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FACTORS INFLUENCING PROJECT PERFORMANCE IN RURAL HEALTH
DEVELOPMENT PROJECTS: A CASE OF MIGORI COUNTY
BY MICHAEL MWITA ATANASI
PPM/44/12
A RESEARCH PROJECT SUBMITTED TO THE UNIVERSITY IN PARTIAL
FULLFILLMENT FOR THE REQUIREMENTS OF A DEGREE IN BARCHELOR OF
PROJECT PLANNING AND MANAGEMENT IN MOI UNIVERSITY
2015
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DECLARATION
DECLARATION BY STUDENT
I hereby declare that this is my original work and has not been submitted to any institution for
award of a degree.
NAME: MICHAEL A MWITA
REG NO: PPM/44/12
SIGN:
DATE:
DELARATION BY THE SUPERVISOR
This research project has been submitted for an examination with my approval as university
supervisor.
NAME: MR. JEREMIAH OJUKI
SIGN:
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DEDICATION
I dedicate this project to my family, Moi University and all the people who helped do the project
by giving me support and easy working time. I appreciate all for being supportive throughout the
period of the study.
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ACKNOWLEDGEMENT
Special thanks to my supervisor Mr. Jeremiah Ojuki. The support and guidance provided helped
me in writing this proposal. I also thank my supervisor for the patience and understanding
throughout this work. Also thanks to my friends and classmates for taking time to read through
my work and all the support. I cannot forget the support from my family for patience and support
during the entire course.
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ABSTRACT
Rural health development projects face various challenges in their implementation and their
service delivery. The purpose of this study is to determine the factors affecting service delivery
in rural health development projects. This study will be carried out in Migori County. To achieve
this objective, the study will adopt the following specific research objectives towards the study
purpose: establishing the main contributors of project performance on rural health development
projects in Migori County; finding out community participation or involvement in rural health
development projects in Migori county and investigating if resource allocation plays a part in
success or failure of rural health development projects in Migori county. This study was limited
to one County-the County of Migori and as such, the findings may not apply to other Counties
in Kenya because of the uniqueness of the County as well as its projects and project duration.
The study will adopt a descriptive research design which, according to Cooper and Schindler
(2003), a descriptive study is concerned with finding out the what, where and how of a
phenomenon. A sample size of 30 respondents from the rural development board, heads of
public health centers and citizens of Migori County will be used. Stratified sampling techniques
will be used to obtain the sample size of 30 respondents from 100 people. The main data
collection instruments will be questionnaires and interviews. The study aims to collect data using
the instruments and the data that will be obtained will be presented in tables, graphs and pie
charts and the final data will be analyzed using the SPSS statistical package. This study will be
of importance to several stakeholders including the Government of Kenya, the County
Government of Migori, project managers, the management and staff of the rural health projects
as well as the community.
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LIST OF ABBREVIATIONS
ADB-African development Bank
ADF-African development fund
OPEC-Organization of petroleum exporting countries
GOK-Government of Kenya
FBO- Faith-based organization,
NGO- Non-governmental organization
IMR-Immortality rate
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Contents
DECLARATION .................................................................................................................................... i
DEDICATION..................................................................................................................................... iii
ACKNOWLEDGEMENT........................................................................................................................iv
ABSTRACT..........................................................................................................................................v
LIST OF ABBREVIATIONS.....................................................................................................................vi
CHAPTER ONE....................................................................................................................................1
1.0 Introduction............................................................................................................................1
1.1 Background.............................................................................................................................1
1.2 Statement of the problem........................................................................................................2
1.3 Objectives of the study ............................................................................................................3
1.3.1 General objective ...................................................................................................................3
1.3.2 Specific objectives ..................................................................................................................3
1.4 Research questions..................................................................................................................4
1.5 Significance /Justification of the Study......................................................................................4
1.6 Limitations of the Study.................................................................................................................5
1.7 Scope of the Study ........................................................................................................................5
CHAPTER TWO ...................................................................................................................................6
LITEREATURE REVIEW.........................................................................................................................6
2.1 Introduction..................................................................................................................................6
2.2 Empirical study .............................................................................................................................6
2.2.1 Rehabilitation of Rural Health Projects.....................................................................................6
2.2.2 Factors that play roles in performance of rural health projects..................................................8
2.2.3 Health worker shortage ..........................................................................................................9
2.2.4 Health worker motivation.......................................................................................................9
2.2.4 Competence of the Implementation Team and Performance of rural health projects ...............10
2.2.5 Availability of Human Resources and Performance of rural health projects..............................12
2.2.6 Commitment by Political Leaders and Performance of community development projects.........13
2.2.7 Leadership Capabilities and Project Planning..........................................................................14
2.3 Critical Review of major issue ......................................................................................................16
2.4 Summary and gaps to be filled by the study..............................................................................16
2.5 Theoretical Framework................................................................................................................16
2.5.1 Stakeholder Theory ..............................................................................................................16
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2.6 Conceptual Frame Work..............................................................................................................19
CHAPTER THREE ...............................................................................................................................19
3.0 Introduction................................................................................................................................20
3.1 Research Design..........................................................................................................................20
3.2 Population of the study...............................................................................................................20
3.3 Sampling Design..........................................................................................................................21
3.3.1 Sampling Technique .................................................................................................................21
3.4 Data Collection Tools andProcedures...........................................................................................21
3.6 Validity and Reliability of Research Instruments............................................................................22
3.6.1: Validity...................................................................................................................................22
3.6.2: Reliability................................................................................................................................22
3.7 Ethical Considerations.................................................................................................................23
Appendix: Research Questionnaire ................................................................................................27
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CHAPTER ONE
1.0 Introduction
This chapter presents background information on subject of research and covers statement of the
problem, research objectives, research questions, and significance of the study. The chapter also
covers other sections including limitations and delimitations of the study and the scope. In the
background of the study the study reviews the key concepts and how they relate to one another.
1.1 Background
Within 20 years of Kenya’s independence, Kenya had grown in the health sector with a sizeable
rate, and at the founding of the ADF assisted rural health project, between 1982-1985, there were
about 1200 rural health facilities in Kenya. After the government of Kenya started the primary
health care system, for the success of the project there was a necessity for existence of the rural
health development projects .The government then received funding and loans from OPEC to
fund the rural health projects (African development bank, 2007). Implementation of the projects
however faced many constraints and challenges including lack of qualified management and
inadequate manpower.
As part of its all-inclusive approach, this project incorporated participatory methodologies into
its design to ensure that communities developed a sense of awareness of health issues and
ownership of health services to facilitate the government’s initiative of decentralization of health
services based on a progressive community based health care agenda (Africa Development Fund,
2008). According to Kenya Vision 2030, the greatest challenges facing the health sector in
Kenya are; inadequate funding to support planned rehabilitations of health facilities, limited
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capacity in procurement building and supervision, inefficient supply chain management system,
matching supply of skilled human resources with the high rising demand for public health
services, compounded by high population growth rate and lack of data and information on
community health. One of the social pillars which seek to incorporate rehabilitation of county
health facilities aims at offering integrated and comprehensive healthcare to the society, which
the government has embarked on development of health facilities in some parts of the country.
1.2 Statement of the problem
Poor service delivery of rural health projects has continued to be a persistent problem towards
provision of health services in Kenya. The role of health facilities in society cannot be
overlooked since the lives of many people depend on the services rendered by these facilities.
Furthermore, the rural population is more vulnerable to diseases and the performance of rural
health facilities is vital to their wellbeing. Poor performance of rural health projects has an
economic impact on society; which includes costs related to: increased medical costs, low
productivity by members of society as a result of poor health, lack of medicine and drugs,
unmotivated workforce and understaffed health facilities. Migori County is not an exception to
this problem; rural health facilities within the county have performed poorly and below
expectations.
Under Kenya Vision 2030, a number of flagship projects have been identified in each sector
which are to be implemented in five year medium term plans of the vision, to facilitate the
desired growth on a sustainable basis in each sector. Health projects have been identified as key
in driving health growth in the health sector. The millennium development goals (MDGs) can
only be achieved if only the health systems are improved at all levels or regions in the country.
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Yilmaz, Dasdemir, Atmis and Lise (2010), sought to establish the most important factors
affecting rural development in Turkey. The study considered factors measuring environmental,
economic and socio-cultural dimensions which are different from those that the current study
addresses. Gichoya (2005), examined the factors affecting the successful implementation of
technological projects in government. The findings indicate that the vision, strategy and
government support are considered important for success while lack of funds and poor
infrastructure are considered as major factors for failure of project implementation. Under the
factors influencing project implementation, performance and success, the main factors are
funding and management and therefore the study finds it necessary to establish the factors
influencing project performance in rural health development projects in Migori County.
1.3 Objectives of the study
1.3.1 General objective
To determine the factors affecting service delivery of rural health development projects with a
focus on Migori County.
1.3.2 Specific objectives
1. To establish the main contributors of service delivery in rural health development
projects in Migori County.
2. To find out the impact of community participation or involvement in rural health
development projects in Migori County.
3. To investigate if resource allocation plays a part in success or failure of rural health
development projects in Migori County.
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1.4 Researchquestions
1. What are the main contributors of service delivery in rural health development projects?
2. What is the impact of community participation or involvement in rural health
development projects in Migori County?
3. Is there a part played by resource allocation on success or failure of rural health
development projects in Migori County?
1.5 Significance /Justification of the Study
This study is important to the government and the financial donors in the health sector. They will
benefit from the findings of the study as it will highlight the factors that determine the results,
performance and success of rural health development projects. It would enable them to determine
whether they should continue funding the projects or change tactics to enable success of the
projects. The government will also be able to obtain information about existent gaps or needs in
the health sector in the rural areas and act on the gaps.
Project managers especially those running the rural health development projects and other
projects as well, will also benefit from the findings of the study. They will be able to know the
factors that affect the service delivery of rural health development projects and to know where to
increase or reduce effort and resources.
The community will also benefit from the findings of the study as the study will indicate the
impact of their participation on the rural health development projects and solicit more of their
participation. The findings will also enable the rural health projects to improve their performance
by offering better and more quality services to the community.
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1.6 Limitations of the Study
This study was limited to one County-the County of Migori. As such the findings may not apply
to other Counties in Kenya because of the uniqueness of the County as well as its projects and
project duration. A larger research would be more appropriate for generalization of the findings
to the whole Health sector in Kenya.
The study is to rely on the self-reported data collected through interviews and filling of
questionnaires. However, self-reported data are subject to biasness. Biasness may include
selective memory where in this case, the respondent may fail to remember past experiences that
may be relevant to the study. Attribution is also another problem, where a respondent may
attribute positive responses to the questions concerning him/her and give negative responses to
questions relating to the external environment. Exaggeration of responses is also likely to be
encountered where a respondent may allocate too much weight on some questions and give more
weighty responses than the actual occurrences.
1.7 Scope of the Study
This study was limited to the County of Migori. The study targeted all the rural health
development projects in Kuria West Ward, Migori County. This constituted the scope of the
study.
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CHAPTER TWO
LITEREATURE REVIEW
2.1 Introduction
This chapter gives an insight into the literature by other scholars and researchers on the aspect of
factors affecting performance of and successful implementation of rural health development
projects. It reviews literature that is related to the specific and general objectives of the research.
It specifically covers the past studies/main review where it discusses literature related to the
specific objectives of the study. It also presents literature on the critical review of major issue,
summary and gaps to be filled and the conceptual framework.
2.2 Empirical study
2.2.1 Rehabilitation of Rural Health Projects
In August 2000, the Government of Kenya requested the ADB to finance rehabilitation of six
district hospitals. A project to rehabilitate the 6 district hospitals and strengthen district health
systems was prepared through a Japanese grant in March 2002. However, in 2003, the
Government decided to drop the rehabilitation of hospitals and strengthen the health system in
the seven Rural Health Project II districts (African Development Bank, 2003). This was done in
an effort to introduce cost effective interventions, and to consolidate and maximize the impact of
ADB’s input in the health sector. The purpose of the project is to support the Government’s
effort in reversing the declining health indicators, increases in infection of preventable diseases
and poor performance of the health sector. The project was an integral part of the strategic
initiative for sustainable implementation of the National Health Sector Strategic Plan (NHSSP)
1999-2004.
In 1998, the ADB approved financing of Rural Health Project II whose objective was to
rehabilitate and upgrade one health center from each of the 7 target districts and to create an
environment for increased community participation in the improvement of health status. During
the same year, a Bank financed study assessing rehabilitation requirements of district hospitals
was completed. In August 2000, the Government requested the Bank to finance rehabilitation of
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29 of the 57 priority hospitals. The Bank advised the Government to reduce the number of
hospitals to be rehabilitated. As a result, the Government developed criteria for selecting priority
project areas, which included the level of poverty, disease burden for malaria, tuberculosis and
HIV/AIDS prevalence rate, and population age cohort of women aged 15-49. On the basis of this
information, the Bank approved the six districts that were selected by Government. Through a
Japanese grant, a project to rehabilitate the 6 district hospitals and strengthen district health
systems was prepared in March 2002. Subsequently, the Government and the Bank agreed to
change project sites and focus the proposed project to the same 7 districts covered by Rural
Health II in order to consolidate the impact of ADF support in the health sector. A mission to up-
date the preparation report was launched in November 2003 (African Development Fund, 2003).
Furthermore, in January 2004, the Government dropped rehabilitation of district hospitals in an
effort to introducing cost-effective interventions and to re-align stated policies with expenditure
patterns. This decision was taken in order to shift resources from urban to rural areas and thereby
focus on preventive and provision of effective essential health care. The project will include
rehabilitation of dispensaries and health centers, which provide the first contact level to
comprehensive health services for about 80% of the population in Kenya.
The mission to up-date the preparation report and the appraisal mission ensured transparency and
wide participation of stakeholders through fieldwork and extensive consultations. The design of
the project is a product of joint definition of objectives, identification of critical areas of
intervention and mechanisms for implementation. Rural Health Project III was appraised in
February 2004 and it was jointly financed by African development fund, OPEC and GOK. The
project is consistent with the Bank Group’s plans, Health Policy, and Strategies for Combating
Communicable Diseases, HIV/AIDS and Malaria.
Success or failure of the rural health development projects is entirely dependable on both internal
and external factors within the projects and the study seeks to identify the influencing factors
towards rural health development projects.
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2.2.2 Factors that play roles in performance of rural health projects
According to GOK 2010, emergence and re-emergence of medical conditions such as
HIV/AIDS, TB, drug resistant malaria and increasing poverty are among the major challenges in
the rural health sector. These challenges together with increases in preventable diseases have led
to continued decline in health indicators. There has been a reduction in life expectancy, IMR
increased by 30% from 60 deaths per 1,000 live births in 1989 to 78 deaths per 1,000 live births
in 2003. Similarly, under 5 mortality rates increased from 89 to 114 during the same period.
Rural communities through consultations under the process identified poor access to and high
cost of quality health services including drugs, as major challenges in the health sector.
Historically, tertiary and secondary care facilities have absorbed 70% of the health resources
compared to 30% for primary health care facilities which provide the bulk of services to the
majority of Kenyans.
The 2003 Public Expenditure Review shows that budget plans to reallocate increased resources
to the priority areas remains a challenge. For example, allocation to rural health services was
budgeted to increase from 13.9% of the total expenditure to 35.9% in 2001/02 and yet the actual
expenditure was 11.7%. Declining health indicators and poor performance of the health sector is
partly due to the fact that Government’s expenditure pattern has not been consistent with its
stated policy objectives. This has resulted in the general neglect and non-functioning of most
rural health facilities due to shortage of drugs and medical supplies, poor referral system, poorly
maintained health facilities, and inadequate technical and managerial skills. A significant
proportion of district health facilities are in need of repair, rehabilitation and replacement of
basic capital equipment essential for effective provision of quality health care. Support and
supervision to peripheral health institutions and their communities are limited. Few districts have
been able to establish adequate referral mechanisms with corresponding information,
communication, logistics, and managerial and technical support. Furthermore, most of the
interventions through vertical programmes have failed to strengthen the health system, which is
fundamental for their effective delivery.
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2.2.3 Health worker shortage
Kenya currently faces significant challenges in overcoming health care worker (HCW) shortages
and low health care workers retention, as well as difficulty attaining equitable distribution of
human resources for health particularly in hard-to-reach areas. A 2008 GOK Health Report
indicates that the Ministry of Health had an overall vacancy level of 29%. There are about 1.5
health care workers per 1,000 population in Kenya, which falls below the figure of 2.3 per 1,000
population reported in analyses by the World Health Organization (WHO) on the minimum
staffing threshold to achieve minimum coverage. Vacancy levels based on World Health
Organization suggestions were highest in Northern Kenya, with 85% and 93% health worker
vacancy levels in Turkana and Mandera counties, respectively.
2.2.4 Health worker motivation
Health worker motivation, defined as the extent an individual is willing to exert and maintain
effort towards the achievement of an organization’s goals has frequently been cited as a critical
barrier towards performance of rural health projects in Kenya and a contributor to the health
worker shortage. In this regard, several themes characterize motivation and these include
financial aspects, career development, continuing education, health facility infrastructure,
availability of resources, relationships with the management of the health facility, and personal
recognition (Lutwama GW, Roos JH 2012). Further, there is an urgent need to ascertain and
employ successful retention strategies that are suitable for different regions with diverse needs,
where retention strategies are commonly understood to mean incentive mechanisms provided to
health care providers, already working in rural (and remote) areas to continue working in these
regions.
Motivation is closely tied to job satisfaction and neither of these is directly observable, but both
are critical to the retention and performance of health workers (Mbindyo P, Gibson L, and
Blaauw 2009). A study on health worker motivation in Kenyan district hospitals demonstrated
that altruistic motives are important in these settings, but that their organizational commitment
(in terms of decisions of performance on the job depending on whether the senior
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management/the organization appreciated the particular staff or not) and motivation was
threatened by the many challenges that service providers face in public sector health care
provision (Mbindyo P, Gibson L, and Blaauw 2009).This further highlights the need to evaluate
differences in the motivation and retention of health care workers between private and public
health facilities, since challenges faced in these facilities often differ. In this case, private
facilities encompass faith-based organization (FBO), non-governmental organization (NGO), and
private for profit health facilities that are owned by individuals or corporates. This said, one
important unifying framework for analyzing factors in the motivation and retention of health
workers is Herzberg’s hygiene and motivation theory on job satisfaction At the operational level,
the human resource action framework (which includes the human resources management
systems) helps to address issues related to staff shortages, uneven staff distribution, skill and
competency gaps, low retention, and poor motivation
Ensuring that staff receive adequate pay for their work is key to retention. However, salary is not
the only important dimension in many contexts, the low numbers of trained health staff in rural
areas is due to the lack of supporting infrastructure and opportunities for staff and their families.
In fragile environments, these factors include poor living conditions, the lack of safety and
security in the workplace, and the absence of continuous professional development. Several
reasons explain attrition of health workers in Kenya. These include retirement, resignation, and
death. A number of critical factors contribute to the motivation and retention of staff, yet these
are not currently well understood in the Kenyan context.
2.2.4 Competence of the Implementation Team and Performance of rural health projects
Teamwork and composition in the project implementer-vendor-consultant partnership is a key
factor influencing project implementation success. Good coordination and communication
between the implementation partners is essential. Since project covers a wide range of functional
areas, it is also important to have a cross-functional project core team. It is extremely critical that
partnership trust is present and the team members are working well together. Another critical
factor is change management program and culture. An organizational culture where the
employees share common values and goals and are receptive to change is most likely to succeed
in project implementation. Furthermore, user training, education and support should be available
and highly encouraged. Change agents should also play a major role in the implementation to
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facilitate change and communication, and to leverage the corporate culture. Al-Mashari et al.
(2003) argues that constantly monitoring the progress of project implementation and providing
direction to the project team is also major duties of top management which is critical for the
success of project implementation. In general, although there are some variations in defining top
management duties in project implementation, the importance of their commitment and support
is highlighted by all referred researchers. Zwikael (2006) argues that the high importance of top
management support is considered to be among the Critical Success Factors for project
management. It is also important to emphasize effective top management support for different
project scenarios. Critical top management support includes a broad range of activities in an
organization, including developing project procedures that include the initiation stage, training
programs, establishing a project management office, support quality management and so on.
Young and Jordan (2008) suggest that “the essence of top management support related to
effective decision-making is to manage risk and to authorize business process change”. A crucial
part of a successful project is top management support, the benefit of which is related to
improving decision making in order to manage risk. Top-level management responds to business
processes and manages risk. Successful mitigation or bearing of risk is contingent upon
commitment and support from top management. Moreover, commitment and support from top
management plays a key role in influencing the success of almost any initiative within an
organization (Hasanali, 2002). Top management formulates and decides objectives and strategies
for organizational risk management activities, mission and overall objectives (Henriksen and
Uhlenfeldt, 2006).
Project implementation is not a top-down-approach. Consequently, the success of any
implementation effort depends on the level of involvement of middle managers. To generate the
required acceptance for the implementation as a whole, the affected middle managers knowledge
(which is often underestimated) must already be accounted for in the formulation of the strategy.
Then, by making sure that these managers are a part of the strategy process, their motivation
towards the project will increase and they will see themselves as an important part in the process
(Rapa and Kauffman, 2005). Unfortunately, in practice, managers and supervisors at lower
hierarchy levels who do have important and fertile knowledge are seldom involved in strategy
formulation. When they are, however, the probability for realizing a smooth targeted and
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accepted strategy implementation process increases substantially. Research studies indicate that
less than 5 percent of a typical workforce understands their organization’s strategy (Kaplan and
Norton, 2001). This is a disturbing statistic as it is generally believed that, without understanding
the general course of strategy, employees cannot effectively contribute to a strategy
implementation. To involve employees is an important milestone to make strategy everyone’s
everyday job. That is why the involvement of middle managers is essential to increase the
general awareness of the strategy. A lack in strategic consensus can limit a company’s ability to
concentrate its efforts on achieving a unified set of goals.
2.2.5 Availability of Human Resources and Performance of rural health projects
Human Resource Management is the process of utilizing all the individuals involved in the
project effectively in order to get the best result for the project. This includes all the stakeholders
of the project including the sponsors, customers, individual contributors, and all others (Wright,
1998). Organizations are increasingly looking at human resources as a unique asset that can
provide sustained competitive advantage. The changes in the business environment with
increasing globalization, changing demographics of the workforce, increased focus on
profitability through growth, technological changes, intellectual capital and the never-ending
changes that organizations are undergoing have led to increased importance of managing human
resources (Devanna, Fombrum, and Tichy, 1981). According to Huang (2000), Human Resource
Management practices are one area that influences employees‟ intention to leave, levels of job
satisfaction, and organizational commitment (Guest, 1989). Since the concept of Human
Resource Management (HRM) became popular in the early 1980s, there has been an increasing
academic interest in the concept as well as research in the area. Early models of HRM (Miles and
Walton, 1984) were largely conceptual and not based on substantial empirical evidence for their
validity. In this scenario, a human resource department that is highly administrative and lacks
strategic integration fails to provide the competitive advantage needed for survival, thus losing
its relevance as evident in the dispensary where its performance will be deterred due to provision
of one nurse per dispensary to offer services. Huselid and Becker (1997) found that there were
noticeable financial returns for the organizations whose human resource management systems
have achieved operational excellence and are aligned with business strategic goals. Schuler and
Jackson (1987) have examined the Human resource practices followed by the firms following
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three kind of generic strategies, namely dynamic growth, extract growth and turnaround strategy.
They found that the Human resource practices vary according to these three strategies. Strategic
human resource management sees development and deployment of Human resource as the key to
organizational success. The conception of Human resource appears to be similar to that of
managers of State-Owned Enterprises in Lao PDR: keeping personnel records, recruitment and
salary administration (Quang and Thavisay, 1999). The government is responsible for what is
described as recruitment and deployment of nurses, staff management, promotion and transfer.
However, staffs are engaged on clerical tasks that are outcomes of processes managed elsewhere.
2.2.6 Commitment by Political Leaders and Performance of community development
projects
Shared understanding without commitment may result in counter effort and negatively affect
performance (Rapert, Lynch and Suter, 1996). Project success may fail if the projects do not
enjoy support and commitment by the team responsible for overseeing the project. Riketta (2002)
and Ostroff (1992), argue that commitment is a major antecedent of performance. According to
(Eyaa and Qian, 2010), the overall performance of a project is a function of the individual
commitment of each participant in the project. Studies by (Yoon and Suh, 2003) in a Korean
context, found a positive relationship between individual Commitment and perceived service
quality. This suggests that the quality of citizenship services is a function of the energy and
loyalty that individual members devote to the project. The inadequacy of an intrinsic drive to
perform tasks also causes project failures in terms of time overruns/ failure to beat deadlines
(Riketta, 2002). Involvement and commitment should be developed and maintained throughout
the implementation process of projects. Noble and Mokwa, 1999, put forward role commitment
as a central factor which directly influence project performance. 19 committed project members
more often than not have no intentions to quit and give their best to ensure the success of the
project which saves the project costs and time. Also, costs of supervision are mitigated if the
project members are committed to their project tasks.
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2.2.7 Leadership Capabilities and Project Planning
Leadership is the art and science of applying a set of knowledge, skills, tools, and techniques by
a leader to a project in order to meet or exceed the needs and expectations of the stakeholders. It
requires achieving a delicate balancing of strategic and tactical requirements. Leadership often
requires determining what is possible and what is needed. Balancing capability and need
generally results in defining the best that can be achieved with the limited resources available,
rather than attempting to find the perfect solution. Need for professional leadership techniques
emerged with growing scope and complexity of projects, with tightening restrictions and
requirements for use of material, financial and labour resources and for quality of work and
performance (Neverauskas, 2008). Leadership through application of different project leadership
techniques and tools contributes to timely completion of the project conforming to specific
requirements and intended budget. The current trends towards global competition, rapid
technological change and innovations are increasing the importance of the leadership processes
since the project leaders and their teams are agents of change. Tidd (2001), support the
importance of organizational project leadership competencies and view them as highly correlated
with an organization's ability to innovate their systems successfully. Leadership is a cyclical
process of planning, monitoring and reviewing, where strong inference placed on communication
during the planning stage further expands on the project leadership process, viewing it as
encompassing the stages of project initiation, planning, execution, control and the closing
process. A leadership capability/characteristic is a structured approach for delivering a project,
and consists of a set of processes, with each process having clearly defined resources and
activities (Turner, 2009). A leadership capability will set out what an organization regards as best
practice; improve inter-organizational communication; and minimize duplication of effort by
having common resources, documentation and training. Kerzner (2001), believes the best way to
increase the likelihood of an organization having a continuous stream of successfully managed
projects is to develop in-house capability of leadership that is flexible enough to support all
projects. The amount of time and effort needed to develop such capability will vary from
company to company depending upon factors such as the size and nature of projects, competitive
pressures and the number of functional boundaries to be crossed. The existing literature
recognizes the benefits of capably managing projects in an order, and does not distinguish
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between leadership capabilities that are internally developed or internationally recognized.
Deploying a leadership style can have a positive impact on an organization, as the standards set
out can reduce the time to deploy new practices by providing a common reference point for those
developing the infrastructure to support the standard (Garcia, 2005).
The effects of leadership capability to the organization include: effective leadership and planning
of the project; the controlling of budgets and resources; and the provision of a consistent method
of reporting across all projects, allowing staff to move between projects without having to
relearn the leadership approach. In other words leadership capability pushes 18 team members to
understand each other. Another characteristic of leadership is to manage change effectively by
providing appropriate tools and techniques (Kerzner, 2009). Muhammad, Chaudhry and Abdur
(2012) analyzed the impact of leadership on project performance. In this research study,
leadership factors of HR planning were adopted on the basis of project nature and analyzed the
effect of the factors on the performance of the project. The links of these factors with strategic
goals and objectives of the project were explored in order to improve project performance. The
data was collected from 70 employees from four main consultancies companies working together
on a project, located in Lahore, Pakistan. Results suggest that leadership has positive links with
project performance. According to Chan and Suhaiza (2007) strong leadership style by the
project manager is necessary for the successful planning and implementation of projects.
Normally the project manager has a great deal of responsibility but does not have the
commensurate authority as a line manager whereas the line manager has a great deal of authority
but only limited project responsibility. Considering this fact, it is therefore important for a
project manager to maintain a leadership style that adapts to each employee assigned to the
project. The researchers further argue that project management is unlikely to succeed unless
there is any visible support and commitment by executive management. Ongoing and positive
executive involvement, in a leadership capacity was reflecting executive management’s
commitment to project management. Passia (2004) and Gyorkos (2003), notes that project
planners should include a clearly delineated monitoring and evaluation plan as an integral part of
the overall project plan that include monitoring and evaluation activities , persons to carry out the
activities, frequency of activities, sufficient budget for activities and specification of the use of
monitoring and evaluation findings. Jody and Ray (2004), identify the complementary roles of
the two functions. Information from monitoring feeds into evaluation in order understand and
16 | P a g e
capture any lessons in the middle or at the end of the implementation with regard to what went
right or wrong for learning purposes.
2.3 Critical Review of major issue
Despite the concerted efforts of academicians and researchers to identify the various factors
affecting service delivery of rural health development projects in the country, the research is also
limited by the fact that successful implementation and performance of rural health projects are
affected by many other moderating factors such as government policies, management policies
and the strategy implementation process.
2.4 Summary and gaps to be filled by the study
Regardless of the abundance of research that has examined commitment and performance, there
remain a number of gaps that form the basis for this study. Firstly, a literature review shows that
although organizational commitment has been shown to be an important predictor of service
delivery (Riketta, 2002), very few studies have examined this phenomenon in a Kenyan
perspective and more so in the rural community development projects. It is imperative therefore,
that the understanding of individual commitment as an antecedent of performance is enriched
through extending the frontiers of research.
2.5 Theoretical Framework
This study is founded on the stakeholder theory which requires that all stakeholders be involved
in community projects if such projects are to be a success.
2.5.1 Stakeholder Theory
R. Edward Freeman is the proponent of stakeholder theory. Although Freeman himself credits
several bodies of literature in the development of his approach including: strategic management,
corporate planning, systems theory, organization theory, and corporate social responsibility. A
17 | P a g e
related field of research examines the concept of stakeholders and stakeholder salience, or the
importance of various stakeholder groups to a specific firm. More recent scholarly works on the
topic of stakeholder theory that exemplify research and theorizing in this area include Donaldson
and Preston (1995), Mitchell, Agle, and Wood (1997), Friedman and Miles (2002), and Phillips
(2003). Donaldson and Preston argue that the theory has multiple distinct aspects that are
mutually supportive: descriptive, instrumental, and normative. The descriptive approach is used
in research to describe and explain the characteristics and behaviors of firms, including how
companies are managed, how the board of directors considers corporate constituencies, the way
that managers think about managing, and the nature of the firm itself. The instrumental approach
uses empirical data to identify the connections that exist between the management of stakeholder
groups and the achievement of corporate goals. The normative approach, identified as the core of
the theory by Donaldson and Preston, examines the function of the corporation and identifies the
"moral or philosophical guidelines for the operation and management of the corporation
Mitchell, et al. derive a typology of stakeholders”based on the attributes of power (the extent a
party has means to impose its will in a relationship), legitimacy (socially accepted and expected
structures or behaviors), and urgency (time sensitivity or criticality of the stakeholder's claims).
By examining the combination of these attributes in a binary manner, 8 types of stakeholders are
derived along with their implications for the organization. Friedman and Miles explore the
implications of contentious relationships between stakeholders and organizations by introducing
compatible/incompatible interests and necessary/contingent connections as additional attributes
with which to examine the configuration of these relationships. Robert Allen Phillips
distinguishes between normatively legitimate stakeholders (those to whom an organization holds
a moral obligation) and derivatively legitimate stakeholders (those whose stakeholder status is
derived from their ability to affect the organization or its normatively legitimate stakeholders).
Chew and Gillan (2006) argue that Stakeholder Theory does not provide single corporate
objective, but directs managers to serve many “masters”. They went further to point out that
without the clarity of mission provided by a single valued objective function; companies
embracing stakeholder theory will experience managerial confusion, conflict, inefficiency and
perhaps even competitive failure of the firm or organization. The stakeholder theory focuses on
individual whose interests are directly affected by the activities of a firm. These individuals are
referred to as stakeholders in the organization. Some of the stakeholders are the shareholders
18 | P a g e
who provide the risk capital of the firm and their goal is to maximize their wealth; trade creditors
supplied goods or services to the firm and have the objective of being paid the full amount for
the goods and services supplied (Klapper and Love, 2003).
19 | P a g e
2.6 Conceptual Frame Work
Project performance
Dependent variables
Political Organizations
 Influence of political
leaders,
 Political parties and
groups
Societal Culture
 Societal involvement
in project.
 Traditional norms and
rules
Independent variables
Resources
 Human resources
 Financial availability
Leadership Capabilities
 Competence in
leadership
 Commitment of
leaders
20 | P a g e
CHAPTER THREE
3.0 Introduction
This chapter presents the research methodology that will be used to conduct this study thus, it
focuses on the following: research design, population and sampling techniques, data collection
methods, research procedures, and data analysis methods.
3.1 ResearchDesign
The research design that will be used for this study will be a descriptive research design.
Research design can have a number of classifications which could incorporate the degree to
which the research question has been crystallized, the method of data collection, the ability of the
researcher to produce effects in the variables which are being studied, the purpose of the study
being carried out, the time dimension, the focus of the study and also the research environment.
A descriptive study collects data in order to answer questions about current status of the subject
or topic of study. The classification of the particular research design for this study is the purpose
of the study. We have three options under this which include; Reporting study, Descriptive
study, and Causal study and these can be said to be either causal-explanatory study or causal-
predictive study. The researcher believes that a descriptive research design will be appropriate
for this study.
3.2 Population of the study
The study population will comprise of 30 respondents from 100 people, mainly comprising of
staff of the community health projects in the categories of senior management, middle
management and support staff, whose names will be obtained from the Ministry of Health offices
in the County. The study population refers to the total collection of elements which one would
like to study or make inferences. The population aspect however refers to the individual
participant or object on which the measurement is taken. It is the unit of study (Cooper and
Schindler, 2011).
21 | P a g e
3.3 Sampling Design
Kombo and Tromp (2006) define a sample as a finite part of a statistical population whose
properties are studied to gain information about the whole sample. Saunders, Lewis & Thornhill
(2003) define sampling as the process of selecting a number of individuals for a study from the
larger group referred to as the population.
The sample for this study will consist of 100 respondents consisting of staff of the community
health projects in the categories of senior management, middle management and support staff,
whose names will be obtained from the Ministry of Health offices in the County, and from which
30 respondents will be selected. Sampling frame refers to the list of elements from which the
sample is actually drawn, and is closely related to the population (Cooper and Schindler, 2001).
According to Cooper and Schindler (2011), it is a complete and correct list of population
members only. However, it is important to note that the sampling frame often differs from the
theoretical population because of errors and omissions. It is therefore a matter of judgment when
it comes to exactly how much inaccuracy one can accept while choosing a sampling frame.
3.3.1 Sampling Technique
The stratified random sampling technique will be used in the selection of sample elements (top,
middle and management personnel) from the sampling frame. The population can be segregated
into several mutually exclusive sub populations, or strata, the process by which the sample is
constrained to include fundamentals from each of the segments is referred to as stratified random
sampling. Stratified random sampling has three main benefits, it: increases a sample’s statistical
efficiency, provides adequate data for analyzing the various subpopulations and enables different
research methods and procedures to be used in different strata (Cooper and Schindler, 2001).
3.4 Data Collection Tools and Procedures
There are numerous ways of collecting data and these depend on the purpose and aims of the
research. In this study data will be collected by means of questionnaires and interviews. Data
collection involves contacting the members of the population that will be sampled in order to
collect the required information about the study (Saleemi, 1997). The researcher will employ the
services of research assistants who will be given a time frame for collection of the data for
analysis.
22 | P a g e
3.5 Data Analysis and Presentation
After collection of the questionnaires, the researcher will read through them to ascertain their
numbers and to see whether all the items have been responded to. Quantitative data will
be analyzed by use of descriptive statistics which employs measures of central tendencies,
measures of dispersion and skewness. To analyze the data, the Statistical Package for Social
Sciences (SPSS) software will be used to aid data analysis. Qualitative data do not produce
discrete numerical data (Mugenda and Mugenda, 2003), it is in form of words rather than
numbers and therefore inferences will be made from the responses of the respondents. The data
collected will be analyzed using statistical methods by use of tables, charts, frequencies and
percentages. Finally, harmonization of the responses given by the various respondents will be
undertaken, where responses on similar themes or objectives, emanating from different
respondents will be compared to find if the various responses concurred on various issues
and, if not, the possible reasons for the observed discrepancies. This discussion will be
guided by the specific objectives of the study.
3.6 Validity and Reliability of Research Instruments
3.6.1: Validity
The validity of a research instrument is the extent to which such an instrument is able to measure
what it is supposed to measure. According to Mugenda et al (1999), validity is the accuracy and
meaningfulness of inferences, which are based on the research results. Hence, validity refers to
the degree to which results obtained from the analysis of the data actually represent the variables
under study. In this research, the instruments used will be validated in terms of content validity.
The content related technique measures the degree to which the question items reflect the
specific areas covered.
3.6.2: Reliability
According to Mugenda et al (1999), reliability is the ability of a research instrument to
consistently measure characteristics of interest over time. Hence, reliability is the degree to
which a research instrument yields consistent results or data after repeated trials. To test the
reliability of research instruments used, test and re-test techniques will be used.
23 | P a g e
3.7 Ethical Considerations
The goal of ethics is to ensure that no one is harmed or suffers adverse consequence from the
research activities. Given the often sensitive relationships between researcher and respondents,
reasonable safeguards will be built in this study based on ethical considerations and
requirements. Therefore, the information that the researcher receives during the period of this
study will be treated in confidence and purely for academic purposes. Names of respondents will
not be used or mentioned in this study.
24 | P a g e
REFERENCES.
Al-Mashari, M, Al-Mudimigh A, Zairi M. (2003). Enterprise resource planning: A taxonomy of
critical factors, European Journal of Operational Research 146 352-364.
Awiti O. L (2007). CDF Best Practices Analysis Report
Bourne, L. (2008b). Stakeholder relationship management maturity. Paper presented at PMI
Global Congress – EMEA, St Julian’s.
Cooper, R. and Schindler, P. (2003). Business Research Methods. Boston: McGraw- Hill.
Donaldson, T., and Preston, L. E. (1995). The Stakeholder Theory of the Corporation: Concepts,
Evidence, and Implications. Academy of Management Review, 20(1), 65–91.
Fama, E. F. (2001). Agency Problems and the Theory of the Firm. Journal of Political Economy,
88(2), 288–307.
Freeman, R. E. (2007). Managing for Stakeholders: Survival, Reputation, and Success, New
Haven, CT: Yale University Press.
Gituto B.M. (2007). Beyond CDF: Making Kenya’s Sub-Soverein Finance Work for the Socially
Excluded, Henrich Boll Foundation,
Government of Kenya, (2003). Kenya Gazette Supplement CDF Act.
Henriksen, P. & Uhlenfeldt, T. (2006). Contemporary Enterprise-Wide Risk Management
Frameworks. In: Andersen, Torben Juul [Ed.]. Perspectives on Strategic Risk Management.
Gylling: Copenhagen Business School Press. 107 - 129.
Kerote O. A. (2007) The Role of the Local Community in the Management of Constituency
Development Funds in Sabatia Constituency in Vihiga. A research Project Submitted in Partial
Fulfilment for the Requirements of Post Graduate Diploma in Project Planning and Management,
University of Nairobi, Kenya.
25 | P a g e
Klapper, L. F. and Love, I. (2003). Corporate Governance, Investor Protection and Performance
in Emerging Markets. Journal of Corporate Finance, 10 (5), 703-28.
Kothari, C. R. (2007). Research methodology: Methods and techniques. New Delhi: New Age
International.
Loo, R. (2002). Working towards best practices in project management: A Canadian study.
International Journal of Project Management, 20, 93-8 67
Mugenda O. & Mugenda A. (2003). Research Methods: Quantitative and Qualitative
Approaches, Kenya-Acts Press, Nairobi,
Munyori, C. M. (2012). The Influence of Constituency Development Fund (CDF) Projects on
Public Primary Schools Performance in Kenya Certificate of Primary Education (KCPE)
Examination in Starehe Constituency, Nairobi County. Unpublished MBA thesis, University of
Nairobi.
Mwangi S. K. and Meagher, P. (2004), Devolution and Development, Ashgate Publishers, UK.
Nick, B. (2003). How to Measure and Analyze Corporate Governance. International Financial
Law Review, 22 (1) 40–47
Obwari, H. N. (2013). Influence of constituency development fund on education development in
the counties: a study of public secondary schools in Likuyani constituency, Kakamega County,
Kenya. Unpublished MBA thesis, University of Nairobi.
Ochieng, F. O., and Tubey R. (2013). Factors Influencing Management of CDF Projects. A Case
of Ainamoi Constituency, Kericho County. International Journal of Science and Technology
Volume 2 No. 1.
Pfeffer, J. (1994). Competitive Advantage through People, Cambridge, MA: Harvard Business
School Press.
26 | P a g e
Rapa, A. and Kauffman, D. (2005). Strategy implementation – an insurmountable obstacle,
Handbook of Business Strategy, 6 (1): 141-146
Republic of Kenya (2002). Poverty Reduction Strategy Paper. Nairobi: Government Printer.
Roxana G, R. (2009). Decentralization, Accountability and the MPs Elections: The Case of the
Constituency Development Fund in Kenya. Briefing Paper 02.
Wanjiru G, (2007). The CDF Social Audit Guide Open Society Initiative for East Africa
Websites surfed:
Winter, M., Smith, C., Cooke-Davies, T. and Cicmil, S. (2006b). The importance of „process‟ in
rethinking project management: the story of a UK government-funded research network.
International Journal of Project Management, 24(8), 650-62.
Zwikael, O. and Globerson, S. (2006). From critical success factors to critical success processes.
International Journal of Production Research, 44(17), 3433-49.
27 | P a g e
Appendix: ResearchQuestionnaire
This is a study intended to determine the factors affecting service delivery in rural health
development projects. Kindly fill in the information as accurately as possible. The
information provided here will be confidential and used only for research purposes.
Tick where appropriate
1. Gender
Male [ ] female [ ]
2. Age
18-30 years [ ] `
31-35 years [ ]
36-40years [ ]
41-45 years ` [ ]
0ver 46 years [ ]
3. What is your education level?
College [ ]
Diploma certificate [ ]
Undergraduate [ ]
Postgraduate [ ]
4. Level of experience
Below 3 years [ ]
4-6 Years [ ]
28 | P a g e
7-10 years [ ]
Over 10 years [ ]
5. What’s your view on the level of human labour available in the projects?
Highly available [ ]
Available [ ]
Not enough [ ]
No presence of human labour [ ]
6. Does the number of human resources affect the performance of projects?
Strongly agree [ ]
Agree [ ]
Strongly disagree [ ]
Disagree [ ]
Not sure [ ]
7. Does human resource motivation influence the outcome of rural health projects?
Strongly agree [ ]
Agree [ ]
Strongly disagree [ ]
Disagree [ ]
Not sure [ ]
8. What’s your opinion on the level of involvement of the community in the rural health
projects
Very much involved [ ]
Fairly involved [ ]
29 | P a g e
Less involved [ ]
Not involved at all [ ]
9. How does community involvement influence the outcome or the performance of rural
health projects in your area?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
…………….
10. What’s your opinion on the level of competence of the projects team in the rural helath
projects in your area?
Very competent [ ]
Fairly competent [ ]
Less competent [ ]
Not competent at all [ ]
11. What’s the level of involvement of political leaders in the rural health projects in your
area?
Very much involved [ ]
Fairly involved [ ]
Less involved [ ]
Not involved at all [ ]
30 | P a g e
12. Does the involvement of political leaders influence the performance of rural health
projects in your area?
Yes [ ] No [ ]
If yes explain
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………

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University Project Proposal docx

  • 1. i | P a g e FACTORS INFLUENCING PROJECT PERFORMANCE IN RURAL HEALTH DEVELOPMENT PROJECTS: A CASE OF MIGORI COUNTY BY MICHAEL MWITA ATANASI PPM/44/12 A RESEARCH PROJECT SUBMITTED TO THE UNIVERSITY IN PARTIAL FULLFILLMENT FOR THE REQUIREMENTS OF A DEGREE IN BARCHELOR OF PROJECT PLANNING AND MANAGEMENT IN MOI UNIVERSITY 2015
  • 2. ii | P a g e DECLARATION DECLARATION BY STUDENT I hereby declare that this is my original work and has not been submitted to any institution for award of a degree. NAME: MICHAEL A MWITA REG NO: PPM/44/12 SIGN: DATE: DELARATION BY THE SUPERVISOR This research project has been submitted for an examination with my approval as university supervisor. NAME: MR. JEREMIAH OJUKI SIGN:
  • 3. iii | P a g e DEDICATION I dedicate this project to my family, Moi University and all the people who helped do the project by giving me support and easy working time. I appreciate all for being supportive throughout the period of the study.
  • 4. iv | P a g e ACKNOWLEDGEMENT Special thanks to my supervisor Mr. Jeremiah Ojuki. The support and guidance provided helped me in writing this proposal. I also thank my supervisor for the patience and understanding throughout this work. Also thanks to my friends and classmates for taking time to read through my work and all the support. I cannot forget the support from my family for patience and support during the entire course.
  • 5. v | P a g e ABSTRACT Rural health development projects face various challenges in their implementation and their service delivery. The purpose of this study is to determine the factors affecting service delivery in rural health development projects. This study will be carried out in Migori County. To achieve this objective, the study will adopt the following specific research objectives towards the study purpose: establishing the main contributors of project performance on rural health development projects in Migori County; finding out community participation or involvement in rural health development projects in Migori county and investigating if resource allocation plays a part in success or failure of rural health development projects in Migori county. This study was limited to one County-the County of Migori and as such, the findings may not apply to other Counties in Kenya because of the uniqueness of the County as well as its projects and project duration. The study will adopt a descriptive research design which, according to Cooper and Schindler (2003), a descriptive study is concerned with finding out the what, where and how of a phenomenon. A sample size of 30 respondents from the rural development board, heads of public health centers and citizens of Migori County will be used. Stratified sampling techniques will be used to obtain the sample size of 30 respondents from 100 people. The main data collection instruments will be questionnaires and interviews. The study aims to collect data using the instruments and the data that will be obtained will be presented in tables, graphs and pie charts and the final data will be analyzed using the SPSS statistical package. This study will be of importance to several stakeholders including the Government of Kenya, the County Government of Migori, project managers, the management and staff of the rural health projects as well as the community.
  • 6. vi | P a g e LIST OF ABBREVIATIONS ADB-African development Bank ADF-African development fund OPEC-Organization of petroleum exporting countries GOK-Government of Kenya FBO- Faith-based organization, NGO- Non-governmental organization IMR-Immortality rate
  • 7. vii | P a g e Contents DECLARATION .................................................................................................................................... i DEDICATION..................................................................................................................................... iii ACKNOWLEDGEMENT........................................................................................................................iv ABSTRACT..........................................................................................................................................v LIST OF ABBREVIATIONS.....................................................................................................................vi CHAPTER ONE....................................................................................................................................1 1.0 Introduction............................................................................................................................1 1.1 Background.............................................................................................................................1 1.2 Statement of the problem........................................................................................................2 1.3 Objectives of the study ............................................................................................................3 1.3.1 General objective ...................................................................................................................3 1.3.2 Specific objectives ..................................................................................................................3 1.4 Research questions..................................................................................................................4 1.5 Significance /Justification of the Study......................................................................................4 1.6 Limitations of the Study.................................................................................................................5 1.7 Scope of the Study ........................................................................................................................5 CHAPTER TWO ...................................................................................................................................6 LITEREATURE REVIEW.........................................................................................................................6 2.1 Introduction..................................................................................................................................6 2.2 Empirical study .............................................................................................................................6 2.2.1 Rehabilitation of Rural Health Projects.....................................................................................6 2.2.2 Factors that play roles in performance of rural health projects..................................................8 2.2.3 Health worker shortage ..........................................................................................................9 2.2.4 Health worker motivation.......................................................................................................9 2.2.4 Competence of the Implementation Team and Performance of rural health projects ...............10 2.2.5 Availability of Human Resources and Performance of rural health projects..............................12 2.2.6 Commitment by Political Leaders and Performance of community development projects.........13 2.2.7 Leadership Capabilities and Project Planning..........................................................................14 2.3 Critical Review of major issue ......................................................................................................16 2.4 Summary and gaps to be filled by the study..............................................................................16 2.5 Theoretical Framework................................................................................................................16 2.5.1 Stakeholder Theory ..............................................................................................................16
  • 8. viii | P a g e 2.6 Conceptual Frame Work..............................................................................................................19 CHAPTER THREE ...............................................................................................................................19 3.0 Introduction................................................................................................................................20 3.1 Research Design..........................................................................................................................20 3.2 Population of the study...............................................................................................................20 3.3 Sampling Design..........................................................................................................................21 3.3.1 Sampling Technique .................................................................................................................21 3.4 Data Collection Tools andProcedures...........................................................................................21 3.6 Validity and Reliability of Research Instruments............................................................................22 3.6.1: Validity...................................................................................................................................22 3.6.2: Reliability................................................................................................................................22 3.7 Ethical Considerations.................................................................................................................23 Appendix: Research Questionnaire ................................................................................................27
  • 9. 1 | P a g e CHAPTER ONE 1.0 Introduction This chapter presents background information on subject of research and covers statement of the problem, research objectives, research questions, and significance of the study. The chapter also covers other sections including limitations and delimitations of the study and the scope. In the background of the study the study reviews the key concepts and how they relate to one another. 1.1 Background Within 20 years of Kenya’s independence, Kenya had grown in the health sector with a sizeable rate, and at the founding of the ADF assisted rural health project, between 1982-1985, there were about 1200 rural health facilities in Kenya. After the government of Kenya started the primary health care system, for the success of the project there was a necessity for existence of the rural health development projects .The government then received funding and loans from OPEC to fund the rural health projects (African development bank, 2007). Implementation of the projects however faced many constraints and challenges including lack of qualified management and inadequate manpower. As part of its all-inclusive approach, this project incorporated participatory methodologies into its design to ensure that communities developed a sense of awareness of health issues and ownership of health services to facilitate the government’s initiative of decentralization of health services based on a progressive community based health care agenda (Africa Development Fund, 2008). According to Kenya Vision 2030, the greatest challenges facing the health sector in Kenya are; inadequate funding to support planned rehabilitations of health facilities, limited
  • 10. 2 | P a g e capacity in procurement building and supervision, inefficient supply chain management system, matching supply of skilled human resources with the high rising demand for public health services, compounded by high population growth rate and lack of data and information on community health. One of the social pillars which seek to incorporate rehabilitation of county health facilities aims at offering integrated and comprehensive healthcare to the society, which the government has embarked on development of health facilities in some parts of the country. 1.2 Statement of the problem Poor service delivery of rural health projects has continued to be a persistent problem towards provision of health services in Kenya. The role of health facilities in society cannot be overlooked since the lives of many people depend on the services rendered by these facilities. Furthermore, the rural population is more vulnerable to diseases and the performance of rural health facilities is vital to their wellbeing. Poor performance of rural health projects has an economic impact on society; which includes costs related to: increased medical costs, low productivity by members of society as a result of poor health, lack of medicine and drugs, unmotivated workforce and understaffed health facilities. Migori County is not an exception to this problem; rural health facilities within the county have performed poorly and below expectations. Under Kenya Vision 2030, a number of flagship projects have been identified in each sector which are to be implemented in five year medium term plans of the vision, to facilitate the desired growth on a sustainable basis in each sector. Health projects have been identified as key in driving health growth in the health sector. The millennium development goals (MDGs) can only be achieved if only the health systems are improved at all levels or regions in the country.
  • 11. 3 | P a g e Yilmaz, Dasdemir, Atmis and Lise (2010), sought to establish the most important factors affecting rural development in Turkey. The study considered factors measuring environmental, economic and socio-cultural dimensions which are different from those that the current study addresses. Gichoya (2005), examined the factors affecting the successful implementation of technological projects in government. The findings indicate that the vision, strategy and government support are considered important for success while lack of funds and poor infrastructure are considered as major factors for failure of project implementation. Under the factors influencing project implementation, performance and success, the main factors are funding and management and therefore the study finds it necessary to establish the factors influencing project performance in rural health development projects in Migori County. 1.3 Objectives of the study 1.3.1 General objective To determine the factors affecting service delivery of rural health development projects with a focus on Migori County. 1.3.2 Specific objectives 1. To establish the main contributors of service delivery in rural health development projects in Migori County. 2. To find out the impact of community participation or involvement in rural health development projects in Migori County. 3. To investigate if resource allocation plays a part in success or failure of rural health development projects in Migori County.
  • 12. 4 | P a g e 1.4 Researchquestions 1. What are the main contributors of service delivery in rural health development projects? 2. What is the impact of community participation or involvement in rural health development projects in Migori County? 3. Is there a part played by resource allocation on success or failure of rural health development projects in Migori County? 1.5 Significance /Justification of the Study This study is important to the government and the financial donors in the health sector. They will benefit from the findings of the study as it will highlight the factors that determine the results, performance and success of rural health development projects. It would enable them to determine whether they should continue funding the projects or change tactics to enable success of the projects. The government will also be able to obtain information about existent gaps or needs in the health sector in the rural areas and act on the gaps. Project managers especially those running the rural health development projects and other projects as well, will also benefit from the findings of the study. They will be able to know the factors that affect the service delivery of rural health development projects and to know where to increase or reduce effort and resources. The community will also benefit from the findings of the study as the study will indicate the impact of their participation on the rural health development projects and solicit more of their participation. The findings will also enable the rural health projects to improve their performance by offering better and more quality services to the community.
  • 13. 5 | P a g e 1.6 Limitations of the Study This study was limited to one County-the County of Migori. As such the findings may not apply to other Counties in Kenya because of the uniqueness of the County as well as its projects and project duration. A larger research would be more appropriate for generalization of the findings to the whole Health sector in Kenya. The study is to rely on the self-reported data collected through interviews and filling of questionnaires. However, self-reported data are subject to biasness. Biasness may include selective memory where in this case, the respondent may fail to remember past experiences that may be relevant to the study. Attribution is also another problem, where a respondent may attribute positive responses to the questions concerning him/her and give negative responses to questions relating to the external environment. Exaggeration of responses is also likely to be encountered where a respondent may allocate too much weight on some questions and give more weighty responses than the actual occurrences. 1.7 Scope of the Study This study was limited to the County of Migori. The study targeted all the rural health development projects in Kuria West Ward, Migori County. This constituted the scope of the study.
  • 14. 6 | P a g e CHAPTER TWO LITEREATURE REVIEW 2.1 Introduction This chapter gives an insight into the literature by other scholars and researchers on the aspect of factors affecting performance of and successful implementation of rural health development projects. It reviews literature that is related to the specific and general objectives of the research. It specifically covers the past studies/main review where it discusses literature related to the specific objectives of the study. It also presents literature on the critical review of major issue, summary and gaps to be filled and the conceptual framework. 2.2 Empirical study 2.2.1 Rehabilitation of Rural Health Projects In August 2000, the Government of Kenya requested the ADB to finance rehabilitation of six district hospitals. A project to rehabilitate the 6 district hospitals and strengthen district health systems was prepared through a Japanese grant in March 2002. However, in 2003, the Government decided to drop the rehabilitation of hospitals and strengthen the health system in the seven Rural Health Project II districts (African Development Bank, 2003). This was done in an effort to introduce cost effective interventions, and to consolidate and maximize the impact of ADB’s input in the health sector. The purpose of the project is to support the Government’s effort in reversing the declining health indicators, increases in infection of preventable diseases and poor performance of the health sector. The project was an integral part of the strategic initiative for sustainable implementation of the National Health Sector Strategic Plan (NHSSP) 1999-2004. In 1998, the ADB approved financing of Rural Health Project II whose objective was to rehabilitate and upgrade one health center from each of the 7 target districts and to create an environment for increased community participation in the improvement of health status. During the same year, a Bank financed study assessing rehabilitation requirements of district hospitals was completed. In August 2000, the Government requested the Bank to finance rehabilitation of
  • 15. 7 | P a g e 29 of the 57 priority hospitals. The Bank advised the Government to reduce the number of hospitals to be rehabilitated. As a result, the Government developed criteria for selecting priority project areas, which included the level of poverty, disease burden for malaria, tuberculosis and HIV/AIDS prevalence rate, and population age cohort of women aged 15-49. On the basis of this information, the Bank approved the six districts that were selected by Government. Through a Japanese grant, a project to rehabilitate the 6 district hospitals and strengthen district health systems was prepared in March 2002. Subsequently, the Government and the Bank agreed to change project sites and focus the proposed project to the same 7 districts covered by Rural Health II in order to consolidate the impact of ADF support in the health sector. A mission to up- date the preparation report was launched in November 2003 (African Development Fund, 2003). Furthermore, in January 2004, the Government dropped rehabilitation of district hospitals in an effort to introducing cost-effective interventions and to re-align stated policies with expenditure patterns. This decision was taken in order to shift resources from urban to rural areas and thereby focus on preventive and provision of effective essential health care. The project will include rehabilitation of dispensaries and health centers, which provide the first contact level to comprehensive health services for about 80% of the population in Kenya. The mission to up-date the preparation report and the appraisal mission ensured transparency and wide participation of stakeholders through fieldwork and extensive consultations. The design of the project is a product of joint definition of objectives, identification of critical areas of intervention and mechanisms for implementation. Rural Health Project III was appraised in February 2004 and it was jointly financed by African development fund, OPEC and GOK. The project is consistent with the Bank Group’s plans, Health Policy, and Strategies for Combating Communicable Diseases, HIV/AIDS and Malaria. Success or failure of the rural health development projects is entirely dependable on both internal and external factors within the projects and the study seeks to identify the influencing factors towards rural health development projects.
  • 16. 8 | P a g e 2.2.2 Factors that play roles in performance of rural health projects According to GOK 2010, emergence and re-emergence of medical conditions such as HIV/AIDS, TB, drug resistant malaria and increasing poverty are among the major challenges in the rural health sector. These challenges together with increases in preventable diseases have led to continued decline in health indicators. There has been a reduction in life expectancy, IMR increased by 30% from 60 deaths per 1,000 live births in 1989 to 78 deaths per 1,000 live births in 2003. Similarly, under 5 mortality rates increased from 89 to 114 during the same period. Rural communities through consultations under the process identified poor access to and high cost of quality health services including drugs, as major challenges in the health sector. Historically, tertiary and secondary care facilities have absorbed 70% of the health resources compared to 30% for primary health care facilities which provide the bulk of services to the majority of Kenyans. The 2003 Public Expenditure Review shows that budget plans to reallocate increased resources to the priority areas remains a challenge. For example, allocation to rural health services was budgeted to increase from 13.9% of the total expenditure to 35.9% in 2001/02 and yet the actual expenditure was 11.7%. Declining health indicators and poor performance of the health sector is partly due to the fact that Government’s expenditure pattern has not been consistent with its stated policy objectives. This has resulted in the general neglect and non-functioning of most rural health facilities due to shortage of drugs and medical supplies, poor referral system, poorly maintained health facilities, and inadequate technical and managerial skills. A significant proportion of district health facilities are in need of repair, rehabilitation and replacement of basic capital equipment essential for effective provision of quality health care. Support and supervision to peripheral health institutions and their communities are limited. Few districts have been able to establish adequate referral mechanisms with corresponding information, communication, logistics, and managerial and technical support. Furthermore, most of the interventions through vertical programmes have failed to strengthen the health system, which is fundamental for their effective delivery.
  • 17. 9 | P a g e 2.2.3 Health worker shortage Kenya currently faces significant challenges in overcoming health care worker (HCW) shortages and low health care workers retention, as well as difficulty attaining equitable distribution of human resources for health particularly in hard-to-reach areas. A 2008 GOK Health Report indicates that the Ministry of Health had an overall vacancy level of 29%. There are about 1.5 health care workers per 1,000 population in Kenya, which falls below the figure of 2.3 per 1,000 population reported in analyses by the World Health Organization (WHO) on the minimum staffing threshold to achieve minimum coverage. Vacancy levels based on World Health Organization suggestions were highest in Northern Kenya, with 85% and 93% health worker vacancy levels in Turkana and Mandera counties, respectively. 2.2.4 Health worker motivation Health worker motivation, defined as the extent an individual is willing to exert and maintain effort towards the achievement of an organization’s goals has frequently been cited as a critical barrier towards performance of rural health projects in Kenya and a contributor to the health worker shortage. In this regard, several themes characterize motivation and these include financial aspects, career development, continuing education, health facility infrastructure, availability of resources, relationships with the management of the health facility, and personal recognition (Lutwama GW, Roos JH 2012). Further, there is an urgent need to ascertain and employ successful retention strategies that are suitable for different regions with diverse needs, where retention strategies are commonly understood to mean incentive mechanisms provided to health care providers, already working in rural (and remote) areas to continue working in these regions. Motivation is closely tied to job satisfaction and neither of these is directly observable, but both are critical to the retention and performance of health workers (Mbindyo P, Gibson L, and Blaauw 2009). A study on health worker motivation in Kenyan district hospitals demonstrated that altruistic motives are important in these settings, but that their organizational commitment (in terms of decisions of performance on the job depending on whether the senior
  • 18. 10 | P a g e management/the organization appreciated the particular staff or not) and motivation was threatened by the many challenges that service providers face in public sector health care provision (Mbindyo P, Gibson L, and Blaauw 2009).This further highlights the need to evaluate differences in the motivation and retention of health care workers between private and public health facilities, since challenges faced in these facilities often differ. In this case, private facilities encompass faith-based organization (FBO), non-governmental organization (NGO), and private for profit health facilities that are owned by individuals or corporates. This said, one important unifying framework for analyzing factors in the motivation and retention of health workers is Herzberg’s hygiene and motivation theory on job satisfaction At the operational level, the human resource action framework (which includes the human resources management systems) helps to address issues related to staff shortages, uneven staff distribution, skill and competency gaps, low retention, and poor motivation Ensuring that staff receive adequate pay for their work is key to retention. However, salary is not the only important dimension in many contexts, the low numbers of trained health staff in rural areas is due to the lack of supporting infrastructure and opportunities for staff and their families. In fragile environments, these factors include poor living conditions, the lack of safety and security in the workplace, and the absence of continuous professional development. Several reasons explain attrition of health workers in Kenya. These include retirement, resignation, and death. A number of critical factors contribute to the motivation and retention of staff, yet these are not currently well understood in the Kenyan context. 2.2.4 Competence of the Implementation Team and Performance of rural health projects Teamwork and composition in the project implementer-vendor-consultant partnership is a key factor influencing project implementation success. Good coordination and communication between the implementation partners is essential. Since project covers a wide range of functional areas, it is also important to have a cross-functional project core team. It is extremely critical that partnership trust is present and the team members are working well together. Another critical factor is change management program and culture. An organizational culture where the employees share common values and goals and are receptive to change is most likely to succeed in project implementation. Furthermore, user training, education and support should be available and highly encouraged. Change agents should also play a major role in the implementation to
  • 19. 11 | P a g e facilitate change and communication, and to leverage the corporate culture. Al-Mashari et al. (2003) argues that constantly monitoring the progress of project implementation and providing direction to the project team is also major duties of top management which is critical for the success of project implementation. In general, although there are some variations in defining top management duties in project implementation, the importance of their commitment and support is highlighted by all referred researchers. Zwikael (2006) argues that the high importance of top management support is considered to be among the Critical Success Factors for project management. It is also important to emphasize effective top management support for different project scenarios. Critical top management support includes a broad range of activities in an organization, including developing project procedures that include the initiation stage, training programs, establishing a project management office, support quality management and so on. Young and Jordan (2008) suggest that “the essence of top management support related to effective decision-making is to manage risk and to authorize business process change”. A crucial part of a successful project is top management support, the benefit of which is related to improving decision making in order to manage risk. Top-level management responds to business processes and manages risk. Successful mitigation or bearing of risk is contingent upon commitment and support from top management. Moreover, commitment and support from top management plays a key role in influencing the success of almost any initiative within an organization (Hasanali, 2002). Top management formulates and decides objectives and strategies for organizational risk management activities, mission and overall objectives (Henriksen and Uhlenfeldt, 2006). Project implementation is not a top-down-approach. Consequently, the success of any implementation effort depends on the level of involvement of middle managers. To generate the required acceptance for the implementation as a whole, the affected middle managers knowledge (which is often underestimated) must already be accounted for in the formulation of the strategy. Then, by making sure that these managers are a part of the strategy process, their motivation towards the project will increase and they will see themselves as an important part in the process (Rapa and Kauffman, 2005). Unfortunately, in practice, managers and supervisors at lower hierarchy levels who do have important and fertile knowledge are seldom involved in strategy formulation. When they are, however, the probability for realizing a smooth targeted and
  • 20. 12 | P a g e accepted strategy implementation process increases substantially. Research studies indicate that less than 5 percent of a typical workforce understands their organization’s strategy (Kaplan and Norton, 2001). This is a disturbing statistic as it is generally believed that, without understanding the general course of strategy, employees cannot effectively contribute to a strategy implementation. To involve employees is an important milestone to make strategy everyone’s everyday job. That is why the involvement of middle managers is essential to increase the general awareness of the strategy. A lack in strategic consensus can limit a company’s ability to concentrate its efforts on achieving a unified set of goals. 2.2.5 Availability of Human Resources and Performance of rural health projects Human Resource Management is the process of utilizing all the individuals involved in the project effectively in order to get the best result for the project. This includes all the stakeholders of the project including the sponsors, customers, individual contributors, and all others (Wright, 1998). Organizations are increasingly looking at human resources as a unique asset that can provide sustained competitive advantage. The changes in the business environment with increasing globalization, changing demographics of the workforce, increased focus on profitability through growth, technological changes, intellectual capital and the never-ending changes that organizations are undergoing have led to increased importance of managing human resources (Devanna, Fombrum, and Tichy, 1981). According to Huang (2000), Human Resource Management practices are one area that influences employees‟ intention to leave, levels of job satisfaction, and organizational commitment (Guest, 1989). Since the concept of Human Resource Management (HRM) became popular in the early 1980s, there has been an increasing academic interest in the concept as well as research in the area. Early models of HRM (Miles and Walton, 1984) were largely conceptual and not based on substantial empirical evidence for their validity. In this scenario, a human resource department that is highly administrative and lacks strategic integration fails to provide the competitive advantage needed for survival, thus losing its relevance as evident in the dispensary where its performance will be deterred due to provision of one nurse per dispensary to offer services. Huselid and Becker (1997) found that there were noticeable financial returns for the organizations whose human resource management systems have achieved operational excellence and are aligned with business strategic goals. Schuler and Jackson (1987) have examined the Human resource practices followed by the firms following
  • 21. 13 | P a g e three kind of generic strategies, namely dynamic growth, extract growth and turnaround strategy. They found that the Human resource practices vary according to these three strategies. Strategic human resource management sees development and deployment of Human resource as the key to organizational success. The conception of Human resource appears to be similar to that of managers of State-Owned Enterprises in Lao PDR: keeping personnel records, recruitment and salary administration (Quang and Thavisay, 1999). The government is responsible for what is described as recruitment and deployment of nurses, staff management, promotion and transfer. However, staffs are engaged on clerical tasks that are outcomes of processes managed elsewhere. 2.2.6 Commitment by Political Leaders and Performance of community development projects Shared understanding without commitment may result in counter effort and negatively affect performance (Rapert, Lynch and Suter, 1996). Project success may fail if the projects do not enjoy support and commitment by the team responsible for overseeing the project. Riketta (2002) and Ostroff (1992), argue that commitment is a major antecedent of performance. According to (Eyaa and Qian, 2010), the overall performance of a project is a function of the individual commitment of each participant in the project. Studies by (Yoon and Suh, 2003) in a Korean context, found a positive relationship between individual Commitment and perceived service quality. This suggests that the quality of citizenship services is a function of the energy and loyalty that individual members devote to the project. The inadequacy of an intrinsic drive to perform tasks also causes project failures in terms of time overruns/ failure to beat deadlines (Riketta, 2002). Involvement and commitment should be developed and maintained throughout the implementation process of projects. Noble and Mokwa, 1999, put forward role commitment as a central factor which directly influence project performance. 19 committed project members more often than not have no intentions to quit and give their best to ensure the success of the project which saves the project costs and time. Also, costs of supervision are mitigated if the project members are committed to their project tasks.
  • 22. 14 | P a g e 2.2.7 Leadership Capabilities and Project Planning Leadership is the art and science of applying a set of knowledge, skills, tools, and techniques by a leader to a project in order to meet or exceed the needs and expectations of the stakeholders. It requires achieving a delicate balancing of strategic and tactical requirements. Leadership often requires determining what is possible and what is needed. Balancing capability and need generally results in defining the best that can be achieved with the limited resources available, rather than attempting to find the perfect solution. Need for professional leadership techniques emerged with growing scope and complexity of projects, with tightening restrictions and requirements for use of material, financial and labour resources and for quality of work and performance (Neverauskas, 2008). Leadership through application of different project leadership techniques and tools contributes to timely completion of the project conforming to specific requirements and intended budget. The current trends towards global competition, rapid technological change and innovations are increasing the importance of the leadership processes since the project leaders and their teams are agents of change. Tidd (2001), support the importance of organizational project leadership competencies and view them as highly correlated with an organization's ability to innovate their systems successfully. Leadership is a cyclical process of planning, monitoring and reviewing, where strong inference placed on communication during the planning stage further expands on the project leadership process, viewing it as encompassing the stages of project initiation, planning, execution, control and the closing process. A leadership capability/characteristic is a structured approach for delivering a project, and consists of a set of processes, with each process having clearly defined resources and activities (Turner, 2009). A leadership capability will set out what an organization regards as best practice; improve inter-organizational communication; and minimize duplication of effort by having common resources, documentation and training. Kerzner (2001), believes the best way to increase the likelihood of an organization having a continuous stream of successfully managed projects is to develop in-house capability of leadership that is flexible enough to support all projects. The amount of time and effort needed to develop such capability will vary from company to company depending upon factors such as the size and nature of projects, competitive pressures and the number of functional boundaries to be crossed. The existing literature recognizes the benefits of capably managing projects in an order, and does not distinguish
  • 23. 15 | P a g e between leadership capabilities that are internally developed or internationally recognized. Deploying a leadership style can have a positive impact on an organization, as the standards set out can reduce the time to deploy new practices by providing a common reference point for those developing the infrastructure to support the standard (Garcia, 2005). The effects of leadership capability to the organization include: effective leadership and planning of the project; the controlling of budgets and resources; and the provision of a consistent method of reporting across all projects, allowing staff to move between projects without having to relearn the leadership approach. In other words leadership capability pushes 18 team members to understand each other. Another characteristic of leadership is to manage change effectively by providing appropriate tools and techniques (Kerzner, 2009). Muhammad, Chaudhry and Abdur (2012) analyzed the impact of leadership on project performance. In this research study, leadership factors of HR planning were adopted on the basis of project nature and analyzed the effect of the factors on the performance of the project. The links of these factors with strategic goals and objectives of the project were explored in order to improve project performance. The data was collected from 70 employees from four main consultancies companies working together on a project, located in Lahore, Pakistan. Results suggest that leadership has positive links with project performance. According to Chan and Suhaiza (2007) strong leadership style by the project manager is necessary for the successful planning and implementation of projects. Normally the project manager has a great deal of responsibility but does not have the commensurate authority as a line manager whereas the line manager has a great deal of authority but only limited project responsibility. Considering this fact, it is therefore important for a project manager to maintain a leadership style that adapts to each employee assigned to the project. The researchers further argue that project management is unlikely to succeed unless there is any visible support and commitment by executive management. Ongoing and positive executive involvement, in a leadership capacity was reflecting executive management’s commitment to project management. Passia (2004) and Gyorkos (2003), notes that project planners should include a clearly delineated monitoring and evaluation plan as an integral part of the overall project plan that include monitoring and evaluation activities , persons to carry out the activities, frequency of activities, sufficient budget for activities and specification of the use of monitoring and evaluation findings. Jody and Ray (2004), identify the complementary roles of the two functions. Information from monitoring feeds into evaluation in order understand and
  • 24. 16 | P a g e capture any lessons in the middle or at the end of the implementation with regard to what went right or wrong for learning purposes. 2.3 Critical Review of major issue Despite the concerted efforts of academicians and researchers to identify the various factors affecting service delivery of rural health development projects in the country, the research is also limited by the fact that successful implementation and performance of rural health projects are affected by many other moderating factors such as government policies, management policies and the strategy implementation process. 2.4 Summary and gaps to be filled by the study Regardless of the abundance of research that has examined commitment and performance, there remain a number of gaps that form the basis for this study. Firstly, a literature review shows that although organizational commitment has been shown to be an important predictor of service delivery (Riketta, 2002), very few studies have examined this phenomenon in a Kenyan perspective and more so in the rural community development projects. It is imperative therefore, that the understanding of individual commitment as an antecedent of performance is enriched through extending the frontiers of research. 2.5 Theoretical Framework This study is founded on the stakeholder theory which requires that all stakeholders be involved in community projects if such projects are to be a success. 2.5.1 Stakeholder Theory R. Edward Freeman is the proponent of stakeholder theory. Although Freeman himself credits several bodies of literature in the development of his approach including: strategic management, corporate planning, systems theory, organization theory, and corporate social responsibility. A
  • 25. 17 | P a g e related field of research examines the concept of stakeholders and stakeholder salience, or the importance of various stakeholder groups to a specific firm. More recent scholarly works on the topic of stakeholder theory that exemplify research and theorizing in this area include Donaldson and Preston (1995), Mitchell, Agle, and Wood (1997), Friedman and Miles (2002), and Phillips (2003). Donaldson and Preston argue that the theory has multiple distinct aspects that are mutually supportive: descriptive, instrumental, and normative. The descriptive approach is used in research to describe and explain the characteristics and behaviors of firms, including how companies are managed, how the board of directors considers corporate constituencies, the way that managers think about managing, and the nature of the firm itself. The instrumental approach uses empirical data to identify the connections that exist between the management of stakeholder groups and the achievement of corporate goals. The normative approach, identified as the core of the theory by Donaldson and Preston, examines the function of the corporation and identifies the "moral or philosophical guidelines for the operation and management of the corporation Mitchell, et al. derive a typology of stakeholders”based on the attributes of power (the extent a party has means to impose its will in a relationship), legitimacy (socially accepted and expected structures or behaviors), and urgency (time sensitivity or criticality of the stakeholder's claims). By examining the combination of these attributes in a binary manner, 8 types of stakeholders are derived along with their implications for the organization. Friedman and Miles explore the implications of contentious relationships between stakeholders and organizations by introducing compatible/incompatible interests and necessary/contingent connections as additional attributes with which to examine the configuration of these relationships. Robert Allen Phillips distinguishes between normatively legitimate stakeholders (those to whom an organization holds a moral obligation) and derivatively legitimate stakeholders (those whose stakeholder status is derived from their ability to affect the organization or its normatively legitimate stakeholders). Chew and Gillan (2006) argue that Stakeholder Theory does not provide single corporate objective, but directs managers to serve many “masters”. They went further to point out that without the clarity of mission provided by a single valued objective function; companies embracing stakeholder theory will experience managerial confusion, conflict, inefficiency and perhaps even competitive failure of the firm or organization. The stakeholder theory focuses on individual whose interests are directly affected by the activities of a firm. These individuals are referred to as stakeholders in the organization. Some of the stakeholders are the shareholders
  • 26. 18 | P a g e who provide the risk capital of the firm and their goal is to maximize their wealth; trade creditors supplied goods or services to the firm and have the objective of being paid the full amount for the goods and services supplied (Klapper and Love, 2003).
  • 27. 19 | P a g e 2.6 Conceptual Frame Work Project performance Dependent variables Political Organizations  Influence of political leaders,  Political parties and groups Societal Culture  Societal involvement in project.  Traditional norms and rules Independent variables Resources  Human resources  Financial availability Leadership Capabilities  Competence in leadership  Commitment of leaders
  • 28. 20 | P a g e CHAPTER THREE 3.0 Introduction This chapter presents the research methodology that will be used to conduct this study thus, it focuses on the following: research design, population and sampling techniques, data collection methods, research procedures, and data analysis methods. 3.1 ResearchDesign The research design that will be used for this study will be a descriptive research design. Research design can have a number of classifications which could incorporate the degree to which the research question has been crystallized, the method of data collection, the ability of the researcher to produce effects in the variables which are being studied, the purpose of the study being carried out, the time dimension, the focus of the study and also the research environment. A descriptive study collects data in order to answer questions about current status of the subject or topic of study. The classification of the particular research design for this study is the purpose of the study. We have three options under this which include; Reporting study, Descriptive study, and Causal study and these can be said to be either causal-explanatory study or causal- predictive study. The researcher believes that a descriptive research design will be appropriate for this study. 3.2 Population of the study The study population will comprise of 30 respondents from 100 people, mainly comprising of staff of the community health projects in the categories of senior management, middle management and support staff, whose names will be obtained from the Ministry of Health offices in the County. The study population refers to the total collection of elements which one would like to study or make inferences. The population aspect however refers to the individual participant or object on which the measurement is taken. It is the unit of study (Cooper and Schindler, 2011).
  • 29. 21 | P a g e 3.3 Sampling Design Kombo and Tromp (2006) define a sample as a finite part of a statistical population whose properties are studied to gain information about the whole sample. Saunders, Lewis & Thornhill (2003) define sampling as the process of selecting a number of individuals for a study from the larger group referred to as the population. The sample for this study will consist of 100 respondents consisting of staff of the community health projects in the categories of senior management, middle management and support staff, whose names will be obtained from the Ministry of Health offices in the County, and from which 30 respondents will be selected. Sampling frame refers to the list of elements from which the sample is actually drawn, and is closely related to the population (Cooper and Schindler, 2001). According to Cooper and Schindler (2011), it is a complete and correct list of population members only. However, it is important to note that the sampling frame often differs from the theoretical population because of errors and omissions. It is therefore a matter of judgment when it comes to exactly how much inaccuracy one can accept while choosing a sampling frame. 3.3.1 Sampling Technique The stratified random sampling technique will be used in the selection of sample elements (top, middle and management personnel) from the sampling frame. The population can be segregated into several mutually exclusive sub populations, or strata, the process by which the sample is constrained to include fundamentals from each of the segments is referred to as stratified random sampling. Stratified random sampling has three main benefits, it: increases a sample’s statistical efficiency, provides adequate data for analyzing the various subpopulations and enables different research methods and procedures to be used in different strata (Cooper and Schindler, 2001). 3.4 Data Collection Tools and Procedures There are numerous ways of collecting data and these depend on the purpose and aims of the research. In this study data will be collected by means of questionnaires and interviews. Data collection involves contacting the members of the population that will be sampled in order to collect the required information about the study (Saleemi, 1997). The researcher will employ the services of research assistants who will be given a time frame for collection of the data for analysis.
  • 30. 22 | P a g e 3.5 Data Analysis and Presentation After collection of the questionnaires, the researcher will read through them to ascertain their numbers and to see whether all the items have been responded to. Quantitative data will be analyzed by use of descriptive statistics which employs measures of central tendencies, measures of dispersion and skewness. To analyze the data, the Statistical Package for Social Sciences (SPSS) software will be used to aid data analysis. Qualitative data do not produce discrete numerical data (Mugenda and Mugenda, 2003), it is in form of words rather than numbers and therefore inferences will be made from the responses of the respondents. The data collected will be analyzed using statistical methods by use of tables, charts, frequencies and percentages. Finally, harmonization of the responses given by the various respondents will be undertaken, where responses on similar themes or objectives, emanating from different respondents will be compared to find if the various responses concurred on various issues and, if not, the possible reasons for the observed discrepancies. This discussion will be guided by the specific objectives of the study. 3.6 Validity and Reliability of Research Instruments 3.6.1: Validity The validity of a research instrument is the extent to which such an instrument is able to measure what it is supposed to measure. According to Mugenda et al (1999), validity is the accuracy and meaningfulness of inferences, which are based on the research results. Hence, validity refers to the degree to which results obtained from the analysis of the data actually represent the variables under study. In this research, the instruments used will be validated in terms of content validity. The content related technique measures the degree to which the question items reflect the specific areas covered. 3.6.2: Reliability According to Mugenda et al (1999), reliability is the ability of a research instrument to consistently measure characteristics of interest over time. Hence, reliability is the degree to which a research instrument yields consistent results or data after repeated trials. To test the reliability of research instruments used, test and re-test techniques will be used.
  • 31. 23 | P a g e 3.7 Ethical Considerations The goal of ethics is to ensure that no one is harmed or suffers adverse consequence from the research activities. Given the often sensitive relationships between researcher and respondents, reasonable safeguards will be built in this study based on ethical considerations and requirements. Therefore, the information that the researcher receives during the period of this study will be treated in confidence and purely for academic purposes. Names of respondents will not be used or mentioned in this study.
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  • 35. 27 | P a g e Appendix: ResearchQuestionnaire This is a study intended to determine the factors affecting service delivery in rural health development projects. Kindly fill in the information as accurately as possible. The information provided here will be confidential and used only for research purposes. Tick where appropriate 1. Gender Male [ ] female [ ] 2. Age 18-30 years [ ] ` 31-35 years [ ] 36-40years [ ] 41-45 years ` [ ] 0ver 46 years [ ] 3. What is your education level? College [ ] Diploma certificate [ ] Undergraduate [ ] Postgraduate [ ] 4. Level of experience Below 3 years [ ] 4-6 Years [ ]
  • 36. 28 | P a g e 7-10 years [ ] Over 10 years [ ] 5. What’s your view on the level of human labour available in the projects? Highly available [ ] Available [ ] Not enough [ ] No presence of human labour [ ] 6. Does the number of human resources affect the performance of projects? Strongly agree [ ] Agree [ ] Strongly disagree [ ] Disagree [ ] Not sure [ ] 7. Does human resource motivation influence the outcome of rural health projects? Strongly agree [ ] Agree [ ] Strongly disagree [ ] Disagree [ ] Not sure [ ] 8. What’s your opinion on the level of involvement of the community in the rural health projects Very much involved [ ] Fairly involved [ ]
  • 37. 29 | P a g e Less involved [ ] Not involved at all [ ] 9. How does community involvement influence the outcome or the performance of rural health projects in your area? ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………. 10. What’s your opinion on the level of competence of the projects team in the rural helath projects in your area? Very competent [ ] Fairly competent [ ] Less competent [ ] Not competent at all [ ] 11. What’s the level of involvement of political leaders in the rural health projects in your area? Very much involved [ ] Fairly involved [ ] Less involved [ ] Not involved at all [ ]
  • 38. 30 | P a g e 12. Does the involvement of political leaders influence the performance of rural health projects in your area? Yes [ ] No [ ] If yes explain ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………………………………………………………