Nationally representative survey of Kenya’s public sector health centres and dispensaries
Public sector health centres and dispensaries represent an important source of primary level care for low income populations. Ensuring that such facilities have access to adequate resources in the form of qualified staff, medical supplies and drugs is key to improving service quality and utilisation at the local level. In 2010 we conducted a nationally representative survey of Kenyan public sector health centres and dispensaries, collecting data on a range of indicators including staffing, equipment, supplies, service availability and utilisation. The survey was conducted as a baseline for the evaluation of a new financing mechanism for these facilities called the Health Sector Services Fund (HSSF). The endline evaluation for HSSF has yet to take place but the baseline survey is a useful resource in itself, providing extensive detail on the strengths and weaknesses of Kenya’s public primary health care facilities.
Key positive findings include high coverage of important services such as immunization, antenatal care and family planning together with some basic equipment and high levels of patient satisfaction. Most facilities had active health facility committees (HFC) which included community representatives and relationships between health workers and HFC members were generally positive and productive.
Key challenges included poor drug availability and low compliance with Government norms around staffing, infrastructure and equipment. Coverage of delivery and outreach services was low and availability of funds for emergency referral transport was inadequate. Adherence to official user fee policy was particularly low, with most facilities over-charging. Less than half of facility users were aware of the existence of an HFC and few knew their roles.
The findings suggest that improving funding and enhancing community accountability at the facility level could have an important impact on delivery and utilisation of quality services.