Patients are still bypassing poorly equipped dispensaries to seek direct services from level 4 and 5 hospitals, an early analysis indicates.
That is because counties have neglected the lower level facilities as governors concentrate on big health projects and equipment.
Dispensaries and health centres are the primary care facilities that Kenyans should visit first and be referred to bigger hospitals if necessary.
But the analysis in counties that are already implementing this system, indicates it hardly works.
The Primary Care Networks will be the anchor of the universal health coverage that will be launched on October 1 through the Social Health Authority.
The analysis, released by Path Kenya, indicates major teething problems where the lower level facilities lack basic drugs and some have no health workers to help patients.
“Frequent stockouts of drugs and other commodities was cited as a major reason why community members bypass primary care facilities, that offer free services, to go to the levels 4 and 5 facilities where some services are offered at a cost,” the report launched in Nairobi on Thursday says.
It is titled 'County-Level Approaches To Implementing And Financing Primary Health Care In Kenya'. It focuses on seven counties-Kisumu, Nakuru, Vihiga, Makueni, Garissa, Mombasa and Nyeri.
“Ill-equipped primary health facilities, drugs and commodity stockouts, and healthcare worker shortage contribute to disruption of service delivery and in some cases or closure of primary health facilities due to health worker shortage,” the report indicates.
It also indicates health workers are poorly informed about how the new system will work, barely a month before it rolls out.
"This was evident in Nyeri where the dissemination had been done but the county and subcounty health management teams had not been sensitised,” the report says.
It also indicates county bosses still prefer to invest more in curative than in preventive and promotive health services.
Politically, buying machines and other equipment works, but it does not help the primary health services.
The report also indicates poor linkages between community level structures and the facility linkage whereby community members cited access barriers such as transport costs and distance to facilities. Others are poor community perception of availability of and readiness of health facilities to provide quality health services at the primary health facilities.
There is also inadequate engagement of the private sector through public-private partnerships to offer PHC services.
“This assessment will enable the government of Kenya and partners to establish the level of implementation of PHC related policies, specifically on the roll out of the Primary Care Networks in the seven counties and glean lessons to inform scale up that is currently going on countrywide,” said Carolyne Njuguna, Path Kenya country director and East Africa Regional Hub director, who presented the report.
She said the lessons and learnings from the documentation will inform PHC financing practices, including what has worked well, bottlenecks for effective and sustainable financing and scaling up of working models already employed in the seven counties.
The report also indicates dispensaries and health centres are not being funded properly.
It indicates only one to eight per cent of county health expenditure is allocated to preventive and promotive health services.
Of the seven counties, only three allocated more than seven per cent, with Garissa getting the highest at eight per cent, 7.5 per cent in Kisumu and seven per cent in Nakuru county.
“NHIF has emerged as a key source of funding for PHC. With increased NHIF facility contracting, counties’ efforts in streamlining NHIF claim processes were matched with higher reimbursements leading to continuity of services at primary health care facilities − Kisumu, Makueni, Mombasa and Nakuru counties had high claims and reimbursement rates,” the report indicates.
Health Director General Patrick Amoth said the report will be useful in implementation at the early stages of Primary Health Care Networks establishment and a source of strategies to advance scale up and sustainability of PHC in Kenya.
“It is important that we understand what works and I am delighted that this report highlights some of the innovations in a number of areas such as financing and provides lessons to inform the scale up and policy direction,” he said.
The report recommends that the Ministry of Health should conduct countrywide training to ensure a common understanding of PHC as a bottom-up approach to health.
“Stronger collaboration between the national and county governments through the Council of Governors is encouraged to ensure a clear road map for PCN formation and scale up, learning and innovation,” the authors say.
It also recommends counties should increase budgetary allocation to PHC services and set aside a budget for PCN specific activities.
