02.01.01. The public health system | Kenya

02 Mar 2022

63% of the Kenyan population access public health services within a distance of 1 hour walk on foot (Mugo et al., 2018). The public sector in Kenya is composed of the national government, county government, development partners and public corporations. Their main mandate is to strengthen performance and management systems including the capability of public service leadership and to enhance quality and efficiency of public service delivery while transforming the culture and attitude of its employees (Fortune of Africa, 2019).

The public health system is overseen by the Ministry of Health and parastatal organizations. It includes a total of 4,616 health facilities, and consists of different levels of care, including national referral hospitals (level 6 – highest level of care – only four in Kenya (Kenyatta National Hospital, Moi Referral and Teaching Hospital, Mathari Hospital and National Spinal Injury Hospital), county hospitals (level 5), sub-county hospitals (level 4), health centres (level 3), dispensaries (level 2) and communities (level 1). Any higher level facility acts as a referral centre for the lower level facility (see table 2 below). The different levels of care are outlined below (Noor et al., 2006).

Table 2: Description of health services provided by the Kenyan public sector

Level of service

Purpose

Services offered

% of individuals accessing outpatient public services

Expected catchment population

National Referral services (level 6)

Serve all Kenyans and act as referral centre for County hospitals

Surgical services, internal medicine, and specialty services such as emergency obstetric care (EmOC) and anesthesiology

Referral services accessed

5,000,000

County Referral Services (level 5)

The intermediary between national referral hospitals and sub-County hospitals. Their role is to coordinate Sub-County activities while providing some form of specialized care

Less extensive surgical services, internal medicine, and specialty services as compared to the National Referral Hospitals

18.3%

1,000,000

Sub-County (Primary care services) (level 4)

These serve as the referral centres for health centres and offer outpatient, inpatient and maternity services, emergency surgery, blood transfusion and laboratory services

Antenatal care (ANC) and routine birthing services, formal immunization programs, HIV/ AIDS care, paediatric and Emergency Obstetric Care (EmOC) services

100,000

Health centres (primary health care services) (level 3)

Identification of cases that need to be further managed at higher levels of care

Preventive and curative services with a focus on primary care services

40.1%

30,000

Dispensaries – primary care health services (level 2)

This is the intermediary between the community and health centres. The role is to receive cases directly from the community level for provision of primary health care services.

Preventive and curative services with a focus on primary care services

10,000

Community-based services (level 1)

Health promotion and demand creation: To prevent affliction and promote good health to avert the need for facility-based care

Some of the interventions provided focus on sleeping under insecticide treated mosquito nets to avert malaria. However, when affliction arises, the system expects the first port of call to be the dispensary (Level 2)

Prevention services and based on home visits

5,000 per unit

Source: (Kenya Healthcare Federation and Task Force Health Care, 2016; Ministry of Health, 2014e; Mugo et al., 2018)

References:

Fortune of Africa. (2019). Public Sector Profile of Kenya. https://fortuneofafrica.com/kenya/public-sector/

Kenya Healthcare Federation and Task Force Health Care. (2016). Kenyan Healthcare Sector: Opportunities for the Dutch Life Sciences & Health Sector. Nairobi, Kenya. http://khf.co.ke/wp-content/uploads/2018/03/2016-Kenyan-Healthcare-Sector-Report.pdf

Ministry of Health. (2014e). Towards Universal Health Coverage: The Kenya Health Strategic and Investment Plan, 2014 – 2018 – Human Resources for Health Norms and Standards Guidelines for the Health Sector. https://www.health.go.ke/wp-

Mugo, P., Onsomu, E., Munga, B., Nafula, N., Mbithi, J., & Owino, E. (2018). An Assessment of Healthcare Delivery in Kenya under the Devolved System (No. Special Paper No. 19). Nairobi, Kenya.https://repository.kippra.or.ke/bitstream/handle/123456789/2095/an-assessment-of-healthcare-delivery-in-kenya-under-the-devolved-system-sp19.pdf?sequence=1&isAllowed=y

Noor, A. M., Amin, A. A., Gething, P. W., Atkinson, P. M., Hay, S. I., & Snow, R. W. (2006). Modelling distances travelled to government health services in Kenya. Tropical Medicine & International Health, 11(2), 188–196. https://doi.org/10.1111/j.1365-3156.2005.01555.x