An assessment of the Media High Council as a media regulatory body in Rwanda, 2007-2010

The Media High Council (MHC) was put in place by the 2003 constitution of the Republic of Rwanda as amended to today. As article 34 clarifies, the MHC is an independent institution which aims to address issues of media and press freedom. In the same spirit, the law number 30 /2009 of 16/9/2009 determines its mission, organisation and functioning. According to article 2 of this law, the Media High Council is responsible for protection, control and promotion of media and media professionals. Based on normative theories, qualitative methods and thematic analysis, this study has explored the policy formation of the Media High Council and how it has been balancing the seeming contradictory responsibilities of protecting and controlling media from 2007 to 2010.Communication ScienceM.A. (Communication

Moderating role of transformational leadership styles of hospital management boards on adoption of mobile health innovations by hospitals in Kenya

Sub-Saharan Africa lags other regions in the adoption of both Patient-Centered (PC) and Facility Centered (FC) mobile health (m-health) applications. Transformational Leadership Style (TLS) of Hospital Management Boards (HMBs) is catalytic for the adoption of disruptive technologies such as m-health by hospitals. There is limited evidence on the effect of TLS of HMBs in the adoption of innovations in Low- and Middle-Income Countries (LMICS). This study investigated the moderating role of TLS of HMBs on the adoption of PC and FC m-health by hospitals in Kenya. It used the Logit Regression Model to test null hypotheses that the four constructs of TLS (Idealized Influence (II), Individualized Consideration (IC), Inspirational Motivation (IM), Intellectual Stimulation (IS)) individually or combined had no significant moderating effect on adoption of PC and FC m-health applications.  Primary data was collected from a representative sample size of 211 Top Executives (TEs) of level 4 to 6 hospitals who evaluated the TLS of their HMBs on m-health adoption. At a 5% level of significance, the study found that only the combined application of the four constructs (II, IC, IM, IS) significantly moderated the adoption of PC m-health (p=0.046) but did not moderate FC m-health (p=0.345). Each incremental application of TLS would increase the odds of adopting PC m-health by 1.002 but not for FC. Therefore, this study recommends the capacity strengthening of HMBs in TLS to scale up PC m-health adoption in Kenya and other LMICs. It also recommends a differentiated approach to policies, practices, and theories of adoption of innovations using the PC-FC models

The technological, organizational and environmental determinants of adoption of mobile health applications (m-health) by hospitals in Kenya.

INTRODUCTION:Sub-Saharan Africa lags in adoption of mobile health (m-health) applications and in leveraging m-health for sustainable development goals. There is a need for a comprehensive investigation of determinants of hospitals' adoption of m-health in Sub-Saharan Africa to inform policies, practices and investments. METHODS:This investigation used a logit regression model to analyze the determinants of m-health adoption in Kenyan hospitals applying the Technological, Organizational and Environmental (TOE) framework and the Diffusion of Innovation (DOI) theory. A representative sample of 211 executives of Level 4-6 hospitals in 24 counties provided primary data on Patient-Centered (PC) and Facility-Centered (FC) m-health applications. RESULTS:Both PC and FC m-health adoption were predicted by competition for patients (PC p = 0.041, FC p = 0.021), IT human resource capacity (PC p = 0.048, FC p = 0.037), and hospital pursuit of market growth through technological leadership (PC p = 0.010, FC p = 0.020). Further determinants of PC m-health adoption included hospital access to slack financial resources (p = 0.006), acquisition strategy (p = 0.011), compatibility with the hospital systems (p = 0.015), trialability (p = 0.019), medical insurance company support (p = 0.025),patient pressure (p = 0.036), and perceived effect of global medical tourism (p = 0.039). FC m-health adoption was predicted by hospital size (p = 0.008), ICT infrastructure capacity (p = 0.041), and government support (p = 0.013). CONCLUSION:A differentiated approach is required to scale up m-health adoption. PC m-health requires emphasis on establishing national and regional compatibility and interoperability, developing trialability processes and validation mechanisms, incentivizing patient competition and mobility, establishing innovative and cost-effective acquisition strategies, and ensuring integration of digital services within national insurance schemes and policies. These policies require support from patients and communities to drive demand and spur investment in adequate IT human resources to maintain reliability. Pilot PC m-health projects should prioritize hospitals with slack financial resources, while FC m-health should target large facility size. FC m-health applications are more complex and costly than PC, requiring government incentives to trigger hospital investments and national investment in ICT infrastructure. Investors and hospital managers should integrate m-health into market growth strategies for sustainable m-health scale-up in Kenya and beyond

"How I Wish This Thing Was Initiated 100 Years Ago!" Willingness to Take Daily Oral Pre-Exposure Prophylaxis among Men Who Have Sex with Men in Kenya.

BACKGROUND:The MSM population in Kenya contributes to 15% of HIV incidence. This calls for innovative HIV prevention interventions. Pre-exposure prophylaxis (PrEP) has been efficacious in preventing HIV among MSM in trials. There is limited data on the willingness to take daily oral PrEP in sub-Sahara Africa. PrEP has not been approved for routine use in most countries globally. This study aimed to document the willingness to take PrEP and barriers to uptake and adherence to PrEP in Kenya. The findings will inform the design of a PrEP delivery program as part of the routine HIV combination prevention. METHODS:Eighty MSM were recruited in 2 Counties in December 2013. Quantitative data on sexual behaviour and willingness to take PrEP were collected using semi-structured interviews and analysed using SPSS. Qualitative data on knowledge of PrEP, motivators and barriers to uptake and adherence to PrEP were collected using in-depth interviews and FGDs and analysed using Nvivo. Analysis of data in willingness to take PrEP was conducted on the HIV negative participants (n = 55). RESULTS:83% of MSM were willing to take daily oral HIV PrEP. Willingness to take PrEP was higher among the bi-sexual and younger men. Motivators for taking PrEP were the need to stay HIV negative and to protect their partners. History of poor medication adherence, fear of side effects and HIV stigma were identified as potential barriers to adherence. Participants were willing to buy PrEP at a subsidized price. CONCLUSIONS:There is willingness to take PrEP among MSM in Kenya and there is need to invest in targeted education and messaging on PrEP to enhance adherence, proper use and reduce stigma in the general population and among policy makers

Reported condom use among HIV negative participants (n = 55).

<p>Reported condom use among HIV negative participants (n = 55).</p

Association between willingness to take daily oral PrEP and selected baseline characteristics among the MSM (n = 55).

<p>Association between willingness to take daily oral PrEP and selected baseline characteristics among the MSM (n = 55).</p