Approximately 63% of Kenyans access public health facilities. The facilities are unequally distributed across the 47 counties, with a national average facility density of 22 health facilities per 100,000 populations. The average distance between places of residence and nearest low level health facilities is about 3 kilometers (an average time of one hour by foot), which becomes a hindrance to uptake of health services (Mugo et al., 2018). Considerable distance to the nearest formal health provider acts as an important barrier to access for Kenyans from rural communities, who are therefore more likely to rely on traditional healers rather than seek care services in health facilities.

Nearly a third of the population in Kenya access levels 1-3 levels of care (further described in table 2) which form 80% of public health facilities as they are focused on primary health care services, while the hospitals (rest of the facilities) provide specialized services (Mugo et al., 2018). The national health sector referral strategy aims to improve client access to services and provides clear guidelines on referral processes through (Ministry of Health, 2014d):

• Realization of the capacity of health care providers to make appropriate referrals
• Development of protocols that will lead to referral system efficiency and effectiveness
• Promotion of information use and communication technology (ICT) to manage referral processes
• Promotion of research and innovation for referrals

Another initiative by the national government to increase access to health care services includes implementation of the Universal Health coverage (UHC), called “Afya Care” which is part of the Big Four Agenda. The Big Four Agenda has been implemented by the Kenyan government to ensure (i) the Expansion of the Manufacturing Sector, (ii) Affordable Housing, (iii) Affordable Healthcare and (iv) Food Security.

The pilot phase of the UHC (launched in 2018 with a national roll-out out expected in 2022) is covering 4 out of 47 counties with a high disease burden, (Kisumu, Machakos, Nyeri and Isiolo – which represent about 5% of the Kenyan population) and involves the removal of user fees at all public health facilities (including levels 4 and 5). It also ensures ‘commodity security’ that is, uninterrupted supply of quality and affordable medicines through KEMSA. This pilot phase encourages uptake and utilization of community Health Volunteer (CHVs) services and strengthening health systems in the other 43 counties by ensuring efficient and appropriate use of health funds in preparation for scale-up (Kariuki, 2019). Provision of health services will cover emergency, community, outpatient, and inpatient services for both communicable and no-communicable illnesses including mental health and maternity care. Furthermore, there is a focus on improving access to quality primary health care services by supporting operation and maintenance costs. There is only one out of the 43 non-pilot UHC counties (Makueni County), that has introduced some component of universal health care (Makueni Care), where a family (household) pays an annual fee of Kshs. 500 ($5 US dollars) to cover both preventive and curative services as well as free access to health care services (without payment) for individuals above 70 years. However, most hospitals are located far from people’s homes and only a small percentage of the population is able to access extensive services at higher levels of care (table 2). For instance, the risk of developing multiple illnesses and requiring long-term support is higher among older people, yet some of these services and medications can only be accessed at higher levels of care (levels 4-5) and are therefore inaccessible to a large population. In other non-pilot UHC counties, access to health care is limited. Out-of-pocket costs for registration upon first visit to the health facility and limited supply of medication at the public facilities create barriers to access and quality of care.

References:

Kariuki, S. (2019). World Health Day: Universal Health Coverage – Everyone, Everywhere – Celebrating Kenya’s journey towards universal health coverage. https://www.health.go.ke/wp-content/uploads/2019/04/WORLD-HEALTH-DAY-SUPPORT-07-04-2019.pdf

Ministry of Health. (2014d). Kenya Health Sector Referral Strategy. Ministry of Health Division of Emergency and Disaster Risk Management Afya House. https://www.measureevaluation.org/pima/referral-systems/referral-strategy

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