Counties not ready for UHC rollout, says Health ministry

Counties have designated just half of the needed treatment hubs that will be the first port of call for Kenyans seeking health services in the new SHIF rollout that starts next month, meaning the devolved units are not ready for the shift.

Beginning next month, Kenyans will be required to first visit a health facility within their chosen hub when seeking services.

The hubs, called Primary Health Care Network may then refer them to a higher hospital within or outside the network.

One PCN consists of several dispensaries, health centres and at least one Level 4 hospital that acts as the referral facility for that network.

Public Health PS Mary Muthoni said to date, just 160 primary care networks have been successfully set up, and 41 are in progress.

“This means that currently, 87 per cent of counties have at least one operational PCN. Functional PCNs have demonstrated significant success in delivering quality primary healthcare services, with increased outreach, disease screening, improved patient referrals, and better coordination among health workers,” she said in a statement.

However, CoG chairperson Anne Waiguru said the national government is required to finance all activities leading to the designation of these hubs.

"We have concluded a consultative meeting with the Ministry of Health CS to discuss the status of implementation of Universal Health Coverage," she said.

"In this regard we have agreed that the Ministry of Health shall cover all cost pertaining the rollout and maintenance of the Integrated Health Information system," she said.

The goal is to establish about 315 Primary Health Care Networks across the 47 counties in Kenya.

They will be critical when the government rolls out the Social Health Authority next month.

Unlike the NHIF that tied Kenyans to one health facility for outpatient services, the SHA will allow Kenyans to access any of the lower level facilities within their PCN.

Muthoni explained that these facilities will not be just the first level of contact with the health system but are expected to address most of an individual’s health needs throughout their life.

“Therefore, PHC plays a crucial role in achieving Universal Health Coverage by delivering services when and where needed,” she said.

Community Health Promoters are also tied to specific PCNs where they refer members of the community.

PCNs were first piloted in Kisumu, Garissa, and Kwale in 2021. The pilot phase informed cost-effective approaches for the deployment and critical success factors for scale-up of PCNs countrywide. More counties have since established PCNs by following a 10-step process as stipulated in Kenya PHC Guidelines.

"PCNs must proactively take ownership of community concerns, be accountable and clearly articulate the value proposition for patients, primary health care providers and the broader community," says the Primary Health Care Network Guidelines published in 2021.

Muthoni said in Garissa, PCNs help increase skilled deliveries from 77 per cent to 98 per cent. In West Pokot county, the Kacheliba PCN has been equipped with a functional theatre and increased human resources for health, greatly enhancing service delivery, she said.

“In Lamu county, newly established hubs have reduced referrals to the County Referral Hospital, streamlining healthcare access,” she said.

Amref Health Africa is helping the counties establish the hubs. It says the average time taken to establish one PCN is three weeks and it costs approximately Sh4.4 million for its full establishment.

Muthoni said 248 master trainers have been deployed to support the counties in setting up their PCNs. These trainers disseminate best practices and ensure the effective functioning of PCNs.

She said baseline assessments have been conducted in all established PCNs using standardised tools, ensuring a comprehensive understanding of the primary healthcare landscape.

“The creation of a National PCN observatory allows for real-time tracking and monitoring of PCN establishment across counties, ensuring transparency and accountability,” she said.