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.
These are teams of trained volunteers that are recruited the most basic primary healthcare and basic sanitation services to communities. Services include child medical care, vaccinations, first aid, and many more. [1]
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.
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.[ citation needed ]
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:
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.
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. Each sub-county, formerly district in the country, has a subcounty 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.
Kenya has 47 counties, each with at least one county referral, or teaching and referral 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 was 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". [2]
There are five national hospitals in Kenya, namely:
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 100,000 live births is unavailable and the lifetime risk of death for pregnant women is 1 in 380. [3]
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. [4]
Online sources of healthcare provider data include:
Private companies which offer additional health cover usually including outpatient cover which is not covered by the NHIF. They include:
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. [9]
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. [10]
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. The levels of medical services in Kenya are assessed by the Ministry of Medical Services and the Ministry of Public Health and Sanitation. The same evaluation system is used for all public, private, mission, and NGO type health facilities. [11]
Level | Type | Location | Examples | Total in 2021 |
---|---|---|---|---|
6 | Tertiary referral hospital, national hospitals | Capital City, Province | Kenyatta National Hospital [12] [11] | 6 |
5 | Secondary referral hospital, provincial hospital | Province | Embu Provincial General Hospital [13] [11] | 68 |
4 | Primary facilities, district hospitals and equivalent | District, County | Mombasa Hospital [14] [15] | 110 |
3 | Health Centre, Sub-District Hospital, Maternity Centre | City, County | Jacaranda Maternity Clinic [16] [17] | 5 |
2 | Dispensaries and clinics | Village Level | Isana Dispensary [18] | |
1 | Community level | Community | Kosirai community unit [11] |
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. [19] 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.
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:
In Kenya, the primary sources of funding for healthcare are: [20]
The health service delivery function was formally transferred to counties on 9 August 2013, and one-third of the total devolved budget of KSh.210 billion/= (US$2 billion) was earmarked for health in the 2013/2014 budget following the transfer. [21]
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 KSh.9.3 billion/= to KSh.8.8 billion/=. The Kenya Medical Research Institute was reduced to KSh.1.7 billion/= from KSh1.9 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/=. [22]
A medical assistant, also known as a "clinical assistant" or healthcare assistant in the US is an allied health professional who supports the work of physicians, nurse practitioners, physician assistants and other health professionals, usually in a clinic setting. Medical assistants can become certified through an accredited program. Medical assistants perform routine tasks and procedures in a medical clinic.
Health care in Saudi Arabia is a national health care system in which the government provides free universal healthcare coverage through a number of government agencies. There is also a growing role and increased participation from the private sector in the provision of health care services. Saudi Arabia has been ranked among the 26 best countries in providing high quality healthcare.
Uganda's health system is composed of health services delivered to the public sector, by private providers, and by traditional and complementary health practitioners. It also includes community-based health care and health promotion activities.
The Swedish health care system is mainly government-funded, universal for all citizens and decentralized, although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities. A total of 21 councils are in charge with primary and hospital care within the country.
Healthcare in Brazil is a constitutional right. It is provided by both private and government institutions. The Health Minister administers national health policy. Primary healthcare remains the responsibility of the federal government, elements of which are overseen by individual states. Public healthcare is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System, known as the Unified Health System. The SUS is universal and free for everyone.
The Healthcare in Kazakhstan is a post-Soviet healthcare system under reform. The World Health Organization (WHO), in 2000, ranked the Kazakhstan's healthcare system as the 64th in overall performance, and 135th by overall level of health.
As literacy and socioeconomic status improves in Ethiopia, the demand for quality service is also increasing. Besides, changes in the demographic trends, epidemiology and mushrooming urbanization require more comprehensive services covering a wide range and quality of curative, promotive and preventive services.
Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.
A clinical officer (CO) is a gazetted officer who is qualified and licensed to practice medicine.
Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index .Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
The Economic Stimulus Programme (ESP) was a spending plan initiated by the Government of Kenya to boost economic growth and lead the Kenyan economy out of the 2007–2008 Kenyan crisis and the Great Recession. It was introduced in the 2009/2010 Budget Speech in parliament by Finance Minister Uhuru Kenyatta. Its aim was to jumpstart the Economy of Kenya towards long term growth and development, after the 2007–2008 Kenyan crisis and post-election violence that affected the Kenyan economy. Other economic problems included prolonged drought, a rally in oil prices and food prices, and the effects of the Great Recession. The stimulus was a response to the decline in the economic growth rate from 7.1% in 2007 to 1.7% in 2009.
University College Hospital(UCH), Ibadan is a federal teaching hospital in Ibadan, Nigeria attached to the University of Ibadan.
Examples of health care systems of the world, sorted by continent, are as follows.
The public healthcare system in India evolved due to a number of influences since 1947, including British influence from the colonial period. The need for an efficient and effective public health system in India is large. Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people. Indian healthcare system has been historically dominated by provisioning of medical care and neglected public health. 11.9% of all maternal deaths and 18% of all infant mortality in the world occurs in India, ranking it the highest in the world. 36.6 out of 1000 children are dead by the time they reach the age of 5. 62% of children are immunized. Communicable disease is the cause of death for 53% of all deaths in India.
Healthcare in Malawi and its limited resources are inadequate to fully address factors plaguing the population, including infant mortality and the very high burden of diseases, especially HIV/AIDS, malaria and tuberculosis.
Compared with other neighbouring countries, Guyana ranks poorly in regard to basic health indicators. Basic health services in the interior are primitive to non-existent, and some procedures are not available at all. Although Guyana's health profile falls short in comparison with many of its Caribbean neighbours, there has been remarkable progress since 1988, and the Ministry of Health is working to upgrade conditions, procedures, and facilities. Many Guyanese seek medical care in the United States, Trinidad and Tobago or Cuba.
Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.
Healthcare in Sierra Leone is generally charged for and is provided by a mixture of government, private and non-governmental organizations (NGOs). There are over 100 NGOs operating in the health care sector in Sierra Leone. The Ministry of Health and Sanitation is responsible for organizing health care and after the end of the civil war the ministry changed to a decentralized structure of health provision to try to increase its coverage.