Kenya Primary Health Care Strategic Framework (2019–2024)

Context & Rationale

Kenya aligns its health strategies with the Alma-Ata (1978) and Astana (2018) declarations to achieve Universal Health Coverage (UHC). The nation faces a triple disease burden encompassing communicable, non-communicable diseases, and injuries, necessitating a robust Primary Health Care (PHC) system. PHC is recognized for its capacity to address 80\text{-}90\% of an individual's lifetime health needs while simultaneously lowering overall healthcare costs. This framework specifically covers the period from 2019\text{–}2024.

Vision | Mission | Goal

Kenya's vision for health is to foster a healthy, productive, and globally competitive nation. Its mission is to deliver accessible, affordable, resilient, responsive, and sustainable PHC services of the highest standard. The overarching goal is to significantly reduce the total health burden through universal access to comprehensive health services. Specific targets for 2024 include a reduction in the disease-burden rate.

Core PHC Principles

The core principles guiding PHC in Kenya include equity and social justice, active community participation, and extensive inter-sectoral collaboration. It also emphasizes the use of appropriate technology, a people-centred approach with a strong preventive focus, and ensuring the right service is provided at the right time, in the right place, at an acceptable cost, and by the appropriate provider.

Strategic Directions (6)

Six strategic directions underpin Kenya's PHC framework. First, Leadership & Governance aims to elevate PHC as a political priority, supported by multi-sectoral councils and committees. Second, Human Resources focuses on ensuring an adequate, skilled, and ethical workforce, promoting multidisciplinary teams led by family physicians, and implementing performance contracts. Third, Service Delivery targets the establishment of functional community units, adoption of people-centred models, continuous quality improvement (KQMH), and robust referral and emergency systems. Fourth, Financing seeks to mobilize sustainable domestic funds, ring-fence PHC budgets, explore innovative taxes, expand the National Hospital Insurance Fund (NHIF) and community insurance, and implement results-based financing. Fifth, Commodity & Infrastructure involves updating essential lists, strengthening logistics management information systems (LMIS), improving forecasting, boosting local production, and mapping medical devices. Finally, Information, Technology, Innovation emphasizes the development of digital Health Management Information Systems (HMIS), unique patient IDs, a comprehensive PHC dashboard, a active research agenda, and the establishment of tele-health hubs.

Governance Structure

At the national level, the governance structure includes a dedicated PHC Department within the Ministry of Health (MOH), an Advisory Council, and a Steering (ICC) Committee. At the county level, a PHC Coordinator operates under the County Director of Health, supported by advisory and management committees at the county, sub-county, facility, and community levels.

Service-Delivery Re-organisation

Service delivery re-organisation focuses on levels 2 (dispensaries), 3 (health centres), and 4 (primary referral facilities). A Multidisciplinary Team (MDT) model is central, comprising core cadres such as Medical Officers/Clinical Officers (MO/CO), nurses, public health professionals, pharmacists, laboratory technicians, nutritionists, and records officers. Additional service models include polyclinics for urban areas, mobile/outreach services, community midwifery, and general practitioner (GP) contracting. A key aspect is the registration of every citizen to a community health unit (serving approximately 5\,000 people), which is then linked to a primary PHC facility.

Implementation – 6 Steps

Implementation of the PHC framework involves six key steps. Firstly, establishing PHC coordination structures at both national and county levels. Secondly, conducting feasibility studies and initial adoption assessments, including readiness evaluations and legal/financial reviews. Thirdly, defining implementation mechanisms, such as an essential service package, comprehensive toolkits, and the formation of MDTs. Fourthly, establishing learning sites for piloting and documenting experiences. Fifthly, ensuring continuous monitoring, supervision, and quality audits. Lastly, conducting periodic evaluations and initiating scale-up based on quarterly county and bi-annual national reviews.

Monitoring & Evaluation

Stewardship goals for monitoring and evaluation include strengthening data architecture, conducting comprehensive performance reviews, and effectively utilizing data for decision-making. Core tools include the Kenya Health Information System (KHIS, a type of HMIS), LMIS, Community-Based Health Information System (CBHIS), and a dedicated PHC dashboard. Key indicators are systematically grouped by Inputs/Processes, Outputs (focusing on access and quality), Outcomes (measuring coverage), Impact (assessing mortality and morbidity), and Financial risk. An example impact indicator is the reduction of Under-5 mortality.

Financing Highlights

Kenya aims to move towards the Abuja target of allocating 15\% of its national budget to health, significantly increasing from its current approximate 6\% . The goal is to raise PHC's share of current health expenditure to over 50\% . Revenue streams will include government taxes (including sin taxes), NHIF contributions, conditional county grants, donor pool funds, and community income-generating activities (IGAs). The strategy emphasizes pooling resources to minimize fragmentation and employing strategic purchasing with performance-based payments.

SWOT Snapshot

The SWOT analysis reveals several factors influencing PHC implementation. Strengths include strong political will (aligned with the Big Four UHC agenda), devolution of health services, and an existing community health strategy. Weaknesses largely involve low PHC funding, persistent human resource shortages, gaps in the supply chain, and incomplete data. Opportunities exist in exploring innovative taxes, leveraging digital health solutions, and fostering public–private partnerships. Threats include competing political priorities, workforce attrition, and the rising burden of non-communicable diseases (NCDs).

Essential PHC Service Package

The essential PHC service package encompasses promotive, preventive, curative, rehabilitative, and palliative services. This includes comprehensive immunisations (e.g., BCG, OPV, pentavalent, HPV), maternal and child care (antenatal care, skilled birth attendance, micronutrient supplementation), and communicable disease control (e.g., TB, HIV, malaria). It also covers NCD screening and management (e.g., hypertension, diabetes, cancers), emergency and trauma care, and robust referral systems. Furthermore, rehabilitative services (physiotherapy, occupational therapy) and palliative care are included, alongside community health promotion, sanitation, provision of safe water, nutrition services, and injury prevention.