Focus on infrastructure, staffing as Kenya rolls out universal healthcare

Kenya will on Thursday launch the pilot phase of the Universal Healthcare Coverage (UHC) project which targets to render quality and affordable medical services to citizens.

This phase targets 3.2 million Kenyans in Kisumu, Nyeri, Machakos and Isiolo counties with the aim of providing a host of services.

But even as the country moves towards this milestone, the state of the public healthcare system remains in focus amid concern about poor staffing levels and inadequate infrastructure and equipment.

Data by the Kenya National Bureau of Statistics(KNBS) and the Kenya Institute for Public Policy Research and Analysis (KIPPRA) show that although there has been a remarkable expansion of healthcare infrastructure by counties, the number of facilities and workforce remain inadequate to cater for demand by a steadily rising population in need of such services.

"We have decided to face the challenges head-on which is good because if we were to wait until everything is in order that would take a while. There are gaps in human resource, monitoring and evaluation and financial accountability that cannot be overlooked but we remain hopeful," said Thuranira Kaugiria, secretary-general of Kenya Medical Practitioners and Dentists Union, Nairobi region.

KIPPRA estimates that the country’s population rises by at least a million persons each year — an indication of the pressure on services such as healthcare.

Lack of adequate staff remains one of the biggest challenges to the provision of sound healthcare in public hospitals. “On the supply side, Kenya has significant shortfalls in its health workforce relative to cadre norms, and the distribution of the human resource is not balanced across counties.

“Shortfalls have been observable despite an increase in registered medical personnel, which increased by an annual average of eight per cent between 2013 and 2016,” KIPPRA observed in an assessment report on healthcare delivery in Kenya under the devolved system.

According to the Economic Survey 2018, the number of registered health personnel per 100,000 people increased from 329 in 2016 to 349 in 2017.

The highest increase in the number of personnel per 100,000 population was recorded for registered nurses, from 106 in 2016 to 112 in 2017, while the number of students in-training increased from 17,224 in 2015/2016 to 23,887 in 2016/2017.

Despite remarkable growth in the overall number of health workers in Kenya following devolution, public hospitals and some regions especially those in rural areas and the Arid and Semi-Arid Land (ASALs) remain disadvantaged.

Most medical personnel shun public hospitals in favour of privately run facilities which pay better.

Further, cities such as Nairobi are considered more desirable, especially for professionals who find rural living conditions more difficult.

Rural areas are associated with less access to training opportunities and hence no advancement, inadequate social infrastructure, and less support.

These and other factors have made it difficult to attract health workers to rural areas, KIPPRA observed. Data by KIPPRA showed that in the 2015/2016 period only two counties met requirements on three workers per 10,000 population, even though the ratio improved from 0.25 per 10,000 people in 2012 to 0.6 per 10,000 in 2015/16.

“Perhaps, counties and the Ministry of Health need to either design new norms for distribution of health workers and or mainstream innovative modalities of distributing tasks among existing staff,” KIPPRA observed. Apart from staffing levels, focus is put on the country’s physical health infrastructure. The WHO recommends 15 health centres per 30,000 people and 45 dispensaries per 10,000 people. In addition, the national norms require each person to live within a five-kilometre radius of a health facility to ensure access to basic health services.

A survey by KIPPRA showed that in Kenya, the average of the distance to the nearest health facility was three kilometres and that it took about an one hour to get there.

“Across the counties, the distance ranged between a low of 1.4 kilometres and a high of 52.6 kilometres while the time taken ranged between 13.3 minutes and 93.3 minutes,” the think-thank said.

“Over 50 per cent of counties had average distances higher than the national average, while 27 per cent were above the expected norm. The distance that individuals cover to access a health facility can be a deterring factor to uptake services.”

Healthcare infrastructure has seen expansion and improvement with an increase in the number of facilities from 8,616 before devolution in 2013 to 11,324 in 2017. This has increased the national average facility density from 19 to 24 per 100,000 people.

About 80 per cent of the facilities are at Level Two (dispensaries) and Three (health centres), which focus on primary healthcare, while 20 per cent of the facilities fall in Levels Four and Five.

These comprise secondary health facilities and provide specialised services, while Level Six facilities are highly-specialised referral hospitals and provide healthcare, teaching, training and research services.

On average, in the last four years, the density has been 22 health facilities per 100,000 people.

“Generally, the country had inadequate infrastructure especially in ASALs, leading to limited access, and in other areas congestion in existing facilities.

“Limited facilities translate to fewer in-patient beds per population served; it also implies inadequate medical service provision,” KIPPRA concluded.