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 to offer 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.[need citation]
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 [ permanent dead link ]. 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]
The Social Health Insurance Fund rolled out on July 1, 2024, while the National Health Insurance Fund expired on June 30, 2024. [23]
Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.
Allied health professions (AHPs) are a category of health professionals that provide a range of diagnostic, preventive, therapeutic, and rehabilitative services in connection with health care. While there is no international standard for defining the diversity of allied health professions, they are typically considered those which are distinct from the fields of medicine, nursing and dentistry.
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.
Argentina's health care system is composed of a universal health care system and a private system. The government maintains a system of public medical facilities that are universally accessible to everyone in the country, but formal sector workers are also obligated to participate in one of about 300 labor union-run health insurance schemes, which offer differing levels of coverage. Private medical facilities and health insurance also exist in the country. The Ministry of Health (MSAL), oversees all three subsectors of the health care system and is responsible for setting of regulation, evaluation and collecting statistics.
Healthcare in the Netherlands is differentiated along three dimensions (1) level (2) physical versus mental and (3) short term versus long term care.
Healthcare in Algeria consists of an established network of hospitals, clinics, and dispensaries. The government provides universal health care.
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 United Arab Emirates has enacted federal legislation to require universal healthcare, but this has not yet been implemented by all seven emirates. Healthcare is provided for all nationals. While health insurance is set to be mandated for citizens of other countries. Employers are to be required to provide health insurance for expatriate workers. In the UAE employers must also provide health insurance for up to one spouse and three dependents, while in Dubai expats are required to provide insurance for their dependents.
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).
Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.
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.
Healthcare in Belgium is composed of three parts. Firstly, there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.
Examples of health care systems of the world, sorted by continent, are as follows.
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.
In the past, Kosovo’s capabilities to develop a modern health care system were limited. Low GDP during 1990 worsened the situation even more. However, the establishment of the Faculty of Medicine in the University of Pristina marked a significant development in health care. This was also followed by launching different health clinics which enabled better conditions for professional development.
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.
