PHC: Achieving Universal Health Coverage in Kenya through Primary Health Care 

PHC: Achieving Universal Health Coverage in Kenya through Primary Health Care 

Achieving progress on Universal Health Coverage (UHC) and the health targets of the Sustainable Development Goals (SDGs) necessitates a robust Primary Health Care (PHC) sector as the foundation of health systems. In Kenya, the government has reaffirmed its commitment to PHC through the Afya Bora Mashinani Initiative.  

Efforts to strengthen PHC have accelerated, focusing on enhancing community health services, equipping Community Health Promoters (CHPs), digitizing community health services, providing remuneration, and establishing Primary Care Networks (PCNs) across the country. The government plans to establish 315 PCNs nationwide, with progress viewable on the PCN observatory dashboard. 

Zaheer’s struggle 

As the midday heat radiates, Zaheer Khan rests in the shade, his eyes on the leaves above the huge mango tree we are seated under. His story unfolds, a testament to his resilience and journey in managing diabetes. 

Zaheer Khan during the interview with CHU4UHC in Mwangulu Kwale County.

Zaheer’s struggle began in 2017. He recalls feeling unusually thirsty and needing to urinate frequently. Initially, he attributed it to increased water intake. However, as his family noticed significant weight loss, they sought medical attention. 

Upon diagnosis, Zaheer learned he had diabetes mellitus. This marked the beginning of a challenging journey, battling both the disease and its economic impacts. 

“After the diagnosis, the doctor advised starting treatment immediately. Thus, began five years of frequent hospital visits. I disliked the clinic visits: the hot weather, long distances, and long queues meant waking up very early. Sometimes, due to the cost of insulin and the hassle of clinic visits, I went without medication or rationed my insulin.” 

Introduction of the PCN Model 

In October 2022, the Ministry of Health, supported by Amref Health Africa through the CHU4UHC project, piloted a Primary Care Network model in Lungalunga Sub-County, Kwale County. 

PCNs are a crucial component of PHC and a key building block for scaling up UHC. They operate in a ‘hub and spoke’ model, with a level 4 facility as the hub supporting the spokes (levels 3, 2, 1, and the community health units). 

“For Kwale County, the Multi-Disciplinary Team (MDT) provides health services at a PHC facility or in the community. The primary health care network hub (Lungalunga sub-county Hospital) which is a referral site sends MDTs with the necessary skills and supplies regularly (once a month) to a PHC facility to provide PHC care and treatment services. This approach aims to transfer capacity and services to the healthcare workers at the PHC facility over time,” notes Dr. MwanaHalifa Swaleh, the family physician and MDT lead in Kwale County. 

Dr. MwanaHalifa Swaleh, the family physician and MDT lead for Kwale County.

The Impact 

Two years later, Zaheer shares how the new PCN model has alleviated his suffering and its impact. 

“The specialists come monthly or bi-monthly. I no longer worry about the cost of traveling 20 kilometres from my village to Lungalunga Sub-County Hospital and facing long queues. My patient/clinician experience has improved, and I feel more comfortable interacting with the doctors. With their advice, I manage my condition through diet.” 

Focus on Preventive Health and Community Engagement 

The PCN model represents a paradigm shift, focusing on preventive rather than curative health. Community Health Promoters (CHPs) are integral to this model, embedded in the primary health care delivery system. 

Tatu Muthami, a CHP from Mwangulu CU, adds, “Two weeks before the outreach, the Community Health Assistant (CHA) supervising my CU informs me so I can mobilize the households I manage to attend. In addition, I monitor Zaheer’s blood sugar levels through a glucometer, which helps me advise him on how to manage the diabetes better through diet and movement.” 

Tatu Muthami, a CHP from Mwangulu Community Health Unit during the interview with CHU4UHC.

The coordination of CHAs and CHPs leads to effective community engagement, linking communities and facilities. 

Commitment to Sustainable Primary Health Care 

In honouring Zaheer’s journey towards better diabetes management, Amref Health Africa reiterates its commitment to working with the Ministry of Health to deliver sustainable primary health care. 

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