Coastal counties have the most satisfactory healthcare services, a new national survey among households showed, reflecting gains of deeper investment in the workforce, equipment and consumables such as medicine.
The study by the Kenya Institute for Public Policy Research and Analysis (KIPPRA) showed that Kwale, Mombasa and Kilifi were among the top-five counties where households felt they had the best deal in terms of access to improved and quality healthcare since the onset of the devolved system of governance in 2013.
The quality of healthcare was determined by the level of investment in health facilities, equipment, medical commodities such as drugs and other consumables, and human resources in health.
Kwale topped the 47 counties with an overall satisfactory rate of 90 percent which households attributed to improved stocks of medical equipment as well as an expanded number of medical facilities and the recruitment of more doctors. For instance, data by KIPPRA showed that the number of health facilities in Kwale rose 35 percent to 147 by 2017, from 99 when the devolution system kicked in five years ago. Mombasa was ranked second with a healthcare satisfaction rate of 89.8 percent, followed by Turkana (83.6 percent), Uasin Gishu (81.4 percent) and Kilifi at 81.17 percent.
On the flip side, households in a host of counties including Nairobi, Tana River and Tharaka-Nithi felt short-changed by the quality of healthcare provided.
The KIPPRA survey ranked Tana River as having the lowest level of satisfaction in its healthcare. Households in the county ranked their satisfaction at 12 percent, citing lack of essential medical equipment at dispensaries and other health facilities as well as shortage of doctors.
Similar concerns saw Nairobi and Tharaka Nithi ranked lowly by households at 38 percent and 35 percent respectively. “Overall, the KIPPRA Health Assessment Survey 2017 found that 60 percent and 57.1 percent of respondents at both the national and county government healthcare systems felt that there was need for substantial improvement in these dimensions,” the think-tank said in its survey report.
It added: “About 90 percent of the counties had established management structures composed of community health committees, primary care management committees, hospital boards and county departments responsible for health.”
Overall, KIPPRA said, though a significant number of respondents indicated that improvement in the health system is required, both the national and county healthcare systems fell short of their expectations.
“Only 28.6 percent and 2.9 percent individuals from counties felt that the national healthcare system met expectations or exceeded expectations, respectively,”the report said.
In terms of the level of satisfaction with services provided across health facilities, maternity/nursing homes (88.3 percent), mobile clinics (85.7 percent) and district hospitals (65.6 percent) were rated fairly well compared to the other types of facilities.
The highest level of dissatisfaction was observed in medical clinics.
Over 95 percent of the population which visited health facilities was satisfied. Specifically, 96.7 percent, 97.3 percent and 96.7 percent were satisfied with services rendered by health administrators, nurses and doctors, respectively.
The approval ratings were generally greater in rural areas than urban areas. All the aspects of service delivery were rated above 70 percent.
“Medical personnel generally understood their duties and could treat patients with high standards of courtesy. They were also able to respect patients’ privacy during consultation, listen to them carefully, undertake necessary physical examination, recommend laboratory examination where necessary, and explain required medical procedures in an understandable manner” the survey showed.
Despite the high approval ratings for personnel services, availability of medical drugs was the single area in which respondents recorded adverse levels of satisfaction. The drug availability index was 65.8 percent at the national level, ranging from a high of 84 percent to low of 50 percent for the various clusters of drugs. This implies that access to basic drugs such as child health tracer drugs, first line drugs for HIV, first line treatment for malaria, medicine for TB and metformin oral treatment for diabetes is still a challenge with a national deficit of 34.2 percent.
On average, 83 percent of health facilities in counties had HIV drugs. Availability of maternal health tracer drugs in counties was recorded at 78.3 percent but just 39 percent had child health tracer drugs.
Most facilities had drugs for diabetes; availability of metformin was at 71.7 percent nationally. Counties such as Laikipia, Mombasa, Nakuru and Narok missed essential drugs for tuberculosis, child health tracer drugs, maternal health tracer drugs, and HIV drugs respectively.
However, compared to the period prior to devolution, availability of drugs in facilities has improved with 55.6 percent of households indicating that health facilities had more drugs and medical supplies (63.9 per cent) than the period before devolution.
Perceptions were higher in rural areas (77.2 percent) compared to urban areas (22.8 percent), meaning the biggest gainers from devolution were those using rural facilities.
Whereas drug availability had marginally improved in urban areas, a majority (76.5 percent) of the purchases were executed at the facility pharmacy.
“This may be interpreted to imply that the facilities in urban areas are better equipped than those in rural areas long before devolution. On average, about 38 percent of households purchased commodities from private facilities and/or shops,” KIPPRA said.