Strengthening Primary Healthcare in Kenya: Impact, Challenges, and Potential Solutions

Understanding Primary Healthcare: A Foundation for Health

by Abdalla Mwita

What is Primary Healthcare (PHC):

?Primary health care (PHC) is “essential health care made accessible, acceptable and affordable through full participation of individuals, families and communities.

What are the Key Components of Primary Health Care?

?Health in All Policies (HIAP)/ Multi-sectoral Action 2) Empowering individuals, families & communities 3) Integrating health services.

Why Primary Health Care?

·?????? It provides High-quality, low cost of care to individuals and families.

·?????? It supports more equitable distribution of health and reduce health inequalities.

·?????? PHC serves as an early warning system to detect and stop disease outbreaks.

·?????? It Empowers Individuals, families and communities to make decisions about their

·?????? health.

·?????? PHC improves health by providing access to more appropriate services.

·?????? Targeted investment in PHC amplifies efforts to Improve Health across the lifespan

from Birth to old Age.

What is the role of government in implementation Primary health care?

·?????? Creating an enabling environment through Laws, Regulations, Policies, and Strategies)

·?????? Capacity Building

·?????? Providing financial support.

·?????? Promoting awareness and education.

·?????? Offering Health services.

·?????? Addressing social

How are the health services classified in Kenya?

Levels:

·?????? Level 1: Community services

·?????? Level 2: Dispensaries and clinics

·?????? Level 3: Health centers and maternity/nursing homes

·?????? Level 4: Sub-county hospitals and medium-sized private hospitals

·?????? Level 5: County referral hospitals and large private hospitals ? Level 6: National referral hospitals Sector Classification:

·?????? Public: Government-run facilities

·?????? Private: For-profit healthcare providers

·?????? Faith-based: Mission hospitals and clinics operated by religious organizations

What are the PHC services packages available for Kenyans

·?????? Promotive – It will include consoling and health education and awareness

·?????? Preventive – This will comprise primary, secondary and tertiary screening immunization,

·?????? chemoprophylaxis and adherence monitoring

·?????? Ambulance and emergency response

·?????? Acute ambulatory care – this is the health care given to “walk in” stable patients.

·?????? Chronic diseases care:

?Palliative care – This will be given to patients with terminal illness

?Rehabilitative care – this will be given to persons with disability from any cause to

?improve the quality of their lives

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What is the role of communities in Primary Health Care?

·?????? Communities are essential partners in PHC.

·?????? They participate in community dialogues,

·?????? Support community health promoters,

·?????? Seek care at the nearest health facility when sick,

·?????? Contribute to addressing social determinants of health.

·?????? They also support the development of local health facilities and the delivery of

·?????? services by health workers.

PHC’s Impact in Kenya

·?????? Increased access to healthcare:

By establishing health facilities at the community level, primary healthcare brings essential services closer to people, especially in rural areas, allowing for earlier detection and treatment of diseases (Muthuri RNDK et.al., 2024)

·?????? Improved maternal and child health:

Primary healthcare programs focus on prenatal care, skilled birth attendants, immunizations, and nutrition counseling, leading to reductions in infant and maternal mortality rates (Esamai et al., 2023).

·?????? Disease prevention and management:

Early diagnosis and treatment of common illnesses like malaria, tuberculosis, and HIV/AIDS through primary healthcare can significantly reduce disease burden (Asiki et al., 2018).

·?????? Family planning promotion:

Primary health facilities provide family planning services, enabling individuals to make informed reproductive choices (UNFPA Kenya, 2016).

·?????? Community engagement:

Utilizing community health promoters (CHPs) to deliver health education and outreach programs fosters community participation and empowers individuals to manage their health (Muthuri RNDK et.al., 2024).

·?????? Cost-effectiveness:

Investing in primary healthcare is considered cost-effective as it prevents complications from diseases that could require more expensive treatments at higher levels of care (Olago et al., 2023).

Challenges in PHC Delivery

Funding and Resource Constraints

·?????? Low Health Budget: Only 11% of Kenya’s national budget goes to healthcare, limiting PHC funding.

·?????? Scarcity of Supplies and Equipment: Essential medicines and medical supplies are often in short supply, affecting service quality. Inconsistent Funding: Dependency on external donors leads to unstable funding, making PHC unsustainable in some regions.

·?????? High out-of-pocket costs: Many patients are forced to pay significant amounts out-of-pocket for healthcare services, deterring them from seeking necessary care.

·?????? Limited health insurance coverage: The reach of health insurance schemes is often inadequate, leaving many individuals without financial protection for healthcare needs

Workforce Shortages

·?????? Lack of Trained Healthcare Professionals: Kenya has a shortage of doctors, nurses, and community health workers, especially in rural areas.

·?????? High Workload and Burnout: Overburdened staff face high patient-to provider ratios, reducing service quality and morale.

·?????? Migration of Healthcare Workers: Skilled professionals often leave for better opportunities abroad, further straining local PHC systems.

·?????? Uneven distribution of healthcare workers: Most healthcare professionals tend to concentrate in urban areas, leaving rural communities underserved.

·?????? Poor training and retention

? Infrastructure and Accessibility Issues

·?????? Rural Access Barriers: Many remote communities lack health facilities within accessible distances.

·?????? Poor Transportation and Connectivity: Limited roads and transport make it difficult for patients to reach clinics, especially during emergencies.

·?????? Inadequate Health Facility Infrastructure: Existing facilities may lack proper sanitation, electricity, and essential utilities.

Data Management and Health Information Systems

·?????? Lack of Digital Health Records: Many PHC facilities still rely on paper records, making patient data management inefficient.

·?????? Inconsistent Data Collection and Analysis: Limited data impacts decision-making and resource allocation for PHC.

·?????? Privacy and Security Concerns: Limited technology infrastructure affects the secure handling of sensitive health information.

Innovative Solutions to Address Primary Healthcare Challenges

Solutions to Funding and Resource Constraints??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????

·?????? Increased Government Allocation: Advocate for a higher health budget, aiming for at least 10% of the national budget.

·?????? Public-Private Partnerships (PPPs): Collaborate with private entities and NGOs to supplement funding and resources.

·?????? Blockchain for Transparency: Use blockchain to track donor funds and ensure transparency in fund distribution.

·?????? Incentivized Community Contributions: Encourage local contributions through micro-insurance and savings programs to enhance selfsustained PHC funding.

·nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Healthcare Challenges

Addressing Workforce Shortages

·?????? Telemedicine Solutions: Use telemedicine to extend care reach, allowing urban doctors to support rural practitioners remotely.

·?????? Training Programs with AI Support: Implement AI-based training platforms to rapidly train healthcare workers in essential skills.

·?????? Retention Programs: Introduce incentives like career development opportunities and better working conditions to retain healthcare professionals.

·?????? Leverage Task Shifting: Empower trained community health workers

·?????? (CHWs) to handle basic tasks, reducing the load on doctors and nurses.

·nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Healthcare Challenges

Improving Infrastructure and Accessibility

·?????? Mobile Clinics: Deploy mobile clinics in remote areas to reduce travel burdens on patients.

·?????? Digital Health Kiosks: Set up digital health kiosks in remote communities for basic check-ups, supported by telemedicine consultations.

·?????? Blockchain-Based Logistics Tracking: Use blockchain for efficient tracking of medical supplies and transportation routes to remote areas.

·?????? Infrastructure Grants & Investments: Advocate for more international and local investments in infrastructure to improve roads, sanitation, and facility maintenance.

·nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Healthcare Challenges

Enhancing Data Management and Health Information Systems

·?????? Electronic Health Records (EHR) System: Implement a national EHR system using blockchain for secure, unified data access.

·?????? Standardized Data Collection with AI: Utilize AI to standardize data collection and analytics, improving resource allocation.

·?????? Decentralized Data Security: Employ blockchain for data decentralization and security, ensuring privacy while allowing for authorized access.

·?????? Capacity Building: Train staff on data security protocols and efficient EHR management to optimize patient data handling

References

Muthuri RNDK, Nzinga J, Tsofa B et al. A mixed methods study examining the impact of primary health care financing transitions on facility functioning and service delivery in Kenya: a study protocol [version 1; peer review: 1 approved, 2 approved with reservations]. Wellcome Open Res

2024, 9:220 (https://doi.org/10.12688/wellcomeopenres.21173.1)

????? Esamai, F., Mwangi, A., Nangami, M., Tabu, J., Ayuku, D., & Were, E. (2023). Maternal and child health indicators in primary healthcare facilities: Findings in a health systems quasi-experimental study in western Kenya. Dialogues in Health, 2, 100133. https://doi.org/10.1016/j.dialog.2023.100133

????? Asiki, G., Shao, S., Wainana, C., Khayeka–Wandabwa, C., Haregu, T. N., Juma, P. A., Mohammed, S., Wambui, D., Gong, E., Yan, L. L., & Kyobutungi, C. (2018). Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3152-4

????? UNFPA Kenya. (2016, February 9). Family Planning. UNFPA Kenya. https://kenya.unfpa.org/en/topics/family-planning-1

????? Olago, A., Suharlim, C., Hussein, S., Njuguna, D., Macharia, S., Muńoz, R., Opuni, M., Castro, H., Clarisse Uzamukunda, Walker, D., Birse, S., Wangia, E., & Gilmartin, C. (2023). The costs and financing needs of delivering Kenya’s primary health care service package. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1226163

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