Kenya’s health system has been dogged with numerous challenges, key among them being the poor referral systems across the various levels of care, which affects performance and contributes to insufficient service.
Nairobi is among the counties that host national referral hospitals including Kenyatta National Hospital. Citizens seeking medical care often bypass lower-level facilities to go directly to the referral hospitals.
Health systems, not just in Kenya but across the world, are hierarchical, starting with primary care, secondary care facilities, and the highest level of care, consisting of tertiary level facilities that provide highly specialised services.
Nairobi Metropolitan Services director-general Mohammed Badi on May 12 announced plans to close KNH for walk-in patients and admit only referrals by July.
This is a commendable move towards implementing the Kenya Health Policy 2012–2030 which identifies the need to strengthen the referral system to improve efficiency.
However, it requires a cautious and systemic approach before it is effected, especially at this time when the nation is facing a critical health crisis necessitated by the heavy burden of C0vid-19.
Access to the highest attainable standard of health is a fundamental human right.
Central to this right is the delivery of healthcare in a hierarchical health system is the existence of a well-functioning referral system that allows for seamless continuity of care across different tiers.
The enforcement of this may prove to be counterproductive if not well planned and actualised, considering the high number of patients KNH serves including street men, women, and children who are reported to only rely on KNH and Casino health facility.
The two months before blocking walk-in patients from accessing care at the referral facility is not adequate to plan for referral adherence measures.
The implementation of this requires a participatory approach of all state and non-state actors in the health sector including health management teams in different subcounties, to increase the use of services at lower levels of the health care system and reduce self-referral.
Before this, NMS must also strengthen service providers’ capacity to provide not verbal but written referral at each healthcare system level.
The ability to transfer clients and specimens between the different levels of the health care system and public education are other key aspects that the metropolitan area leadership should consider closely.
Dollarman Fatinato is a project assistant at the Centre for the Study of Adolescence
