Healthcare in Kenya

This article is about Healthcare in Kenya. For the general health issues, see Health in Kenya.

Kenya’s health care system is structured in a step-wise manner so that complicated cases are referred to a higher level. Gaps in the system are filled by private and church run units.

Health care units

Dispensaries

The government runs dispensaries across the country and are the lowest point of contact with the public. These are run and managed by enrolled and registered nurses who are supervised by the nursing officer at the respective health centre. They provide outpatient services for simple ailments such as common cold and flu, uncomplicated malaria and skin conditions. Those patients who cannot be managed by the nurse are referred to the health centres there.

Private clinics

Most private clinics in the community are run by nurses. In 2011 there were 65,000 nurses on their council's register. A smaller number of private clinics, mostly in the urban areas, are run by clinical officers and doctors who numbered 8,600 and 7,100 respectively in 2011. These figures include those who have died or left the profession hence the actual number of workers is lower.

Health centres

All government health centres have a clinical officer as the in-charge and provide comprehensive primary care. Because of their heavy focus on preventive care such as childhood vaccination, rather than curative services, local council (municipal) and most mission, as well as many private health centres, do not have clinical officers but instead have a nurse as the in-charge.

Health centres are medium-sized units which cater for a population of about 80,000 people. A typical health centre is staffed by:

All the health centre staff report to the clinical officer in-charge except the public health officers and technicians who are deployed to a geographical area rather than to a health unit and report to the district public health officer even though they may have an office at the health centre.

The health centre has the following departments:

Sub-district hospitals

These are similar to health centres with addition of a surgery unit for Caeserian section and other procedures. Many are managed by clinical officers. A good number have a medical officer and a wider range of surgical services.

Nursing Home

These are owned privately by individuals or churches and offer services roughly similar to those available at a sub-district or district hospital. They are also believed to provide better medical services compared to public hospitals.

District hospitals

Each district in the country has a district hospital which is the co-ordinating and referral centre for the smaller units. They usually have the resources to provide comprehensive medical and surgical services. They are managed by medical superintendents.

County hospitals

Kenya has 47 counties, each with a county hospital which is the referral point for the district hospitals. These are regional centres which provide specialised care including intensive care and life support and specialist consultations.

National hospitals

There are two national hospitals in Kenya, namely:

Major causes of morbidity and mortality

Maternal and child healthcare

The 2010 maternal mortality rate per 100,000 births for Kenya is 530. This is compared with 413.4 in 2008 and 452.3 in 1990. The under 5 mortality rate, per 1,000 births is 86 and the neonatal mortality as a percentage of under 5's mortality is 33. In Kenya the number of midwives per 1,000 live births is unavailable and the lifetime risk of death for pregnant women 1 in 38. [1]

Ministry of Health

The Ministry of Health has its headquarters at Afya house in Nairobi. There are two ministers:

Each minister has two assistant ministers and a permanent secretary.

Director of medical services (DMS)

District medical officer of health (DMOH)

Health centre management committee (HCMC)

Important institutions (acts of parliament)

Clinical officers council

The Clinical Officers Council (COC) in Kenya is a statutory body in the Ministry of Medical Services legit as by CAP 260 of the laws of Kenya which oversees the training, registration and licensing of Clinical officers in Kenya.

Nursing Council of Kenya (NCK)

The Nursing Council of Kenya is a body corporate established under the Nurses Act Cap 257 of the Laws of Kenya to regulate standards of nursing education and practice in Kenya. It protects the public by promoting standards of clinical care through training, licensure and enforcement of codes of regulation.

Kenya Medical Supplies Agency (KEMSA)

The Kenya Medical Supplies Agency (KEMSA) is a specialised medical logistics provider for Ministries of Medical Services/Public Health-supported health facilities and programmes.[2]

Pharmacy and Poisons Board

The Pharmacy and Poisons Act, Cap 244 is an Act of parliament to make better provision for the Control of the Profession of Pharmacy and trade in drugs and poisons. The Pharmacy and Poisons Board (PPB) is established as a body corporate, under the Pharmacy and Poisons Act, Cap 244 Laws of Kenya. The PPB is regulatory body within the Ministry of Medical Services. It is a body corporate under Section 3(6), and the de-linking process is on-going.

National Hospital Insurance Fund (NHIF)

Membership to the National Hospital Insurance Fund is compulsory to all salaried employee with voluntary membership to those in self-employment. Contributions range from Ksh 160 to a maximum Ksh 320. However plans are underway to compute contributions as a percentage of ones salary. When members or their declared dependants fall ill and are admitted in accredited hospitals, they are only required to pay the balance of the bill after the rebate has been calculated. The rebate varies depending on the hospital status and ranges from ksh 400 to ksh 2,000 per day.

Kenya Medical Research Institute (KEMRI)

A state corporation that carries out medical research in Kenya. It collaborates with foreign research organisations such as CDC, The Wellcome Trust, Walter Reed Army Institute of Research etc.

Private Health management organisations

Private companies which offer additional health cover usually including outpatient cover which is not covered by the NHIF. They include:

Careers and training

Decentralization

Location Kenya AU Africa

In August 2010, Kenya conducted a national referendum that ushered in a new constitution. The new constitution introduced a new governance framework with a national government and 47 counties. This has been termed as decentralization or devolution. This was a marked shift from the highly centralized form of government that had been in place since independence in 1963. The centralized governance was plagued by political and economic dis-empowerment and unequal distribution of resources.[4]

The term ‘decentralization’ is used to describe a wide variety of power transfer arrangements and accountability systems. Policies range from the transfer of limited powers to lower management levels within current health management structures and financing mechanisms to extensive sectoral reform efforts, which reconfigure the provision of even the most basic services. In the first case, decentralization may later become the driving force for health sector reform; in the latter, it is driven by the wider sectoral reform efforts. The parameters for decentralization -- the speed, the pressures, and the scope of issues to consider -- vary considerably.[4]

In the Kenya context, the expectation is that a devolved health system will lead to improvement in efficiency of service delivery, stimulate innovation in the wider sector, improve access to and equity of available services, and promote accountability and transparency in service delivery.[5]

Context of Healthcare in Kenya

Map of Kenya.

A majority of Kenya’s population receives healthcare services from the public sector. The range of services include preventive, promotive, curative and rehabilitative. Preventive services include routine childhood immunizations and environmental activities to control mosquito breeding which in turn reduce malaria transmission. Promotive services are mostly educational services provided to the general population on healthy lifestyles and available interventions. Curative and rehabilitative services include all treatment activities available at hospitals and other healthcare facilities.

To achieve these functions, the Kenya government has traditionally run a network of healthcare facilities staffed by government employees and run directly by the budgets allocated by the government from public resources. Under the centralized system, all healthcare facilities were organized into 6 levels as follows:

Level Type Location Examples
1 Community Units Community Kosirai community unit
2 Dispensary Village Level Isana Dispensary
3 Health Centre Locational Level Mosoriot Health Centre
4 District Hospital District Headquarters Kapsabet District Hospital
5 Provincial Hospital Provincial Headquarters Rift Valley Provincial General Hospital
6 National Hospital Capital City Kenyatta National Hospital

Strategy of Decentralized Healthcare

In the devolved government, the Kenya Health Policy 2014 – 2030 provides guidance to the health sector in terms of identifying and outlining the requisite activities in achieving the government’s health goals.[6] The policy is aligned to Constitution of Kenya and global health commitments.

Under the devolved system, healthcare facilities are organized as follows:

In essence, the decentralized system has consolidated service areas into 4 main categories for ease of governance and responsibility. These responsibilities are shared between the national government and county governments.

Devolution Kenya

National Level Responsibilities

County Level Responsibilities

Kenya Devolved Health. Source: Kenya Health Policy

Governance

The Kenya Health Policy 2014 – 2030 also provides an institutional framework structure that specifies the new institutional and management arrangements required under the decentralized system. The policy acknowledges the need for new governance and management arrangements at both levels of government and outlines governance objectives.

Some of key objectives that are set for governance systems at the county levels include:

Financing

In Kenya, the primary sources of funding for healthcare are:[7]

  1. The public. These are government allocations from the national budget comprising about 30% of the total yearly expenditure in healthcare in the country. This also the main source of funding for about 80% of the population that receives services from the public sector.
  2. Private (consumers). This is the largest contributor of total healthcare funds spent in the country at 35.9% of the total expenses. These funds serve about 20% of the population that is able to access private healthcare services. These are mostly funded through company or employee insurance schemes. These funds are thus not available for the newly decentralized units.
  3. Donors. These include funds to fight high burden diseases such as HIV, malaria and Tuberculosis. These funds directly supplement public sector funds and contributes about 30% of the total healthcare expenditure in the country.

The health service delivery function was formally transferred to counties on August 9, 2013, and one-third of the total devolved budget of KSh 210 Billion ($2 Billion) was earmarked for health in the 2013/2014 budget following the transfer.[8]

The budget for 2015/6 imposed severe restrictions. KSh 43 billion was allocated to the maternity budget, as in the previous year. Funding for the Kenyatta National Hospital was reduced from 9.3 to 8.8 KSh billion. The Kenya Medical Research Institute was reduced to KSh 1.7 billion from KSh 1.9 billion and the National Aids Control Council was cut to KSh 600 million from KSh 900 million and the slum health programme to KSh 700 million from KSh 1 billion.[9]

See also

References

  1. ↑ "The State of the World's Midwifery". United Nations Population Fund. Retrieved August 2011. Check date values in: |access-date= (help)
  2. ↑ http://www.kemsa.co.ke/index.php?option=com_content&view=article&id=34&Itemid=3
  3. ↑ http://avenuehealthcare.com/managed%20care.html
  4. 1 2 Decentralization: The World Bank Group; Accessed. http://www1.worldbank.org/publicsector/decentralization/service.htm.
  5. ↑ Nyongesa H, Munguti C, Odok C, Mokua W. Perceptions of medical students towards healthcare devolution: an online cross-sectional study. The Pan African medical journal. 2015;20:355.
  6. ↑ MOH. Kenya Health Policy 2014-2030.
  7. ↑ Government of Kenya, 2011. National Health Accounts, 2009/2010. Ministry of Medical Services and Ministry of Public Health and Sanitation.
  8. ↑ Health Policy Project, Futures Group. Devolution of healthcare in Kenya assessing county health system readiness in Kenya: a review of selected health inputs. July 2014.
  9. ↑ "Kenya's health budgets either slashed or stagnated". Standard media. 9 June 2016. Retrieved 9 June 2016.
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