Ibrahim hassan RESEARCH METHODOLOGY.pptx

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1. Dr ibrahim abdi hassan Phd jkuat

2. Background of the Study Sub-Saharan Africa accounted for 86 percent of all deaths, resulting in over 250,000 deaths. This depicts a depressing and concerning trend. While Sub-Saharan Africa and Southern Asia accounted for the majority of these deaths, the WHO (2017) also noted that deaths in Southern Asia had decreased by about 38% overall. The sustainable development goals (SDGs) aim to reduce maternal mortality to less than 70 deaths per 100,000 live births by 2030, but the main barrier to achieving this goal is the inadequate status of maternal and child health care systems which can only be improved on through vigorous reforms in the health care delivery mechanism. In Africa health service delivery accounts for a big chunk of global maternal deaths, in 2013 about 289,000 women worldwide died during pregnancy or childbirth, and of those deaths, 62% occurred in sub-Saharan Africa. Trends in Maternal Mortality: 1990 to 2013. The report adds that in 2013, the maternal mortality ratio in developing countries was 230 women per 100,000 births, versus 16 women per 100,000 in developed countries Demographic Health Survey (2008/09) noted that in Kenya, maternal mortality remains high at 488 maternal deaths per 100,000 live births. While this is below the Sub-Saharan average of 640 deaths per 100,000, Kenya experiences a very slow progression in maternal health. Many of these deaths could have been averted if women had timely access to skilled attendance and essential obstetric and neonatal care. UNFPA (2015) a recent analysis by the University of Nairobi showed that 98 per cent of these deaths are concentrated in just 15 of the country’s 47 counties (Okoth Joshua Odhiambo, 2021). In Uganda, Child and maternal mortality rates remain high with 90 under-five child deaths per 1,000 live births and 438 maternal deaths per 100,000 live births. Among children under 5, more than a third are stunted and under-nutrition contributes to four in 10 deaths. A particular challenge in Uganda is inconsistent service coverage along the continuum of care and low uptake of reproductive and child health services in public health facilities (UNICEF, 2018). Since 2000, Ethiopia has reduced maternal and child mortality by half, but a maternal mortality rate of 412 per 100,000 live births and a child mortality rate of 67 per 1,000 are still too high. Nearly 4 out of every 10 Ethiopian children are stunted from chronic malnutrition due to the lack of nutrient-rich foods or appropriate care and feeding practices (USAID, 2019).

3. Background of the Study Somalia is among the 15 countries that WHO marked as very high alert countries for maternal deaths. Somalia has one of the worst maternal conditions in the world (Adam, Magan, & Ali Omar, 2021). The Maternal Mortality Ratio (MMR) is 692/100,000 live births where 1 in 20 women would die from pregnancy-related causes during their reproductive lifetime. Four in 100 Somali children die during the first month of life, eight in 100 before their first birthday, and 1 in 8 before they turn five. Many die or suffer near misses due to lack of access or lack of knowledge of health services (Adam, Magan, & Ali Omar, 2021). Delay in seeking medical care is one of the most significant factors contributing to maternal deaths in Somalia. This is largely due to cultural beliefs and practices, a lack of knowledge about complications and the benefits of modern healthcare services, and women's low status in society ( Reliefweb , 2021). Somalia is dealing with health issues, including malaria in children, tuberculosis in adults, and cholera outbreaks. Furthermore, the healthcare quality provided to individuals is very low, and the number of maternity services accessible is limited in comparison to the population, resulting in a severe shortage. Consequently, due to a lack of availability of high-quality food and balanced diets, there is a low rate of immunization among newborns with severe malnutrition (MOHDPS, 2013). The situation of access to medical care by mothers and children in Somalia is currently undergoing a rapid shift as access to health care is improved as a result of the decentralization of health services to local governments. Although Somalia's government has approved a constitution to empower citizens, setting the way for accessible access to health care, more has to be done in terms of assessing the role of decentralization in health service delivery (MOHDPS, 2013).

4. General Objective The General objective of this research will be to establish the moderating effect of decentralization policy on the relationship between health services delivery decentralization strategies and the health of mothers and children in Somalia. Specific Objectives To determine the effect of fiscal decentralization strategy on the health of mothers and children in Somalia To establish the effect of administrative decentralization strategy on the health of mothers and children in Somalia To assess the effect of procurement decentralization strategy on the health of mothers and children in Somalia To find out the effect of community participation decentralization strategy on the health of mothers and children in Somalia To establish the moderating effect of decentralization policy on the relationship between decentralization strategy and the health of mothers and children in Somalia.

5. Research Hypotheses Fiscal decentralization strategy has no significant effect on the health of mothers and children in Somalia Administrative decentralization strategy has no significant effect on the health of mothers and children in Somalia Procurement decentralization strategy has no significant effect on the health of mothers and children in Somalia Community participation decentralization strategy has no significant effect on the health of mothers and children in Somalia a. To establish the moderating effect of decentralization policy on the relationship between fiscal decentralization strategy and the health of mothers and children in Somalia. To establish the moderating effect of decentralization policy on the relationship between administrative decentralization strategy and the health of mothers and children in Somalia. To establish the moderating effect of decentralization policy on the relationship between procurement decentralization strategy and the health of mothers and children in Somalia. To establish the moderating effect of decentralization policy on the relationship between community participation decentralization strategy and the health of mothers and children in Somalia.

6. Independent Variables Moderating Variable Administrative Decentralization Strategy Decentralization of support staff hiring Decentralization of staff training Decentralization of hiring midwifes Decentralization on hiring medical doctors   Procurement Decentralization Strategy Authority for local purchases Engaging local suppliers Percentage of procurement authority Authority for local tendering Decentralized Policy Fiscal policy Administrative policy Procurement policy Community participation policy Fiscal Decentralization Strategy Autonomy on local revenue collection Autonomy in local revenue spending Autonomy in local health care budgets Autonomy in local social program budgets     Health of Mothers and Children Number of mothers receiving health care Mothers who had receiving prenatal care Mothers who had receiving postnatal care Number of children receiving vaccinations     Community participation Community participation in social programs Community participation in running the hospitals Community participation in decision making   Independent Variables

7. RESEARCH METHODOLOGY Research Philosophy - Positivism philosophy -to help the researcher operationalize the concepts, formulate hypotheses which will be tested and provided the empirical explanations to the causes and effects relationship between variables Research Design – Explanatory Research Design - explore and establish causal relationships between variables. Target Population – 594 (97 doctors and 497 walk in mothers) staff and walk in mother patients in hospitals somalia Sampling Frame – Hospitals of the federal states of Somalia . Sample Size- Yamane, (1973) formulae - 411 n= = = 411 Where: N = Total population, n = Sample population, α = Sampling error which is 0.05 Sampling Technique – cluster sampling – doctors and mothers; purposive sampling method – identify the doctors Si mple random sampling method- to ensure each member of the population has an equal chance of being selected – walk in mothers Unit of analysis – Hospitals in Somalia Unit of observation – doctors and walk in mother patients Data Collection Instruments  - unstructured questionnaire- capture opinion of respondents