prevalence of use of herbal medicine in the study group, b) to determine the socio-demographic factors associated with herbal medicine use in the study group, and c) assess health-seeking behaviour, disclosure to healthcare practitioner and perception of safety and efficacy among users and non-users. It was a cross-sectional survey of 165 randomly selected women. Data was collected using a semi-structured questionnaire administered by an interviewer or self-administered in presence of interviewer. Quantitative data was entered into SPSS version 16.0 and analyzed descriptively (means and frequencies). Chi-square test was used to compare differences between categorical variables at 0.05significance level. Multiple logistic regression models were used to analyze for joint effect of more than one independent variable. The prevalence of herbal medicines use during pregnancy, labour and post-partum period among women attending antenatal clinic at Embu Provincial General Hospital (PGH) was high (70%).Age, distance to the nearest health facility, employment status and number of children were found to be significantly associated with use of herbal medicine. The use of herbal supplements in pregnancy is likely to be relatively high in pregnant Kenyan women and it is important to ascertain which supplements (if any) women are taking. Pregnancy care providers should be aware of the common herbal supplements used by women and of the evidence regarding potential benefits or harm. It is essential that health care personnel teach their patients about possible interactions between herbs and prescription or over-the counter medications.

Strategy implementation is often called the action phase of the strategic management process which is the most challenging. Executing the strategy is a difficult and more consuming management challenge than crafting the strategy because of the wide array of managerial activities that have to be attended to. The demanding peoplemanagement skills required, initiatives that need to be launched and moving, the bedevilling issues that need to be worked out, the resistance to change and the difficulties of integrating the efforts of work groups into functioning whole. For effective implementation of strategy an organization must achieve congruency between structure, leadership, culture and the capability of the organization. This study focused on strategy implementation challenges and measures used to address the challenges at Jaramogi Oginga Odinga Teaching and Referral Hospital. To achieve these objectives a case study was carried out to gain an in-depth understanding of the challenges. Both primary and secondary data were used. Primary data was collected using a self-administered interview guide while the secondary data was collected from organizations documents such as annual reports, website and the strategic plan document. A Total of eight respondents were interviewed by use of an interview guide. The respondents included the senior, middle and lower level managers. Content analysis was used to analyse the data after it was checked for consistency and then coded. There was an alignment between the research findings and the literature review carried out. The major challenges as revealed in the study highlighted inadequate resources which made it difficult for the organization to execute the strategies, employee commitment to strategy that was limited to implementation of specific activities in the operational plan, the policies and procedures practiced and resistance from the staff. The researcher recommends that a similar study be carried out on organizations that are of the same size and operate in areas of intervention that are close to JOOTRH so as to establish if the challenges of strategy implementation encountered are similar to those of JOOTRH or unique. There is need to examine how the process can impact on institutional commitment, narrow organizational vision, discourage change, and breed an atmosphere of politics. Also the ever increasing importance of knowledge and the general recognition of knowledge as the strategic asset in most organizations .Most institutional strategies are time bound thus organizational discontinuity and easily are predicted and these strategies are developed by external strategist who is most at times detached from the operations of the organization. These two strategic planning practices may result to effective strategy implementations.

The energy sector is one of the most important, requiring a substantive shift in energy production from fossil fuels into renewable energy (RE). The increasing global and local impact induced by fossil fuels has instigated policy and technical support towards the use of RE technologies as an alternative to reduce the threats (IPCC, 2007). Drastic changes are happening and the commercial viability of RE technologies is currently at a turning point; they are fast becoming attractive due to various environmental, social and economic reasons. Despite the importance of renewable energy there is dearth empirical evidence on the factors that influence the implementation of renewable energy development projects in Kenya. A descriptive survey research design was used to obtain data. The target population of this study was the top, middle and lower management staff of KenGen. Stratified random sampling was used to pick 30% of the target population. The sample size for the study included 72 respondents. The researcher used primary and secondary sources of data for this study. The primary data was obtained from the respondents through a structured questionnaire comprising of closed and open-ended questions. Descriptive statistics was used to analyze the data. The study concludes that KenGen’s organization culture supports implementation of renewable energy development projects. The study further concludes that KenGen is striving to bring about change in its operations. It can further be concluded that KenGen finances renewable projects by use of equity and debt. The Stakeholders involvement influences the implementation of renewable energy development projects as depicted by the study. The study further concluded that KenGen has innovative edge on renewable energy as it allocates intensive resource on technology development. The study finally concludes that the cost of renewable energy in KenGen has drastically reduced because of technological advancement in efficiency under mass production. The study recommends timely release of funds as a way to ensure completion of projects within the stipulated time. The study further recommends use of asset backed securities to raise funds such as the use of steam as collateral to raise capital from the market. The study further recommends use of high level technological improvements in mega projects so as to make use of various sources to generate electricity from hydro, geothermal and wind. This can be achieved by raising financial resources from local and external sources geared towards geothermal, solar and wind. Also implement projects that are geared towards renewable energy. Further recommendation would be to invest in R&D for renewable energy studies by partnering with global institutions that design, manufacture and trade in renewable energy plants globally.

Outsourcing is the practice of hiring outside professional services to meet in-house needs of an organization. Outsourcing by a firm may be either tactical or strategic. Outsourcing is considered tactical when it is implemented in order to solve specific problems being experienced by the firm. Strategic outsourcing on the other hand is concerned with building long term value for the firm through long term relationships. The firm seeking to outsource works with best in class service providers whom it integrates into its operations. The outsourcing firm considers the vendors offering services as business partners and the emphasis is on mutual benefit. The purpose of this project is to establish the factors that influenced Airtel Kenya’s decision to outsource some of its functions to external vendors, to establish what process was followed and to also establish the effects of strategic outsourcing on the business of Airtel Kenya. The research design was that of a case study and senior members of the Airtel Kenya, Executive Committee were interviewed. The decision to outsource at Airtel Kenya was largely driven by the parent company Bharti Airtel of India which had extensive outsourcing experience in India. However, forces in the macro environment and the competitive environment provided justification for the implementation of the decision. Because of the top down nature of the decision, formal steps necessary to evaluate whether outsourcing was needed by the Company were omitted. The local teams were also not given adequate time to prepare for the transition to the outsource partners. As a result the implementation faced a number of challenges which could have been avoided by ownership of the process by local teams and providing adequate time to plan for the outsourcing. The study found that the Company nonetheless, experienced a raft of benefits such as the ability to focus on the core business of the Company and become more customer-centric; the Company gained access to superior services of the vendors; gained efficiency; helped the company to manage the vendors’ ability to constrain the company’s profitability; enabled the company to manage technological risks; attain cost control; attain standardization across many related operations and to a limited extent save costs. The study findings recommend that the success of strategic outsourcing is dependent on governance structures in place to manage the vendors output. Water tight contracts are needed to manage the roles and responsibilities of the company and the vendor and provide for consequence management. Adequate time also needs to be given to the senior management of the Company for them to transition the services to the outsource vendor as well as manage the impact of the transition on staff. The study was limited by the unavailability of financial and transactional cost information by reason of confidentiality. As a result the study does not establish the actual cost benefit of outsourcing that the company attained or hoped to attain or how outsourcing contributed to the financial performance of the company. The study suggests that further studies should be carried out to determine how widespread is the practice of outsourcing in Kenya and what is the effect of outsourcing on the Kenyan economy? Such further studies would help the government develop appropriate policies on outsourcing.

The drug supply system to health institutions especially the Public Health Institutions in Kenya has for a long time been characterized by many pitfalls. Rational use of medicines requires that a patient receives appropriate medications to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them. A previous study on drug use in Public Health facilities in Kenya was conducted by Health Action International Africa in collaboration with the World Health Organization in April 2003. The baseline survey was conducted in Nairobi, Eastern, Nyanza, Rift Valley and Coast provinces and it was found out that the availability of essential medicines in Public Health facilities was 90%. The survey also established that there was a general tendency to over prescribe antibiotics with 78% of patients receiving antibiotic prescriptions, irrational dispensing was found at 70% of Public Health Institutions. The survey however was not conducted in Central Province and did not evaluate private health facilities, an important component of health care delivery in Kenya. The objectives of the study were to establish the pharmaceutical prescribing practices, patient care factors and health facility factors that affect drug use in Health Facilities and how these factors compare between Public and Private Health Facilities. The study was conducted as a cross sectional survey consisting of 1260 respondents within 42 Health Facilities in Thika District. The sample consisted of 25 Public Health Facilities with 750 respondents and 17 Private Healthcare Facilities with 510 respondents. The data was collected on the three key indicators of rational drug use as provided by the World Health Organization namely prescribing factors, patient care factors and health facility factors. The data collected was analyzed using Statistical Package for Social Sciences. The results on prescribing indicators showed that Private Health Facilities prescribe on average 3.10 drugs compared to Public Facilities which prescribe an average of 2.83. The Public Facilities had on average 77.16% of all prescriptions with an antibiotic prescribed compared to Private Facilities which had an average of 62.44% of antibiotics prescribed. The results showed that antibiotic use in Kenya is higher than in other countries which is a source of concern due to the associated risk of higher antibiotic resistance when antibiotics are over prescribed. The results on patient care factors indicated that the average consultation time in Public Health Facilities 8.10 minutes while the average consultation time in Private Health Facilities was 8.4 minutes. The results on patient care factors indicate that both the consultation time and dispensing time in Kenya is longer than in other countries signifying more personalized attention to patients by the Kenyan clinicians. The average dispensing time in Public Health Facilities was 118.32 seconds while the average dispensing time in Private Health Facilities was 225.82 seconds. The results on Health Facility factors showed that the average cost per prescription was ksh 228.26 in Public Health Facilities while in Private Health Facilities it was ksh 476.32 indicating that Public Health Facilities prescribed cheaper drugs. It was concluded from the study that in order to improve drug use in the health sector, a countrywide study should be conducted in order to establish drug use information where data is unavailable. The results from the study are important to the Ministry of Health in drug use strategy formulation, the county of Kiambu in developing the Kiambu County Health Plan, medical insurance companies in computing insurance premiums based on the average cost of a prescription of drugs and other stakeholders in the Healthcare Sector.

Problem statement: Induction of labor has been associated with poor maternal and perinatal outcomes compared with spontaneous labor (Guerra et al, 2009). Despite this, studies show that it is the fastest growing medical procedure. Up to 25% of all deliveries at term are conducted through induction of labor (WHO, 2011) Purpose of the study: The main purpose of the study was to determine the outcome of induction of labor in women who delivered through induction of labor, taking into consideration the demographic factors, social-economic factors, institutional factors and health indication for induction. Study design: This was a cross- sectional institutional based study to determine the outcome of induction of labor in women at Kenyatta National Hospital. Social, demographic, health and institutional related factors were explored. Population and sample: The study population consisted of women admitted to postnatal wards at Kenyatta National Hospital after delivery through induction of labor. A systematic sampling procedure was used to select 42 study participants. Data collection: A structured pretested questionnaire was used to collect quantitative data and key informant interview guide for qualitative data. Data analysis: Collected data was analyzed using the SPSS for quantitative data and Nvivo for qualitative data. Findings: In this study it was found that the outcome of induction of labor is influenced by age, parity, gestation, type of employment and women being given information on the nature of the procedure. It was also found that parity is significant in determining the time taken between induction and delivery. The most common indication for induction was post-term and pre-eclampsia. It was established that pain management and client information on the procedure were wanting. It was established that the rate of caesarean section after induction of labor was more than six times (38%) the rate in the country (6%). Majority of the women took more than 24 hours to deliver after induction of labor. There were minor maternal complications following induction of labor during the study but 19.5% babies developed complications that influenced the attitude of the mothers toward induction. Recommendations: The department of reproductive health should strive to reduce the rate of caesarean (38%), time taken between induction of labor and delivery and neonatal complications. The doctors and nurses should perform pain management interventions during induction of labor. Health workers should also improve on client involvement during induction of labor. Benefits of findings: The findings may be used by the hospital to evaluate the protocols on induction of labor. It also contributes to the body of knowledge on induction of labor and can be utilized by other researchers.

Job satisfaction is an important determinant of the level of organizational commitment that is exhibited by employees in a particular organization. The purpose of this study was to establish the perceived relationship between job satisfaction and organizational commitment among community based organizations in Mathare constituency in Nairobi Kenya. The study took the form of a descriptive cross sectional survey of community based organizations in Mathare constituency. The population of the study included all the community based organizations operating in Mathare constituency. The sample size involved 110 respondents. Primary data was collected for the study from employees of 24 CBOs through questionnaire in form of job satisfaction index and organizational commitment. The data collected was analyzed using descriptive statistics. The findings reveal that there is low perceived job satisfaction among the employees of community based organizations operating in Mathare constituency in Nairobi. This manifests itself in form of unfair pay for work done, inequitable distribution of duties and responsibilities, subjective judgments from supervisors, lack of fair rules to guide operations and lack of recognition when one performs better. Employees who are not satisfied with their jobs have low organizational commitment as they are more likely to leave the organization any time an opportunity arises. They also don’t have any attachment with the organization since they do not feel as part of the organization. Low job satisfaction leads to low organizational commitment. The study recommends that the community based organizations should establish ways of improving job satisfaction among their employees in order to enhance organizational commitment.

Horizontal violence is a real entity within the health care facilities. The objective of this study was to explore prevalence and factors contributing to violence among nurses at their place of work and the effect violence had on their interrelationship and performance in provision of maternal-child and family planning services in the health facilities that directly serve their surrounding communities. The study design was a cross-sectional descriptive study of nurses working in health facilities with Maternal-Child Health and Family Planning (MCH/FP) clinics of Nairobi City County. Seven health centres that had MCH/FP and cervical cancer screening clinics were chosen for the study. The sampling frame comprised a comprehensive itemized list of all nurses in the fourteen health facilities with MCH/FP and cervical cancer screening clinics. Simple random sampling method was used to come up with seven health facilities with MCH/FP clinics. A sample of 170 participants was recruited for the study out of a calculated sample of 187. Quantitative data was collected using a self-administered structured questionnaire and an observational checklist. Each nurse included in study sample filled a questionnaire. SPSS version 17.0 was used to analyse quantitative data. Inferential statistics using Chi-square, and correlation were used to determine the relationship between the dependent variables and the independent variables. Results and findings of the study indicated that 77.6% (n=132) of the participants reported experiencing many of the negative behaviors associated with horizontal violence and 22.4% (n=38) of the participants had not experienced horizontal violence in last twelve months preceding this study. The prevalence of horizontal violence among the participants was 36.2% or 362 nurses per 1000. The following horizontal violence behaviors were experienced by participants: gossiped (51.8%), shouted at (34%), humiliated (30%), intimidated (24.7%), threatened (20%), excessively criticized (19%) and sexually harassed (4%). The study findings indicated that there were statistically significant differences between age of the participants and humiliation, p=0.005; work experience of the participants and humiliation, p=0.039; professional qualification and threat experience, p=0.031; and professional qualification and intimidation, p=0.034. There were no statistically significant differences between the demographic profiles of the participants and the following horizontal violence behaviors: gossiping, shouting, excessive criticisms, and sexual harassment. The study findings revealed that nonphysical violence was very high among nurses accounting for 76%. Of the non-physical violence gossiping was the most experienced among nurses in the workplace. However, there was no statistically significant difference between horizontal violence behavior of gossiping and demographic profiles of the participants such gender, age, work experience and professional qualification. The findings demonstrate that horizontal violence occurs and that nurses were victims of violence and some nurses were perpetrators of violence amongst themselves as well. The findings are expected to assist policy makers, managers, and nurses on how to intervene in order to control workplace violence among nurses.

This study sought to investigate the effect of national grid connection to the SMEs in Mbita town. Findings from various studies have indicated that many SMEs have embraced various strategies in their effort to improve productivity but the source of power to run modern machinery remains a challenge, resulting in well-formulated SMEs that fail at the effort of trying to expand or add value to their existing products and services. This study departed from the previous studies looking into several causes of rural underdevelopment but instead endeavoured to establish the impact that connection to the national grid had on the SMEs. To achieve the main objective, a descriptive survey of SMEs in Mbita town conducted from a population frame of 280 businesses operating in and around Mbita town. The target population was all the SMEs in town plus its environment. Statistical inferences using correlation and regression analysis indicated that a high reliability was achieved by the data collection instrument. Both tests of correlation using asymptotic significance indicated a strong relationship between connection to the national grid and value addition services in the town. The study recommends that the government in concert with electricity service providers to reduce installation costs as well as introduce subsidies to help more SMEs connect to the national grid. Awareness campaigns were also recommended on the advocacy to help more people connect to the national grid. This enabled a conclusion to be made that connection to the national grid was the motivation for value addition services as well as expansion of SMEs in Mbita town.

Green manufacturing has emerged as a key approach for manufacturing firms seeking to become environmentally sustainable and globally competitive. As a developing country, Kenya has to balance both operational and environmental performance. The objective of this study was to determine the extent of Green Manufacturing Practices' adoption by food processing firms in Mombasa County, Kenya. A descriptive research design was adopted for this study. It targeted a population of food processing firms in Mombasa County listed by Kenya Association of Manufacturers (KAM). A sample of 66 firms was taken. The data was collected using questionnaires. The results obtained indicated that green manufacturing practices adoption was at implementation stage as most food processing had considered adoption. The study also established that the major perceived benefits of adopting green manufacturing are; reduction of waste water, reduction of frequency of environmental accidents and reduction in scrap rate. Lastly, the major factors influencing adoption of green manufacturing were found to be; organization capabilities and awareness, desire for economic benefit, government rules and legislation, and high waste generation. The study recommends that the management in food processing firms should focus and allocate more resources towards pollution prevention practices than pollution control practices, as these results in greater product innovation and thus higher firm performance. They should also strive at achieving green manufacturing through remanufacturing and substitution, this will enhance efficiency and synergy in the industry, environment performance and reduce waste to achieve cost savings. Finally, the managers should act fast and implement green manufacturing practices since there are potential benefits which will result in sales growth.