Healthcare in Kenya

Kenya’s health care system is structured in a step-wise manner so that complicated cases are referred to a higher level. Gaps in the system are filled by private and church run units. 
Health care units.
Dispensaries.
The government runs dispensaries across the country and are the lowest point of contact with the public. These are run and managed by enrolled and registered nurses who are supervised by the nursing officer at the respective health centre. They provide outpatient services for simple ailments such as common cold and flu, uncomplicated malaria and skin conditions. Those patients who cannot be managed by the nurse are referred to the health centres.
Private clinics.
Most private clinics in the community are run by nurses. In 2011 there were 65,000 nurses on their council's register. A smaller number of private clinics, mostly in the urban areas, are run by clinical officers and doctors who numbered 8,600 and 7,100 respectively in 2011. These figures include those who have died or left the profession hence the actual number of workers is lower.
Health centres.
All government health centres have a clinical officer as the in-charge and provide comprehensive primary care. Because of their heavy focus on preventive care such as childhood vaccination, rather than curative services, local council (municipal) and most mission, as well as many private health centres, do not have clinical officers but instead have a nurse as the in-charge.
Health centres are medium-sized units which cater for a population of about 80,000 people. A typical health centre is staffed by:
All the health centre staff report to the clinical officer in-charge except the public health officers and technicians who are deployed to a geographical area rather than to a health unit and report to the district public health officer even though they may have an office at the health centre.
The health centre has the following departments:
Sub-district hospitals.
These are similar to health centres with addition of a surgery unit for Caeserian section and other procedures. Many are managed by clinical officers. A good number have a medical officer and a wider range of surgical services.
Nursing Home.
These are owned privately by individuals or churches and offer services roughly similar to those available at a sub-district or district hospital. They are also believed to provide better medical services compared to public hospitals.
Sub-County or District hospitals.
Each sub county formally district in the country has a subcounty or district hospital which is the co-ordinating and referral centre for the smaller units. They usually have the resources to provide comprehensive medical and surgical services. They are managed by medical superintendents.
County hospitals.
Kenya has 47 counties, each with a county hospital which is the referral point for the district hospitals. These are regional centres which provide specialised care including intensive care and life support and specialist consultations. It is the policy of many hospitals that those who do not pay their bills are not allowed to leave and may be prevented from doing so by armed guards. This policy was found to be illegal in September 2015 by the High Court but was still widespread in October 2018, when the court again ruled that this “is not one of the acceptable avenues (for hospitals) to recover debt”. 
National hospitals.
There are five national hospitals in Kenya, namely:
Maternal and child healthcare.
The 2010 maternal mortality rate per 100,000 births for Kenya is 530. This is compared with 413.4 in 2008 and 452.3 in 1990. The under 5 mortality rate, per 1,000 births is 86 and the neonatal mortality as a percentage of under 5's mortality is 33. In Kenya the number of midwives per 1,00000 live births is unavailable and the lifetime risk of death for pregnant women 1 in 380.
Ministry of Health.
The Ministry of Health has its headquarters at Afya house in Nairobi. There is one minister for health, although there used to be two between 2008 and 2013 when Kenya had a coalition government.
Private Health management organisations.
Private companies which offer additional health cover usually including outpatient cover which is not covered by the NHIF. They include:
Decentralization.
In August 2010, Kenya conducted a national referendum that ushered in a new constitution. The new constitution introduced a new governance framework with a national government and 47 counties. This has been termed as decentralization or devolution. This was a marked shift from the highly centralized form of government that had been in place since independence in 1963. The centralized governance was plagued by political and economic dis-empowerment and unequal distribution of resources.
In the Kenya context, the expectation is that a devolved health system will lead to improvement in efficiency of service delivery, stimulate innovation in the wider sector, improve access to and equity of available services, and promote accountability and transparency in service delivery.
Context of Healthcare in Kenya.
A majority of Kenya’s population receives healthcare services from the public sector. The range of services include preventive, promotive, curative and rehabilitative. Preventive services include routine childhood immunizations and environmental activities to control mosquito breeding which in turn reduce malaria transmission. Promotive services are mostly educational services provided to the general population on healthy lifestyles and available interventions. Curative and rehabilitative services include all treatment activities available at hospitals and other healthcare facilities.
To achieve these functions, the Kenya government has traditionally run a network of healthcare facilities staffed by government employees and run directly by the budgets allocated by the government from public resources.
Under the centralized system, all healthcare facilities were organized into 6 levels as follows:
Strategy of Decentralized Healthcare.
In the devolved government, the Kenya Health Policy 2014 – 2030 provides guidance to the health sector in terms of identifying and outlining the requisite activities in achieving the government’s health goals. The policy is aligned to Constitution of Kenya and global health commitments.
Under the devolved system, healthcare facilities are organized as follows:
In essence, the decentralized system has consolidated service areas into 4 main categories for ease of governance and responsibility. These responsibilities are shared between the national government and county governments.
Governance.
The Kenya Health Policy 2014 – 2030 also provides an institutional framework structure that specifies the new institutional and management arrangements required under the decentralized system. The policy acknowledges the need for new governance and management arrangements at both levels of government and outlines governance objectives.
Some of key objectives that are set for governance systems at the county levels include:
Financing.
In Kenya, the primary sources of funding for healthcare are:
The health service delivery function was formally transferred to counties on August 9, 2013, and one-third of the total devolved budget of KSh 210 Billion ($2 Billion) was earmarked for health in the 2013/2014 budget following the transfer.
The budget for 2015/6 imposed severe restrictions. KSh 43 billion was allocated to the maternity budget, as in the previous year. Funding for the Kenyatta National Hospital was reduced from 9.3 to 8.8 KSh billion. The Kenya Medical Research Institute was reduced to KSh 1.7 billion from KSh 1.9 billion and the National Aids Control Council was cut to KSh 600 million from KSh 900 million and the slum health programme to KSh 700 million from KSh 1 billion.