There is need to prioritize strengthening the capacity of health facilities to provide essential services through availing the requisite health personnel, health infrastructure equipment and health products and technologies for Kenya to attain Universal Health Coverage goals, latest health facility census report has revealed.
According to the newly released ‘Kenya Health Facility Census report there is dearth of basic health equipment, requisite healthcare personnel, health commodities and products which are a critical gap that needs to be bridged if the Universal health coverage dream is to be realized.
The report further reveals that only 7 percent of health facilities are ready to provide services. Of great concern is that only 10 per cent of the facilities had a clinical officer and a medical officer.
Additionally, only 12 counties out of 47 have the required core health worker numbers per population comprising a nurse, a clinical officer and a doctor. The 12 counties are: Nairobi, Mombasa, Kisumu, Tharaka Nithi, Nyeri, Lamu, Vihiga, Uasin Gishu, Laikipia, Taita Taveta, Kirinyaga and Embu.
Narok, Turkana, Wajir, West Pokot, Tana River, Trans Nzoia, Marsabit, Bomet, Kwale, Kilifi, Busia and Nyandarua counties have got lowest number of human resources for health (HRH).
The report notes that, 44 counties out of 47 do not have at least three nurses per hospital as required in the healthcare workforce staffing norms.
Availability of drugs and non-pharmaceutical is critical for effective and complete care especially in primary levels, however, with 57 percent of facilities providing pharmacy services, only 6 percent and 15 percent had tracer drugs and non-pharmaceutical health products. 3 out of 1000 facilities did not have tracer drugs. Tracer drugs are the representative of essential medicines and satisfy the priority healthcare needs of the population. Mental health drugs are least available with less than a quarter of facilities having them in stock.
With the country grappling with higher cases of non-communicable diseases with Kidney as sequalae has seen a rise in demand for renal services the report points out that only 2 percent of facilities offer renal services translating to a low availability.
The report further reveals that the country is also grappling with a shortage of Critical Care Services. According to the report, out of 12,375 health facilities assessed, less than half of them (22 per cent) offer critical services.
While launching the Kenya health census facility report at Afya house Nairobi, Health cabinet secretary (CS) Nakhumicha S. Wafula said that the government is committed to implementing UHC through primary health care as a priority agenda.
“Therefore, determining the level of availability and readiness of health facilities to offer services, as well as the quality of care across the sector, is paramount in planning for UHC implementation,” she said.
With Kenya recording high numbers of under-five mortalities the report reveals that the cause may be because of access to comprehensive maternal care. The report reveals that 40 percent of facilities had maternity services availability but only 5 percent of all facilities assessed were ready to provide comprehensive maternity services. Only 25 percent of facilities had a gynecologist while only 63 percent had a maternity theatre.
Only a third of facilities were found to be offering emergency obstetric care. half had emergency trays and vacuum extractors available.
Additionally, of the facilities that offer maternity services, at least 18 per cent reported conducting CS. However, only 42 per cent of these had blood transfusion services and very few (16 per cent) had Continuous Positive Airway Pressure (CAPAP) machines.
“The readiness to provide maternity services was only five per cent revealing the critical infrastructure, basic amenities and human resources gap that compromise the quality of maternal services being offered,” reads the report in part.
“Whereas reported basic maternity services available were found to be 40 per cent, basic maternity services readiness was noted to be very low with significant gaps in the availability of equipment,” the report found.
The report poke holes into the readiness to provide comprehensive maternity services with inadequate maternity beds and specialist health workforce.
All level 6 facilities are government owned while 49 percent of level 4 and 44 percent of level 5 facilities are privately owned. The report also revealed a need to update Kenya master facility list (KMFL) since a whooping 2,633 facilities did not appear in the Kenya Master facility list.
According to the report, less than a third of the facilities assessed (27 percent) offered inpatient surgical services. Only 25 government facilities offer ICU services whereas 28 government facilities offer High Dependency Unit (HDU).
Only 4 percent of facilities were offering inpatient services for oncology and psychiatric services. A total of 381 facilities offered critical care services; 217 (1.8 percent) facilities provided High Dependency services (HDU) and 164 facilities provided Intensive Care services (ICU).
The report highlighted need to upscale investments in Critical care services especially in public facilities in consideration of the proposed chronic diseases fund.
The report also revealed that about half of facilities reported having access to functional ambulances Basic Life Support (BLS). Basic life support ambulance services were the most accessible in 64 percent of all facilities while advanced life support (ALS) ambulances were only accessible in 31 percent of facilities.
Only 1 in 10 facility provided basic radiology services with less than one percent providing comprehensive radiology services.
“Readiness to provide basic, comprehensive and specialized services was low indicating low availability of the radiology services, equipment and personnel necessary to provide various radiology services.”
NHIF Accreditation
The report reveals that only 40 percent of all facilities were accredited. Level 2 facilities had higher number of facilities accredited at 57 percent. Only 10 counties have more than a half of their facilities accredited.
“Accreditation was generally higher in non-governmental and faith-based facilities in higher levels of care (Level Three upwards),” says the report adding that there is need to accredit health facilities with NHIF especially primary facilities.
The report recommends that for UHC to be achieved, access to efficient, quality services is critical, especially in primary care facilities.
“The Kenya Health Facility Census report provides objective information on the availability of health facility services and the systems that facilities have in place to deliver the services at required standards of quality,” The Cs said adding that ‘the data will support health sector review and ensure evidence-based interventions, beginning of finding a solution is knowing and acknowledging the problem.”
