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

i | 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:

ii | 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.

iii | 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.

iv | 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.

v | P a g e

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

vii | P a g e

ContentsDECLARATION.............................................................................................................................................. ii

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

viii | P a g e

2.5.1 Stakeholder Theory.......................................................................................................................16

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 and Procedures.................................................................................................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

ix | 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

1 | 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.

2 | 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.

3 | P a g e

1.4 Research questions

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.

4 | 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.

5 | 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

6 | 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.

7 | 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.

8 | 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

9 | 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

10 | 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

11 | 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

12 | 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.

13 | 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

14 | 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

15 | 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

16 | 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

17 | 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).

18 | P a g e

2.6 Conceptual Frame Work

19 | P a g e

Project performance

Dependent variables

Leadership Capabilities Competence in

leadership Commitment of

leaders

Resources Human resources Financial availability

Independent variables

Societal Culture Societal involvement

in project. Traditional norms and

rules

Political Organizations

Influence of political leaders,

Political parties and groups

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 Research Design 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 studyThe 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).

20 | 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.

21 | 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.

22 | 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.

23 | 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.

24 | 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.

25 | 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.

26 | P a g e

Appendix: Research Questionnaire

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 [ ]

27 | 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 [ ]

28 | 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 [ ]

29 | 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

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………

30 | P a g e