Optimizing pragmatic strategic management practices to augmentactive tuberculosis case finding within health facilities in Nairobi County, Kenya

Abstract

Strategic management is essential for achieving organizational objectives; however, its application in healthcare—particularly in tuberculosis (TB) control—remains limited. The strategic management practices are known to positively correlate organizations growth and they include strategy formulation, goal establishment, financial ratio examination, Total Quality Management, social capital cultivation, and enhancing entrepreneurial orientation. The Porter Diamond Theory of National Advantage, developed to explain the competitive advantage that nations or regions may possess based on specific domestic factors. Infectious diseases are caused by pathogens and include TB, malaria, HIV/AIDS, and influenza. TB continues to pose a major global health threat, responsible for approximately one million deaths annually. Despite Kenya’s significant investments in active TB case finding, 40% of cases remain undetected, with Nairobi County alone contributing over 14% of the country's annual TB notifications. This study addresses the research gap by assessing how optimizing pragmatic strategic management practices can improve active TB case finding within health facilities in Nairobi County. Specifically, the study sought to: (1) establish the implementation rate of strategic management practices; (2) model the strategic management practices coefficient matrix; (3) measure the capacity of health facility staff in implementing strategic management practices; and (4) determine the challenges and significance associated with optimizing strategic management practices in active TB case finding within healthcare facilities in Nairobi County. Guided by the Porter Diamond Theory and grounded in pragmatic philosophy, the study adopted a mixed-methods design. Data were collected from 220 of 239 TB treatment facilities (92.1%) and 406 clinic respondents (84.9%) between April and June 2024 through structured questionnaires and four focus group discussions conducted. The implementation period assessed was January 2020 to December 2023. The reliability coefficient of the instrument was 0.794, with goal establishment demonstrating strong sampling adequacy (KMO = 0.745). Findings indicate a low implementation rate of strategic management practices, yet these practices significantly predicted TB case finding outcomes (β = .574). Sensitization and availability of strategic plans were significantly associated with case finding success (χ² = 49.771, p < .001). Although infrastructure was generally rated highly, specific areas such as screening spaces were inadequate. Frequent capacity building showed a significant positive relationship with case finding (χ² = 11.223, p = 0.0003), while training duration showed no such association. Strategic practices correlated positively with firm strategy and structure (r = .356, p < .001), and logistic regression revealed that strategic management practices predictors were associated with a 25% to 84% likelihood increase in case detection. Key challenges included inadequate staffing, logistical barriers, financial impropriety and equipment maintenance issues. The study recommends optimizing strategic planning, enhancing community engagement, increasing innovation, and ensuring sustainability through resource mobilization. It also proposes adapting the Porter Diamond Theory with locally grounded frameworks that incorporate health systems thinking and governance tools. The study contributes significant empirical evidence on the role of strategic management practices in improving TB case detection and informs policy and practice in public health strategy design