An Assessment on the Application of the Porter Diamond Model Aspects within Tuberculosis Treatment Healthcare Facilities in Nairobi County, Kenya

Abstract

Strategic management involves formulating and implementing an organization’s vision, mission, and objectives, making decisions on resource allocation, and developing appropriate strategies to achieve set goals. Contemporary strategic management theories provide frameworks and models that guide organizations in these processes. One prominent theory is the Resource-based Theory, particularly the Porter Diamond Theory, which is essential for understanding organizational dynamics, competitive strengths, and strategy development across various sectors, including healthcare. The Porter Diamond Theory posits that an entity's competitiveness is influenced by four interconnected factors: Factor Conditions: These include tangible and intangible resources relevant to the organization. Market Demand Conditions: The nature and scope of market demand that shape industry competitiveness. Related and Supporting Industries: The presence of suppliers, manufacturers, and service providers that enhance organizational capabilities. Industry Strategy, Structure, and Rivalry: The conditions within which institutions are created, organized, and managed, influencing their strategic direction and competitive behavior.
Strategic management in healthcare supports quality improvement, monitoring, and evaluation by identifying strategic advantages. It enhances leadership, streamlines management, improves decision-making, and elevates the appeal and efficacy of healthcare organizations and workers. Quality healthcare is crucial for disease prevention and improving life quality. However, strategic management practices specific to healthcare, especially for tuberculosis (TB), remain under-explored. TB is a contagious bacterial infection primarily affecting the lungs, caused by Mycobacterium tuberculosis. It spreads through airborne droplets from coughing, sneezing, or breathing, and can also impact the kidneys, spine, and brain. Symptoms include persistent cough, fever, chest pain, fatigue, night sweats, and loss of appetite. TB is one of the most common infections globally, causing significant morbidity and mortality. In 2019, the World Health Organization estimated 10 million TB cases and 1.2 million deaths. Despite global efforts, about 3.6 million people with TB are missed annually by health systems and do not receive needed care. Kenya is among the 30 high TB burden countries, facing significant challenges from multidrug-resistant TB and TB/HIV co-infection. In 2019, Kenya had over 140,000 TB cases, with Nairobi reporting the highest numbers. The Kenya Country TB prevalence report (2016) indicates that TB in the country is higher than estimated, with about half of those who fall ill annually being missed. Direct research on the application of strategic management practices for TB case finding in Kenya is limited. A study adopting a pragmatic design, which incorporates the collection and analysis of both quantitative and qualitative data, was conducted to explore this issue comprehensively. Between April and June 2024, a total of 406 respondents (81% response rate) from 239 TB treatment sites in Nairobi participated. Additionally, four Focus Group Discussions (FGDs) involving 44 respondents were conducted. The study reveals variations in strategy formulation practices across facilities, with differing frequencies of TB performance review meetings, indicating a need for standardization. Total Quality Management (TQM) faces implementation challenges, including high staff turnover, shortages, frequent staff rotations, and resource constraints like insufficient human resources and frequent stock-outs of diagnostic tools and drugs. The involvement of diverse technical teams in TB case-finding activities reflects a collaborative approach to TB control. Findings suggest a need for further investigation into factors influencing the establishment of strategic management committees and highlight areas for increased investment in infrastructure and capacity-building to enhance TB services' sustainability and effectiveness. Addressing inadequate sanitation facilities and other environmental factors is crucial for improving TB case-finding and public health outcomes. Emphasizing community awareness campaigns and enhancing demand for TB services among key population groups is essential. The Government of Kenya plays a central role in TB service supply, necessitating robust supply chain management and strategic planning to ensure consistent access to essential commodities. Tailored strategies, technological integration, and strategic partnerships are vital for enhancing TB case-finding and overall service delivery. The study reccomends to Implement a standardized schedule for TB performance review meetings across all sub-counties to ensure uniformity and consistency in TB management practices. Increase investment in staff training and retention programs to address TQM challenges and resource constraints, enhancing the effectiveness and sustainability of TB services