KHFA 2018 19 Popular Version Report Final

KENYA HARMONIZED
HEALTH FACILITY
ASSESSMENT
2018/2019
Popular Version
MINISTRY OF HEALTH
Division of Health Sector Monitoring and Evaluation
MINISTRY OF HEALTH
PREFACE
Kenya has drawn the Roadmap for accelerating implementation of UHC, which is one of the priority
agenda for the National Government. Determining the level of availability and readiness of health
facilities to offer services, as well as the quality of care across the sector is paramount in planning for
UHC implementation. This then demands an objective and comprehensive assessment of the
functionality of the health system at community and facility level. This initiative will therefore serve to
provide baseline information needed for costing health investments in Kenya, including the UHC
Roadmap and the Kenya Health sector strategic and investment plan
The Kenya Harmonized Health Facility Assessment (KHFA) was designed as a system to provide
standardized assessments consisting of harmonized modules that cover all key blocks of service provision
in a health facility, that include service availability, service readiness, quality and safety of care, and
systems that support management as well as functionality of community structures. The KHFA
approach departs from previous health facility assessments methods implemented in the past that have
been implemented fragmentary, focusing on one area at a time.
Kenya is one of the first countries to adopt the approach of harmonizing the facility surveys into one
comprehensive assessment. Lessons learnt during this process will be valuable for other countries in
implementing similar surveys.
The KHFA has come at a critical time when plans to scale up UHC in Kenya are being developed. This
then means that we now have the essential information needed to facilitate critical investments into
health facilities, to facilitate them to deliver the essential health package for UHC.
We are certain that these results will significantly support us at national government, as well as our
counties in planning and consequent management of available resources to maximize on outputs.
Finally, the KHFA findings will provide the foundation for which more regular service availability and
readiness monitoring mechanisms will be established as part of routine reporting for sustainability.
It is our hope that all stakeholders and implementers will embrace these findings and utilize them, as this
is a key element that will help us to significantly contribute towards our vision of a healthy, productive
and globally competitive nation.
............................................................
Sicily K. Kariuki (Mrs), EGH
Cabinet Secretary
Ministry of Health
1
Acknowledgements
The Kenya Harmonized Health Facility Assessment (KHFA) 2018 is a collective effort of multiple
Health Data Collaborative partners at the global level that includes; The Global Fund, The World Bank,
USAID, GAVI, PEPFAR/CDC, UNICEF, UNFPA, UN MDG, Health Envoy and WHO. The Kenya
Harmonized Health Facility Assessment (KHFA) was implemented through a consultative approach
involving Health Data Collaborative (HDC) Health Facility Survey working group of technical experts
from partners, countries, academia, and civil society as a key deliverable of the HDC Operational Work
plan 2016-17, while taking cognizance of all new actors under a devolved system of governance.
The KHFA succeeds other past initiatives that were aimed to provide information on the degree of
preparedness of health facilities to offer services through the SARAM in 2013, SDI 2012 & 2018 and
SPA in 2010 among others. Such initiative will provide baseline information needed for costing the
health investments in the Kenya UHC Roadmap and the Kenya Health Sector Strategic and Investment
Plan 2018- 2023.
The preparation of the KHFA Survey would not have been possible without the support, hard work,
and endless efforts of a large number of individuals and institutions. The team worked tirelessly to
ensure the assessment was completed.
I wish to recognize the effort of the Policy Planning and Health Financing Department, specifically the
Monitoring and Evaluation unit for their tireless efforts in coordinating this process. I commend the
KHFA core team for guiding the process and facilitating the various working groups to steer this work to
completion. In particular, I applaud the efforts by Dr Helen Kiarie and Dr Andreas Bjerrum (MOH,
M&E), Dr Amani Siyam (WHO), Ashley Sheffel, Cosmas Leonard (WHO), Dr Hillary Kipruto, Dr
Immaculate Kathure (USAID), Dr Joseph Mung’atu, William Watembo and Boniface Muganda in this
respect.
Efforts of officers from other departments and programs towards this assessment and report writing
were also commendable. Inputs and contributions from county technical teams, as well as development
and implementing partners were similarly commendable.
The development of the KHFA 2018 was made possible through technical and financial support from
our development partners to whom we are very grateful. Special mention goes to WHO, USAID, JICA,
UNICEF, Global Fund and UNFPA for their immense support.
Lastly, we would like to take this opportunity to thank all those who in one way or the other participated
and contributed in the making the KHFA assessment successful.
............................................................
Dr. Rashid Aman
Chief Administrative Secretary
Ministry of Health
2
Foreword
The Kenya health sector has re-aligned its policy and strategic direction in line with the Constitution of
Kenya 2010. Health Service Delivery is one of the eight policy orientations specified in the Kenya
Health Policy (KHP, 2014-2030). The Constitution of Kenya 2010 guarantees the highest attainable
standard of health as a right while devolving governance to ensure improved service delivery, greater
accountability, improved citizen participation and equity in the distribution of resources. Kenya’s Vision
2030 aims at transforming Kenya into a globally competitive and prosperous country with a high quality
of life by 2030. The Kenya Health Policy 2014-2030 outlines the direction that the sector is taking to
ensure significant improvements are made in the overall status of health in Kenya in line with the
Constitution of Kenya 2010, the country’s long-term development agenda, Vision 2030 and global
commitments such as the Sustainable Development Goals (SDGs).
The Government of Kenya has committed to providing Universal Health Coverage (UHC) under the
“Big Four” agenda as part of socio-economic transformation by providing equitable, affordable and
quality health care of the highest standard to all Kenyans. UHC will ensure that Kenyans receive quality,
promotive, preventive, and curative and rehabilitation health services without suffering financial
hardship. Kenya has drawn the Roadmap towards accelerating implementation of UHC agenda,
determining the level of service availability, readiness, and quality of care across the sector.
Baseline information on service availability, readiness of health facilities to deliver services, quality of
care offered, availability of human resources, leadership, governance, and quality of data is therefore
required to inform strategic and operational planning and implementation processes for UHC in Kenya.
As the country draws the Roadmap towards accelerating implementation of the UHC agenda,
determining the level of service availability and readiness across the sector is paramount to progressive
realization of 100% UHC by 2022.
The Kenya Harmonized Health Facility Assessment (KHFA) 2018 modules that were assessed include;
Availability: Information relating to the physical presence of facilities, resources, and services, Readiness:
Capacity of facility to provide specific services, Management & finance: Practices to support continuous
service availability and quality, Quality & safety of healthcare: Includes indicators of the receipt of
appropriate, effective and timely care by patients under safe conditions, and Community Unit: A
qualitative assessment of the community structures via key informant interviews with Community
Health workers and focus group discussions with clients in all 47 counties.
We look forward to working collaboratively across the national and county governments, partners, and all
other stakeholders to ensure successful implementation of the findings.
............................................................
Susan N. Mochache, CBS
Principal Secretary
Ministry of Health
3
About the KHFA 2018
The Kenya Harmonized Health Facility Assessment (KHFA) 2018 was implemented by the Kenya’s Ministry of
Health in collaboration with the development partners, who provided funding and technical support; USAID,
WHO, JICA, UNICEF, UNFPA among others. The KHFA was implemented through a consultative approach
involving Health Data Collaborative (HDC) Health Facility Survey working group of technical experts from
partners, countries, academia, and civil society, while taking cognizance of all new actors under a devolved system
of governance.
The KHFA succeeds previous assessments of health facilities’ preparedness to offer services; the Service
Availability and Readiness Assessment and Mapping in 2013, SDI 2012 & 2018 and SPA in 2010 among others.
Purpose of the Survey

The rationale for the harmonized KHFA was two pronged, thus:
1. To provide external validation of information on service availability and readiness

2. To provide baseline information needed for planning health investments in Kenya through the UHC
Roadmap towards achieving UHC by 2022, and the Kenya Health Sector Strategic and Investment Plan
2018-2023.
Target Users
National and county government, development partners, private sector, civil society organizations and the general
public
Survey Methodology
The KHFA comprised five main modules:
1. Availability: collected information relating to the physical presence of facilities, resources, and
services (e.g., building and utilities infrastructure, staff, beds, and availability of specific services)
2. Management & finance: collected information on practices to support continuous service
availability and quality (e.g. management practices and supervisory practices)
3. Readiness: collected information on capacity of facility to provide specific services (e.g.,
presence of drugs, supplies, diagnostics, equipment)
4. Quality of care: collected information on the receipt of appropriate, effective and timely care by
patients under safe conditions.
5. Community module: Utilized key informant interviews with community health workers in all
47 counties and focus group discussions, with mothers of children under age 2; qualitative data
collected to understand the functionality and strength of the community structures, as well as to
triangulate the findings of the other survey modules
The Kenya Health Master Facility List (KHMFL) was used as the sampling frame for the survey. Out of the 10,535
health facilities, 2,980 facilities were randomly sampled ensuring a representative sample for each of the 47
counties. The sample design for KHFA provides estimates at National up to County levels including urban and
non-urban areas. The sample included health facilities of all types (dispensary, medical clinics, health centres,
primary hospitals, and secondary hospitals) and all managing authorities (public, private, FBO/NGOs). Specialized
health facilities such as eye hospitals, dental clinics and VCT centres were excluded. Data collection for the survey
was conducted between November and December 2018 in all 47 counties.
This report is a summary of the key findings from the main KHFA 2018 report.
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Survey Results
The data were successfully collected in 2,927 (98%) health facilities out of the targeted 2,980 health facilities.
2 General Service Availability
2.1 Health infrastructure Figure 1: Health facility distribution, Kenya 2018

Based on KMHFL, the national health facility density was 2.2
per 10,000 population, and the country has achieved the
WHO target of 2 per 10,000. However, 14 counties (30%) are
below the target of 2/10,000.
The national average inpatient bed density is at 13.3 which is

below the target of 25. In addition, the national average
inpatient bed occupancy rate is (46%) which is below the
target of 80%. The National Maternity bed density is
13.8/1000. This is above the target of 10/1000.
2.2 Health Workforce

The national core health workforce density is at 15.6/10,000.
This is below the set target of 23/10,000. Only six counties
have surpassed the global target: Tharaka Nithi (33.8), Nyeri
(31.0), Uasin Gishu (28.2), and Nairobi (26.3) while for the
majority of counties, health workforce density is below the set
target.
Figure 2: National density of health workforce by cadre, Kenya 2018
Dispensaries
Overall, the average number of nurses (all Medical Officers 0.6
categories) in dispensaries was 1 compared to a
national norm for dispensaries of 4 revealing a
Lab Technicians 2
25% staffing level of nurses in dispensaries.
Availability of registered nurses averaged at 0.69 Clinical Officers 3

compared to a norm of 1 revealing a gap of 31
for every 100 dispensaries; the average number
Nurses 10
of enrolled nurses was 0.16 compared to 2 in the
norms and the average number of registered
- 5 10 15
midwives was 0.13 against a norm of 1 per
Density per 10,000 population
dispensary shows a gap of 87 midwifes per 100
dispensaries.
An average of 0.43 PHO’s were available against

1 in the norms and standards.
5
Figure 3: Distribution of health workforce density in counties, Kenya 2018
6
Health centres
Understaffing is evident in health centres for all staff other than the registered nurses and support staff.
While the norms and standards require a level 3 facility to have at least two medical officers (MOs), the survey
revealed that an average, 0.23 MOs were available which implies that for every 100 facilities there were 23 medical
officers revealing a gap of 177 medical officers.
In terms of clinical officers, the average number was 1.8 against the required 5. Among the nursing cadres assessed
(Registered nurses, midwives, and enrolled nurses), only registered nurses met the norm of 2. Availability of enrolled and
registered midwives was low at an average of 0.4 and 0.6 respectively against a norm of 3.
Primary hospitals
Generally, availability of all cadres at primary hospitals was below the norms. Nine private and seventy-four primary
public hospitals reported having no doctor. As expected, nurses comprise the majority of staff in public primary hospitals
with registered nurses being the most available. Availability of registered midwives was low, and this would be
expected as training of the cadre has been halted.
Secondary hospitals
Secondary hospitals had a general inadequacy of all staff compared to the norms, meeting between a third and a
half of required health workers. Only 20 medical officers were available compared to the 50 required while a third
of the required nurses were available.
The least available cadre were dentists while pharmacists were the only cadre that met the norms. As far as private
hospitals are concerned, Agha khan hospital reported the highest number of medical officers (74).
Figure 4: Health workforce norms and average health workers present in primary hospitals, Kenya 2018
7
Figure 5: Health workforce norms and average health workers present in secondary level 5 hospitals, Kenya 2018
2.3 Service utilization

Outpatient
The average number of outpatient visit per person per year nationally is 1.2, below the national set target of 5.
Inpatient
The national average for hospital discharges per 100 population is 3.8, which is below the global target of 10. None
of the 47 counties attained the target of 10 hospital discharges per 100 population per year.
Service availability index

The index score for infrastructure was very high (100) while the index score for health workforce (40.4) and service
utilization (31.2) were quite low.
This implies that there is poor utilization of health services by the population that is likely attributed to a shortage
of health workers as well as barriers to accessing services.
Figure 6: General service availability index, Kenya 2018
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3 General Service Readiness
General Service Readiness refers to the overall capacity of health facilities to provide general health services.
Readiness is defined as the availability of components required to provide services such as basic infrastructure and
amenities, basic equipment, standard precautions for infection control, laboratory tests, and medicines and
commodities.
3.1 Basic amenities

Basic amenities comprise: Sanitation facilities; Communication equipment; Consultation room; Improved water
source; Power supply (grid or generator); Emergency transportation; and Computer with internet access. On
average, health facilities have 55% of basic amenities available on the day of the survey. Only 6% of the facilities
have all basic amenities available on the day of the survey.
Figure 7: Mean availability of basic amenities by county, Kenya 2018
3.2 Basic equipment

Nationally, the mean availability of basic equipment stands at 77%. Only 24% of health facilities have all basic
equipment items.
3.3 Standard precautions for infection prevention

Nationally, the mean availability of standard precaution for infection prevention items is 65%. Further, only 12%
of health facilities have all items for standard precaution for infection prevention.
9
Figure 8: Percentage of facilities with standard precautions for infection prevention items available (N=2927), Kenya 2018
3.4 Diagnostic capacity

The mean availability of diagnostic tests is 56%. However, only 17% of health facilities have all the diagnostic
items. Health facilities are most likely to have HIV diagnostic capacity (84%) and malaria diagnostic capacity
(74%), while health facilities are least likely to have diagnostics for haemoglobin (30%).
Figure 9: Percentage of facilities with diagnostic capacity items available (N=2927), Kenya 2018
10
Figure 10: Mean availability of diagnostic tests by county, Kenya 2018
3.5 Essential medicines

The mean availability of essential medicines is 44%. None of the assessed health facilities had all essential
medicines available on the day of the survey.
3.6 General service readiness

General service readiness refers to the overall capacity of health facilities to provide general health services and is
defined as the availability of the five domains above: Basic amenities; Basic equipment; Standard precautions for
infection prevention; Diagnostic capacity; Essential medicines.
The service readiness index for Kenyan health facilities is 59%, meaning that nearly 6 in 10 health facilities are
ready to provide health services. The domain score was highest for equipment (77%) and lowest for essential
medicines (44%)
11
Figure 11: General service readiness index and domain scores (N=2927), Kenya 2018
4 Service specific availability and readiness

In addition to the general services, the HHFA also measures the availability and readiness of health facilities to
offer specific health interventions.
4.1 Reproductive, Maternal, Neonatal, and Child Health services

4.1.1 Family planning
Service availability
Nationally, 85% of facilities sampled offered family planning services. Male condoms ranked highest at 78%
followed by combined oral contraceptives (76%) and IUCD (75%) while the lowest services available were male
and female sterilization (5% and 7% respectively).
Service readiness
The most available tracer items for family planning were BP apparatus (94%), condoms (85%), and injectable
contraceptives (85%). Mean availability of FP tracer items in Kenya was 83% with only 57% of facilities having all
5 FP tracer items
Figure 12: The distribution of the readiness of MNACH services across the counties, Kenya 2018
12
Figure 13: Map of family planning availability by county, Kenya 2018
Figure 14: Percentage of facilities that have tracer items for family planning services among facilities that provide this service (N=2556),
Kenya 2018
4.1.2 Antenatal care

The national average of facilities offering ANC services is at 81%. The most widely available ANC services are iron
supplementation (79%), monitoring for hypertensive disorder of pregnancy (79%), and folic acid supplementation
(77%). The low percent in the provision of IPTp could be because only the malaria endemic areas/counties offer
these services.
13
Figure 15: Percentage of facilities that offer antenatal care services (N=2927), Kenya 2018
Service readiness
Facilities had a mean of 61% of the tracer items, and only 4% of the facilities had all. The commonest tracer item
available was tetanus toxoid vaccine (97%), followed by blood pressure apparatus (95%), then folic acid tablets
(88%), and iron tablets (86%). The least available items were IPT drug (25%) and hemoglobin testing (31%)
Figure 16: Percentage of facilities that have tracer items for antenatal care services among facilities that provide that service (N=2541),
Kenya 2018
4.1.3 Basic emergency obstetric and newborn care (BEmONC)

The facilities assessed on ability to offer BEmONC services were only those which offered delivery services
(n=1683)
Fifty percent of facilities in Kenya offer delivery services. On average, only 12 % of the facilities which offered
delivery services offered all 7 BEmONC signal functions. Among the 7 signal functions, the highest availability
was parenteral administration of oxytocic drugs (87%), parenteral administration of antibiotics (81%) and neonatal
resuscitation (70%). The lowest availability was assisted vaginal delivery (22%).
90% of secondary and tertiary hospitals offered delivery services with 75% offering all BEmONC signal. 98%
public primary hospitals offered delivery services, however, only 33% were BEmONC compliant offering all 7
signal functions, which is very low
14
Service readiness
While mean availability of BEmONC availability seems good (68%) at a national average, the availability of all
BEmONC tracer items is very low at 3%. The unavailability of even one tracer item could compromise the
availability and quality of a lifesaving service to the mother and baby.
Figure 17: Map of BEmONC availability (all signal functions) by county, Kenya 2018
Figure 18: Percentage of facilities that have tracer items for basic obstetric and newborn care among facilities that provide delivery
services (N=1683), Kenya 2018
4.1.4 Comprehensive emergency obstetric and neonatal care (CEmONC)

The CEmONC analysis only included hospitals offering delivery services (N=397) since lower level facilities are
not expected to provide CEmONC services.
15
Of the 411 hospitals sampled, 97% percent offered delivery services(n=397). Nationally, 68% of the hospitals
offered caesarean section while 69% provided blood transfusion service. However, only 25% of hospitals
provided CEmONC services (comprising of all 7 signal functions plus both caesarean section and blood
transfusion). By hospital type, 78% of secondary and tertiary hospitals offered CEmONC services, while 21% of
public primary hospitals offered CEmONC services.
Figure 19: Percentage of hospitals offering comprehensive obstetric care services by facility type (N=411), Kenya 2018
Service readiness
Nationally, the mean availability tracer items required for a facility to be considered ready to offer CEmONC
servicers was 70% with 1% of facilities having all the tracer items.
Figure 20: Percentage of facilities that have tracer items for comprehensive obstetric care services among facilities that provide caesarean
section (N=273), Kenya 2018
4.1.5 Essential medicines for mothers

The mean availability of essential medicines for mothers nationally was 40%, highest being Sodium chloride
injectable solution at 78%, Gentamicin injectable at 71%, and benthazine benzylpenicillin powder for injection at
16
60%. The least available medicines for mothers were ampicillin powder for injection (11%), misoprostol cap/Tab
(15%), and hydralazine (16%).
Figure 21: Percentage of facilities that have essential medicines for mothers observed in stock and valid (N=2927), Kenya 2018
4.1.6 Post-abortion care

The National availability of PAC services is at 27%. All aspects of counseling for PAC (events leading to PAC,
prevention of unwanted pregnancy, and associated risks) are covered during counseling sessions in 25% of visited
facilities.
Figure 22: Map of post-abortion care availability by county, Kenya 2018
Service readiness
On average, facilities offering PAC services had 72% of the tracer items required to deliver the service, while 20%
had all the tracer items. Sterile gloves were the most available items (96%) while antiseptics were the least available
items (34%)
17
Figure 23: Percentage of facilities that have tracer items for post-abortion care services among facilities that provide this service (N=964),
Kenya 2018
4.1.7 Postpartum care for mothers and newborns

Overall, 71% of facilities offer postnatal care (PNC) for mothers as an outpatient service, while about half of all
health facilities offer PNC care as an inpatient service. Similarly, 71% of facilities offer PNC for new-borns. The
most common services provided include routine counselling on cord care and hygiene (98%), general counselling
and counselling on danger signs in the new-born (97%), counselling on women and nutrition needs and
counselling on child nutrition (96%).
Service readiness
Overall, percentage availability of all tracer items for inpatient PNC was very low (7%). The most common items
are: thermometer (91%), visual and auditory privacy (86%), and antibiotics for maternal sepsis (84%).
Chlorhexidine for new-born (56%) and ITNs (45%) for new-borns was the lowest. ITN availability for new-borns
is low because these are only provided in malaria endemic areas.
18
Figure 24: Map of outpatient postnatal care for mothers availability by county, Kenya 2018
4.1.8 Care for low birth weight and sick newborns

93% offer outpatient services for LBW and sick newborns. All secondary and tertiary hospitals offer LBW and sick
newborn care while 99% of public primary hospitals offer these services
Service readiness
Overall, the mean availability of requisite tracer items for LBW and sick newborn care stood at 29% nationally with
53% having a bed for caregiver providing KMC, but only 4% had a register to record KMC on the day of the
interview. Across all facilities, only 3% of facilities had both tracer items for LBW and sick newborn care.
19
Figure 25: Percentage of facilities that offer care for low birth weight and sick new-borns services among facilities that provide delivery
services by county, facility type, managing authority and urban vs. rural location (N=1682), Kenya 2018
Figure 26: Percentage of facilities that have tracer items for care for low birth weight and sick new-borns services among facilities that
provide KMC (N=832), Kenya 2018
4.1.9 Routine child immunization

The national average percentage of facilities offering immunization services is 71%. Overall, 47% of facilities
offered immunization services 5 days a week,
Figure 27: Map of child immunization availability by county, Kenya 2018
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Service readiness
Mean availability of all the tracer items stood at 74% of all facilities assessed.
Overall, the percent of facilities that had all the identified requisite tracer items was only 3% of all the facilities
assessed during this survey.
Figure 28: Percentage of facilities that have tracer items for child immunization services among facilities that provide this service
(N=2192), Kenya 2018
21
4.1.10 Child health preventive and curative care services
In all the health facilities sampled nationally, 89% offered preventive and curative care for under 5 years old
children. ORS and zinc supplementation to children with diarrhoea was offered by 83% of health facilities, while
82% of facilities offered treatment of pneumonia. Iron supplementation was the lowest (56%).
Service readiness
Nationally, the mean availability of all tracer items was 68%, while only 2% of the facilities nationally had all the
tracer items.
For diagnostic test, 76% of the facilities had the capacity to test for Malaria, 30% for Haemoglobin test and 21%
capacity to test parasite in stool. Only 31% of facilities had a child and infant weighing scale.
Figure 29: Percentage of facilities offering key child preventive and curative care services (n=2927), Kenya 2018
Figure 30: Percentage of facilities that have tracer items for child preventative and curative care services among facilities that provide this
service (N=2659), Kenya 2018
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4.1.11 Essential medicines for children
The mean availability of essential medicines for children nationally was 56%. The highest available items were
Paracetamol syrup 85%, ORS at 82%, and zinc sulphate tab/syrup 81%. The least available was Morphine granules
injection/cap/tab at 10%, Ampicillin powder 11%, and Procaine penicillin at 27%.
Figure 31: Percentage of facilities that have essential medicines for children observed in stock and valid (N=2927), Kenya 2018
4.1.12 Adolescent health

The national average of facilities offering adolescent health services is at 62%. HIV testing and counseling services
being the highest with 77% while Provision of ART and Provision of intrauterine contraceptive device (IUCD) to
adolescents were the least services with 32% each.
Service readiness
Overall 91% of facilities had HIV diagnostic capacity while 83% had condoms. 77% of facilities had tracer both
items.
Figure 32: Percentage of facilities that offer adolescent health services (N=2927), Kenya 2018
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Figure 33: Map of adolescent health availability by county, Kenya 2018
4.2 Communicable diseases

Communicable diseases accounts for the highest proportion of disease burden in the country, with the leading
causes being HIV/AIDS, malaria and TB. The most commonly available communicable disease service is malaria
(91%). Eighty-five percent of Kenyan health facilities offer HIV counselling and testing and STI services. More
than three-quarters of health facilities in Kenya offer PMTCT services. About 4 in ten health facilities offer TB
services and HIV care and support services. The least available communicable disease service is ARV prescription
and client management services.
Figure 34: Availability of communicable disease services (N = 2927), Kenya 2018
4.2.1 Malaria
It should be noted that while case management services should be offered across the whole Country, IPTp services
are only offered in malaria endemic areas. Overall, 91% of health facilities in Kenya offer malaria diagnosis or
24
treatment services. Among the services reported, facilities are most likely to offer malaria diagnosis (89%),
followed by malaria treatment (45%) while the least offered services are IPT (28%).
Figure 35: Percentage of facilities that offer malaria services (N=2927), Kenya 2018
Service readiness
Among health facilities offering malaria services, 80% have malaria diagnostic capacity. Among health facilities
offering malaria services, 79% have paracetamol capsule/tablets and 78% have the first-line antimalarial in stock
on the day of the survey. ITNs are available in 73% of facilities located in malaria endemic counties while IPT
drugs are available in 81% of facilities in malaria endemic counties. Overall, the mean availability of malaria tracer
items is 79%. However, only 55% of facilities that offer malaria service have all items available on the day of the
survey – first-line antimalarial, paracetamol, and malaria diagnostic capacity.
Figure 36: Percentage of facilities that have tracer items for malaria services among facilities that provide this service (N=2703), Kenya
2018
4.2.2 Tuberculosis diagnosis and treatment

Overall, 42% of health facilities offer TB diagnosis and treatment services. Management and treatment follow-up
for TB patients and provision of drugs to TB patients are the most likely TB services offered (both 37%), followed
by prescription of drugs to TB patients (34%). Only 31% of health facilities offer TB diagnosis, while 26% offer
TB diagnostic testing and 25% offer TB diagnosis by sputum smear microscopy examination. Only 11% of
facilities offer TB diagnosis by rapid test. Only 4% offer TB diagnosis by culture.
25
Figure 37: Percentage of facilities that offer TB services (N=2927), Kenya 2018
The KHFA also assessed additional tuberculosis services, and the most available services were patient follow-up
for adherence and drug supply which were offered in 38% of the facilities. This was closely followed by clinical
follow-up, including drug prescription revision if needed and adverse drug reaction reporting at 37%. The least
available additional tuberculosis services were assessing drug adherence problems that may be associated with
adverse drug reactions at 17% and TB diagnosis among minor adolescents at 21% of the facilities.
Figure 38: Map of tuberculosis diagnosis and treatment services availability by county, Kenya 2018
26
Figure 39: Percentage of facilities that offer additional tuberculosis services (N=2927), Kenya 2018
Service readiness
Nationally, the mean availability of TB tracer items was 67%. Amongst the facilities offering TB services,
58% had all first-line TB medications, while only 25% have TB microscopy. Among health facilities
offering TB services, 95% had HIV diagnostic capacity and 89% had a system for diagnosis of HIV
among TB clients. Among health facilities that offer TB diagnosis and treatment services, only 18% had
all TB tracer items.
Figure 40: Percentage of facilities that have tracer items for TB services among facilities that provide this service (N=1427), Kenya 2018
27
Figure 41: Map of tuberculosis diagnosis and treatment readiness by county, Kenya 2018
Mean readiness to offer additional TB services was 35%. No facility had all the additional TB tracer items. Les than
half of facilities that offer TB services had supplies for coughing patients like waste receptacle 47%, sputum cup
36%, masks for covering 23%, and tissues 22%. Thirty-four percent of facilities had a system for sending sputum
outside facility and receiving results. In 60% of facilities, faculty staff routinely fast-track coughing patients for
clinical and diagnostic evaluation.
Figure 42: Percentage of facilities that have tracer items for additional TB services among facilities that provide this service (N=1427),
Kenya 2018
28
4.2.3 Drug resistant tuberculosis (DRTB) diagnosis and treatment
Only 24% of facilities in Kenya provide any services for drug resistant TB. Facilities are more likely to follow-up
drug resistant patients for adherence (17%), perform contact tracing for patients with DRTB (17%), facilitate social
support for patients with DRTB (15%), and provide the drugs for drug resistant TB patients (15%). Only 6% of
the facilities diagnose drug resistant TB at the facility while 12% of health facilities diagnose by referral.
Figure 43: Map of drug resistant tuberculosis service availability by county, Kenya 2018
29
Service readiness
Mean service readiness for drug resistant TB was 17%, while only 1% of facilities had all drug resistant TB tracer
items. The KHFA showed that 28% of facility staff were screened for TB in the last 12 months before the survey
and national treatment medicines for drug resistant TB were available in 18% of the facilities
Figure 44: Percentage of facilities that have tracer items for drug resistant tuberculosis services among facilities that provide this service
(N=882), Kenya 2018
4.2.4 HIV/AIDS and STIs

In Kenya, 85% of the health facilities offer Counselling and testing services and 76% provide Prevention of
Mother to Child Transmission (PMTCT) services. The least offered HIV/AIDs services in the health facilities are
Care and support (40%) and ARV Prescription/ARV treatment follow-up services (35%).
4.2.5 HIV/AIDS counselling and testing

HIV testing and counselling has been made accessible to Kenyans up to their doorstep.
Overall, 85% of facilities in Kenya offer HIV counseling and testing services.
Figure 45: Map of HIV counseling and testing availability by county, Kenya 2018
30
Service readiness
The mean availability of tracer items for HIV counselling and testing services nationally was 75%, while the
percentage of the facilities which reported to have all tracer items for HIV counselling and testing readiness was
43%.
Health facilities were most likely to have HIV diagnostic capacity (94%) and least likely to have rooms with visual
and auditory privacy (52%). Only 78% of health facilities providing counseling and testing had condoms available
on the day of the survey.
31
Figure 46: Percentage of facilities that have tracer items for HIV counselling and testing services among facilities that provide this service
(N=2524), Kenya 2018
Figure 47: Map of HIV counselling and testing readiness by county, Kenya 2018
4.2.6 HIV/AIDS care and support services

Overall, 40% of health facilities offer HIV/AIDS care and treatment services. Facilities are most likely to offer
treatment of opportunistic infections (39%), family planning counselling (38%), and provision of condoms to
clients (37%). The services least available at health facilities are the treatment of Kaposi’s Sarcoma (3%) and IV
treatment of fungal infections (10%).
32
Figure 48: Percentage of facilities that offer HIV/AIDS care and support services (N=2927), Kenya 2018
Figure 49: Map of HIV/AIDS care and support availability by county, Kenya 2018
Service readiness
Nationally the mean availability of tracer items for HIV care support was 63%, while the percentage of facilities
with all HIV care and support tracer items was 3%.
Among facilities that offer HIV care and support service, 62% of the facilities had a system for diagnosis of TB
among HIV+ clients. More than 80% of health facilities that offer HIV care and support services had the
following items: co-trimoxazole cap/tab (87%), condoms (82%), and palliative care pain management (81%).
Nearly three-quarters (72%) of these facilities have intravenous solution with infusion set, while half have all first
line TB medications. Only 7% of facilities that offer HIV care and support services have IV treatment for fungal
infection.
33
Figure 50: Percentage of facilities that have tracer items for HIV care and support services among facilities that provide this service
(N=1338), Kenya 2018
4.2.7 HIV/AIDS antiretroviral prescription and client management services

Overall, 35% of facilities offered ARV prescription or ARV treatment follow-up services. One-third (34%) of
facilities provided treatment follow-up for persons on ART, and one-third (34%) of facilities offered ART
prescription.
Figure 51: Map of ARV service availability by county, Kenya 2018
34
Service readiness
Among facilities that offer ARV treatment or ARV follow-up services, the ARV service readiness was 27%
nationally. Only 4% of facilities that offered ARV treatment or ARV follow-up services had all ARV tracer items.
Overall, 83% of facilities that offered ARV treatment or ARV follow-up services had the three 1st line ARVs.
Figure 52: Percentage of facilities that have tracer items for ART services among facilities that provide this service (N=1239), Kenya 2018
Figure 53: Map of ARV readiness by county, Kenya 2018
4.2.8 PMTCT Services

In Kenya, 76% of health facilities offered PMTCT services. Kenyan health facilities were most likely to offer HIV
counseling and testing to HIV+ pregnant women, and least likely to offer HIV counseling & testing to infants
born to HIV+ pregnant women. This is likely because testing pregnant women requires an RDT test at site, while
testing infants requires DBS testing that is sent to the National Reference Laboratory. Above 60% of health
facilities offered the following services: family planning counseling to HIV+ women (69%), nutritional counseling
for HIV+ women & their infants (69%), infant & young child feeding counseling (67%), and ARV prophylaxis to
35
HIV+ women (66%). Only 43% of facilities offered ARV prophylaxis to newborns born to HIV+ pregnant
women.
Figure 54: Percentage of facilities that offer PMTCT service (N=2927), Kenya 2018
Figure 55: Map of PMTCT availability by county, Kenya 2018
Service readiness
Among facilities offering PMTCT services, the mean readiness score was 54%, while only 19% had all
PMTCT tracer items. Ninety-three percent of facilities that offered PMTCT services had HIV
diagnostic capacity for adults and 84% had a room with visual and auditory privacy. Among PMTCT
medicines and commodities, health facilities were most likely to have maternal ARV prophylaxis (44%),
followed by nevirapine syrup (40%), and then ziodovudine syrup (34%). Only 31% of facilities that
offered PMTCT services had DBS for diagnosing newborn HIV.
36
Figure 56: Percentage of facilities that have tracer items for PMTCT services among facilities that provide this service (N=2302), Kenya
2018
Figure 57: Map of PMTCT readiness by county, Kenya 2018
4.2.9 Pediatric HIV services

Six in ten facilities in Kenya offered any paediatric HIV services or referral of children to HIV care and treatment
services elsewhere.
The most commonly available paediatric HIV services were HIV testing and counseling (HTC) for children age 5-
9 (64%) and HTC to minor adolescents age 10-19 (61%). More than half of facilities offer HTC to children under
5 (56%). Nearly one-third of facilities offer ART for paediatric HIV patents, while only 31% of facilities offer
HIV care and support services for children.
37
Figure 58: Percentage of facilities that offer paediatric HIV services (N=2927), Kenya 2018
Figure 59: Map of paediatric HIV service availability by county, Kenya 2018
Service readiness
Overall, the mean availability of pediatric HIV tracer items was 32%, but only 3% of health facilities had all
pediatric HIV tracer items. The most available tracer item was cotrimoxazole syrup or dispersible tables (77%)
followed by nevirapine (NVP) syrup (48%).
38
Figure 60: Percentage of facilities that have tracer items for paediatric HIV services among facilities that provide this service (N=1871),
Kenya 2018
Figure 61 Map of pediatric HIV readiness by county, Kenya 2018
4.2.10 Sexually transmitted infection services

In Kenya, 85% of health facilities offered STI services. Nearly all hospitals offered STI services; 100% of
secondary & tertiary hospitals, 99% of public primary hospitals, and 99% of private/NGO/FBO primary
hospitals. More than 80% of dispensaries and medical clinics also offered STI services.
Service readiness
The mean availability of STI tracer items was 72%, but only 28% of facilities that offered STI services had all the
STI tracer items. Facilities were most likely to have ciprofloxacin (78%) and condoms (76%). Less than 70% of
facilities that offer STI services had ceftriaxone injectable (69%) and metronidazole (67%).
39
Figure 62: Percentage of facilities that have tracer items for STI services among facilities that provide this service (N=2512), Kenya 2018
4.2.11 Neglected tropical diseases

Thirty-one percent of facilities nationally offered any service for Neglected Tropical Diseases (NTDs). Nearly 3 in
10 facilities offered soil transmitted helminths diagnosis and treatment and 15% offered Schistosomiasis diagnosis
and treatment. Availability of other NTD services and tracer items are below 10%.
Figure 63: Percentage of facilities that offer NTD services (N=2927), Kenya 2018
Service readiness
Overall, the NTD service readiness index was 35%, meaning that in average facilities had 35% of the tracer items.
The least available NTD tracer items were diagnostic capacity for lymphatic filariasis (LF) (17%), rapid test for
Dengue (6%), diagnostic capacity for visceral leishmaniasis (VL) 6%, and Kato Katz test for helminth (3%). The
least available medicine and commodity was Ivermectin 5% to treat parasitic infections.
40
Figure 64: Map of NTD availability by county, kenya 2018
Figure 65: Percentage of facilities that have tracer items for NTD services among facilities that provide this service (N=939), Kenya 2018
4.3 Non-communicable disease services

Nationally, availability of management and diagnosis of cardiovascular diseases was highest at 62% while diagnosis
of cervical cancer was lowest at 22%. Some facilities reported that they offered NCD services, however they did
41
not have the requisite items necessary to provide the services. Half of the facilities (50%) that reported to offer
chronic respiratory disease management did not have the requirements while more than three quarters (85%) of
those that reported to offer cervical cancer diagnosis had the necessary requirements.
Figure 66: Availability of non-communicable disease services (N = 2927), Kenya 2018
4.3.1 Diabetes
More than half (58%) of diabetes care services were available countrywide. The services are available at 100% of
the tertiary, secondary and primary hospitals as well as private, NGO/FBO facilities.
Figure 67: Map of diabetes care service availability by county, Kenya 2018
Service readiness
Of the 11 tracer items, on average, about two-thirds (63%) of the items were available with only 4% of the facilities
having all the tracer items. Regarding equipment, the blood pressure apparatus was available in 97% of the
42
facilities. The most available medicine was Metformin at 73% while the least available was the Gliclazide or
glipizide tablets at 12 %.
Figure 68: Percentage of facilities that have tracer items for diabetes services among facilities that provide this service (N=1722), Kenya
2018
4.3.2 Cardiovascular disease services

Countrywide, 62% of all facilities provides CVD services. All secondary and tertiary hospitals reported having
CVD services. In terms of managing authority, majority (71%) of the private facilities offer CVD services while
slightly above half (53%) of government facilities did.
Figure 69: Map of CVD availability by county, Kenya 2018
43
Service readiness
The average availability of tracer items for CVD across the country was about two-thirds of items (64%). Of all the
CVD tracer items, availability of oxygen was the lowest (16%) with stethoscope and blood pressure apparatus joint
highest at 96%. The basic diagnostic equipment (stethoscope, blood pressure apparatus and adult scale) for CVD
were available in more than 85% of facilities. All the tracer items were available only in 8% of facilities.
Figure 70: Percentage of facilities that have tracer items for CVD services among facilities that provide this service (N=1821), Kenya 2018
4.3.3 Chronic respiratory disease (CRD)

Overall, 61% of the health facilities assessed reported to be offering chronic respiratory disease diagnosis and/or
management services. Chronic respiratory disease diagnosis and/or management services was more likely available
in hospitals than other facility types (varying from 95% in hospitals and 48% in dispensaries).
Figure 71: Map of CRD availability by county, Kenya 2018
44
Service readiness
Only 1% of health facilities reported to be having all the tracer items for the diagnosis and /or management of
CRDs. The rest of the tracer items i.e. peak flow meter, spacers for inhalers and oxygen had a low coverage at
11%, 22% and 16% respectively.
Figure 72: Percentage of facilities that have tracer items for CRD services among facilities that provide this service (N=1802), Kenya 2018
4.3.4 Cervical cancer

KHHFA survey, showed cervical cancer services were offered in 22% of the facilities sampled. Secondary and
tertiary hospitals were leading in cervical cancer diagnosis at 90% with dispensaries at 15%.
Figure 73: Percentage of facilities that offer cervical cancer services, by county (N=2927), Kenya 2018
Figure 74: Map of cervical cancer availability by county, Kenya 2018
45
Service readiness
Among health facilities that were providing diagnosis and /or management of cervical cancer, none of the health
facilities assessed had all the items. On average, only 32% of the items were available. A high proportion of the
facilities (91%) had speculum and 79% had acetic acid, while 4% had colposcopy equipment and only 1% had
histopathology services.
Figure 75: Percentage of facilities that have tracer items for cervical cancer services among facilities that provide this service (N=693),
Kenya 2018
4.3.5 Breast cancer

20% of facilities reported offering screening for or diagnose of breast cancer. The service mostly offered was
manual breast examination with other services for screening and diagnosis ranging very low: ultrasound (3%), core
needle biopsy (2%), and mammography (1%).
46
Figure 76: Percentage of facilities that offer breast cancer services (N=2,927), Kenya 2018
Service readiness
Nationally the average availability of tracer items for breast cancer care was 4%. Morphine availability was 15%
making it the most available tracer item. 24% of secondary and tertiary hospitals had all tracer items while none of
the other levels of care had all items available
Figure 77: Percentage of facilities that have tracer items for breast cancer services among facilities that provide this service (N=635),
Kenya 2018
4.3.6 Prostate cancer

Availability of prostate cancer services was low with only 7 % of facilities reporting that they screen for, diagnose
or treat prostate cancer. 80% of secondary and tertiary facilities offered prostate cancer services followed by
private and primary hospitals at 48%.
Service readiness
The mean availability of tracer items was 56%, and 22% of facilities that offered prostate cancer care had all the
items. Diagnostics used for prostate cancer were more readily available compared to medicines and technologies
47
Figure 78: Percentage of facilities that have tracer items for prostate cancer services among facilities that provide this service (N=248),
Kenya 2018
4.3.7 Colorectal cancer

Nationally, the provision of colorectal cancer services was low across the country with only 2% of all health
facilities. Out of the facilities in the urban areas, 4% offer the services compared to 1% in the rural areas.
Figure 79: Percentage of facilities that offer colorectal cancer services by facility type (N=2927), Kenya2018
Service readiness
The average availability of tracer items for colorectal cancer was 15% among the 77 facilities that said they offer
colorectal cancer services. While fecal occult blood test is the one of the most common tests for colorectal cancer,
the test was done in only 27% of facilities
4.3.8 Mental and neurological care

Nationally, 13% of the facilities offer at least one mental health service with secondary and tertiary hospitals (90%)
leading in the provision of the services. The most commonly available mental health service is treatment of mental
disorders such as depression, psychosis, or bipolar disorder (12%) along with treatment for epilepsy (12%). The
least available services were inpatient wards for mental health or neurology (2%)
48
Figure 80: Map of mental and neurological care service availability by county, Kenya 2018
Service readiness
The tracer medicines for mental health services were largely available in facilities offering the services. On average
facilities have 70% of the items required to deliver mental health services and 45% of facilities offering mental
health services had all the tracer items. The most widely available tracer item was medicines used as antiepileptics
(93%) while the least available tracer item was medicines use din psychosis (59%).
Figure 81: Percentage of facilities that have tracer items for mental and neurological care services among facilities that provide this service
(N=429), Kenya 2018
4.3.9 Services for victims of violence and sexual abuse

Nationally, 31% of healthcare facilities are able to provide the necessary healthcare services to victims of violence
and sexual abuse as per the survey. Services for both victims of child maltreatment and youth violence were
offered by 17% of the facilities. The least available service was forensic assessment and examination at 8%.
49
Figure 82: Percentage of facilities that offer services for victims of violence and sexual abuse (N=2927), Kenya2018
4.3.10 Palliative care

Availability of palliative care is dismally low in Kenya, with only 3 percent of the facilities country wide indicating
to have the service. Only 1% of health facilities nationally offer home-based care and only 1% of
health facilities offer facility linkages with home-based services.
Service readiness
The mean availability of tracer items for palliative care was 59% for the 140 facilities providing the service. The
percentage of facilities with all tracer items was 7% nationally. The most available tracer item was iron/iron with
folic acid (90%) while the lowest was intravenous nutritional supplement (17%).
Figure 83: Percentage of facilities that have tracer items for palliative care services among facilities that provide this service (N=140),
Kenya 2018
4.3.11 Rehabilitation care

Countrywide, only 4% of the facilities provided rehabilitation care services. Secondary hospitals were the major
providers of the service at 90% while the lowest was dispensaries at 1%.
50
Service readiness
The mean availability of tracer items for rehabilitative care services was 36% nationally.
Figure 84: Percentage of facilities that have tracer items for rehabilitation care services among facilities that provide this service (N=181),
Kenya 2018
4.4 Surgical services

4.4.1 Basic surgery
More than 80% of the facilities offer basic surgical services the major ones being suturing, incision and drainage of
abscesses, acute burn management and removal of foreign body.
Figure 85: Percentage of facilities that offer basic surgical services (N=2927), Kenya 2018
Service readiness
Only (1%) of the facilities country wide is equipped with all the 15 tracer items that are necessary for a facility to
offer basic surgical services. On average there is 24% availability of the 15 tracer items in the facilities that provide
basic surgical services country wide.
51
Figure 86: Percentage of facilities that have tracer items for basic surgical services among facilities that provide this service (N=2392),
Kenya 2018
4.4.2 Comprehensive surgery

Nationally, 68% of hospitals provide comprehensive surgical services. About 50% of public primary hospitals offer
comprehensive surgical services.
Figure 87: Percentage of hospitals that offer comprehensive surgical services (N=411), Kenya 2018
52
Figure 88: Map of comprehensive surgical service availability by county, Kenya 2018
Service readiness
The mean availability of tracer items in the hospitals that offer comprehensive surgical services was 70% while the
percentage of facilities with all the tracer items was 7%. Government managed facilities have a mean availability of
tracer items of 67% while the percentage of facilities with all the items is 6%.
53
Figure 89: Percentage of hospitals that have tracer items for comprehensive surgical care among facilities that provide this service
(N=227), Kenya 2018
4.4.3 Blood transfusion

Countrywide, only 7% of facilities provided blood transfusion services. Most of the secondary and tertiary health
facilities offered blood transfusion services and more than half of all public primary hospitals offered blood
transfusion services.
Figure 90: Map of blood transfusion readiness by county,Kenya2018
54
Service readiness
Some facilities were offering blood transfusion albeit with minimum tracer items. In the whole country only 10%
of facilities that offered blood transfusion services had all tracer items for blood transfusion. The mean availability
of tracer items was 50% in all the facilities.
Figure 91: Percentage of facilities that have tracer items for blood transfusion services among facilities that provide this service (N=323),
Kenya 2018
4.4.4 General emergency care

The analysis of general service availability was limited to hospitals (N=411).
71% of hospitals provided 24 hour pharmacy services, 67% provided 24 hours laboratory services while only 8%
provided 24 hour surgical services that include a surgeon and anesthetist.
25% of hospitals had a special emergency unit while 20% of hospitals had a dedicated emergency unit that operates
for 24 hours.
Figure 92: Map of general emergency service availability by county (N = 2,927), Kenya 2018
55
Figure 93: Percentage of hospitals that offer general emergency services (N=411), Kenya 2018
56
Service readiness
Figure 94: Percentage of facilities that have equipment and medicines for general emergency services among facilities that provide this
Service readiness
20% of facilities had all the items, while the mean availability was at 68%. Adrenaline and atropine were the most
available medicines at above 80% while sodium bicarbonate was available in 62% of the facilities. Pediatric
intubation set was the least available in only 27% of the facilities while the adult oropharyngeal airway set was
available in 50% of the facilities
4.4.5 Emergency care: Quality support services

About half of all facilities could measure vital signs in the ER unit/OPD, perform emergency delivery and
administer uterotonic drug. About 40% could perform neonatal resuscitation
Figure 95: Percentage of facilities that offer emergency quality support services (N=2927), Kenya 2018
Service readiness
Nationally, the mean availability of tracer items for emergency quality support services was 93% with 85% of
facilities have all tracer items.
57
Figure 96: Percentage of facilities that have tracer items for emergency quality support services among facilities that provide this service
(N=2236), Kenya 2018
4.4.6 Emergency care: Airway interventions

77% of hospitals reported ability to perform suction while 68% use of manual manoeuvres as an intervention.
Surgical technique to create an airway was the least reported at 28% in the assessed facilities.
Figure 97: Percentage of facilities that offer emergency airway intervention services (N=411), Kenya 2018
Service readiness
17% of facilities had all the items with mean availability at 50%. Suction apparatus with a suction catheter was the
most available at 68% while the least available was the cricothyroidotomy or tracheostomy set at 24%.
58
Figure 98: Percentage of facilities that have tracer items for emergency airway intervention services among facilities that provide this
4.4.7 Emergency care: Breathing

The highest available intervention was administration of oxygen followed by critical therapies for reactive airway
disease at 78% and 76% respectively.
Figure 99: Percentage of hospitals that offer emergency breathing intervention services (N=411), Kenya 2018
Service readiness
Mean availability of items was 45% in the facilities, with resuscitation bag and mask being the highest available at
62% and the least being paediatric intubation equipment at 36%.
59
Figure 100: Percentage of hospitals that have tracer items for emergency breathing intervention services among hospitals that provide this
4.4.8 Emergency care: Cardiac interventions

Administration of medicines i.e. adrenaline, aspirin, and thrombolytics was the most offered at 88%, 67%, and
32% respectively.
Figure 101: Percentage of hospitals that offer emergency cardiac intervention services (N=411), Kenya 2018.
Service readiness
The mean availability ranged from 19% to 61%. However, a majority of counties lacked facilities that had all the
items. 15% of secondary and tertiary facilities had all the items.
60
Figure 102: Percentage of facilities that have tracer items for emergency cardiac intervention services among facilities that provide this
4.4.9 Emergency care: Control of bleeding interventions

Availability of the services was relatively low with only 58% of facilities sampled reporting that they can perform
packing and/or suture as a control to bleeding while 6% could apply pelvic binding or sheeting.
Figure 103: Percentage of facilities that offer emergency control of bleeding intervention services (N=2927), Kenya 2018
Service readiness
Out of the sampled facilities that reported to offer emergency care services, only 12% reported that they can apply
a tourniquet as an intervention to arrest bleeding.
4.4.10 Emergency care: Volume resuscitation interventions

Only 65% of facilities reported to provide oral rehydration. Establishing an intraosseous access, venous cut down,
and placing a peripheral IV access were below 10%, while the other methods ranged from 34% to 64%.
61
Figure 104: Percentage of facilities that offer emergency volume resuscitation intervention services (N=2927), Kenya 2018
Service readiness
Oral rehydration salts were the highest available at 85% and the lowest was device for intraosseus injection at 3%.
By facility type, secondary and tertiary facilities had a mean availability of 70% while dispensaries and medical
clinics had a mean availability of 40% and 41% respectively
Figure 105: Percentage of facilities that have tracer items for emergency volume resuscitation intervention services among facilities that
provide this service (N=2236), Kenya 2018
4.4.11 Emergency care: Injury specific interventions

The highest available service was performing appropriate initial wound care (62%) while the least available
intervention was performing fasciotomy or escharotomy for compartment syndrome at 3%.
62
Figure 106: Percentage of facilities that offer emergency injury specific intervention services (N=2927), Kenya 2018
Service readiness
Availability of tracer items was quite low with the mean availability at 17%. The most available being the tetanus
vaccine at 52% while the rabies vaccine was available in 9% of facilities. The least available item was the cervical
collar at 3% only.
Figure 107: Percentage of facilities that have tracer items for emergency injury specific intervention services among facilities that provide
this service (N=xx), Kenya 2018
4.4.12 Emergency care: Sepsis interventions

Nationally, most facilities administered IV antibiotics (66%) as an emergency sepsis intervention while few facilities
performed diagnostic paracentesis (8%).
63
Figure 108: Percentage of facilities that offer emergency sepsis intervention services (N=2927), Kenya 2018
Service readiness
Nationally, the mean availability of the tracer items for emergency sepsis interventions was at 36% whereas only
3% of the facilities had all the tracer items. Generally, administration of antibiotics for management of sepsis was
the most available tracer item (68%).
Figure 109: Percentage of facilities that have tracer items for emergency sepsis intervention services among facilities that provide this
service (N=2236), Kenya 2018.
4.4.13 Emergency care: Seizure interventions

Availability of medicines used to manage seizures ranged from 9% to 31% with the most available being
benzodiazepine.
64
Figure 110: Percentage of facilities that offer emergency seizure intervention services (N=2927), Kenya 2018
4.4.14 Emergency care: Unconscious patient interventions

50% of all the assessed facilities could check the blood glucose level, while 52% could administer glucose for
hypoglycaemia.
Figure 111: Percentage of facilities that offer emergency unconscious patient intervention services (N=2927), Kenya 2018
Service readiness
Mean availability of items was at 3% with only 1% of facilities having all the items. The most available item was
glucose while the least available was antidote for opiate overdose.
65
Figure 112: Percentage of facilities that have tracer items for emergency unconscious patient intervention services among facilities that
provide this service (N=2236), Kenya 2018
4.5 Medicines
WHO defines essential medicines as the medicines that satisfy the priority health care needs of the population.
Tracer medicines are used to examine access in terms of availability of essential medicines.
On average, tracer medicines for infectious diseases had the highest availability (70%) and medicines for mental
health and neurological disorders had the lowest availability (21%). Availability of drugs for non-communicable
diseases was however moderate to low (42%) with less than half of facilities having most of the assessed drugs.
Figure 113: Percentage of facilities that have tracer medicines available by category (N=2927), Kenya 2018
Infectious disease medicines

70%
availability
Non-communicable disease
42%
medicines availability
Palliative care medicines availability 36%
Mental health and neurological

21%
medicines availability
0% 20% 40% 60% 80% 100%
66
Figure 114: Mean availability of 25 essential medicines by county (N=2927). Kenya 2018
4.5.1 Infectious disease medicines

Nationally, the highest available tracer item was dewormers (mebendazole or albendazole) caps/tab at an average
of 85% while fluconazole (antifungal) caps/tab was the least available tracer item at an average of 45%
Figure 115: Availability of 7 infection diseases medicines. (N=2927), Kenya 2018

100% 85%
90% 78% 75% 72%
80% 66% 65% 70%
70%
60% 45%
50%
40%
30%
20%
10%
0%
4.5.2 Non-communicable disease medicines

Nationally, paracetamol was the most available tracer medicine at an average of 77% while Isosorbide dinitrate and
Glyceryl trinitrate sublingual tablet were the least available tracer medicines at an average of 2% each.
67
Figure 116: Availability of 23 non-communicable diseases medicines. (N=2927), Kenya 2018
100%
90%
77% 76% 75%
80%
68%
70% 63% 63%
59% 57%
60% 54% 53% 50% 49% 49%
50% 44% 42.1%
40% 33%
30% 25% 25%
20% 14% 13% 12%

8%
10% 2% 2%
0%
4.5.3 Mental health and neurological medicines

Nationally, Phenobarbital tablets was the most available tracer medicine at an average of 58% while Lithium tablet
and Lorazepam injection were the least available tracer medicines at an average of 1% each
Figure 117: Availability of 14 Mental health and neurological medicines. (N=2927), Kenya 2018
100%
90%
80%
70% 58%
60% 47%
50% 41% 38% 33%
40% 23%
30% 21%
15% 13% 11%
20% 8% 5% 5%
10% 1% 1%
0%
4.5.4 Palliative care medicines

Nationally, Paracetamol was the most available tracer item for palliative care at an average of 77% while
Lorazepam tablets was the least available at an average of 2%.
68
Figure 118: Availability of 10 palliative care medicines. (N=2927), Kenya 2018
100%
90% 77%
80%
70% 63%
58%
60% 48%
50% 43% 39% 36%
40%
30% 20%
20% 10%
10% 4% 2%
0%
4.5.5 Medicine Pricing

From the list of the 32 drug commodities assessed, price data was analysed for eight commodities that were
conveniently selected, amongst them an antibiotic, an antifungal cream, a tocolytic, an inhaler and an injectable
antibiotic.
For level 5 and 6 hospitals, the ratio for patient to procurement prices ranged from 0.6 to 3.15. This means that,
for some of the commodities the clients are paying a lower price than the procurement price while for other
commodities like Amoxicillin 500mg capsule, clients are paying 3 times more. The ratio of procurement price to
the international reference prices ranged from 1.97 to 0.38, this means that for Amoxicillin 250mg dispersible tab,
hospitals are paying almost twice what other countries are paying. Across the level 4 hospitals, the range of the
patient price to procurement price ratio was 0.22 to 4.00 meaning that for ibuprofen, clients are paying 4 times the
procurement price and for amoxicillin 250mg dispersible tablets the clients are paying about 20% of the
procurement price. Across health centres and dispensaries, the patient median price is KShs. 0 as expected
given that the government abolished user fees in government level two and three facilities.
Figure 119: Prices of medicines (procurement vs. patient), Kenya 2018
69
Aspirin tablet
Hydrochorothiazide tablet
Enalapril tablet/capsule
Doxycycline Capsules
Glibenclamide [tablet]
Metronidazole (Flagyl)
Metformin tablet
Brufen (Ibuprofen) tablet
Zinc sulphate [tablet]
Omeprazole tablet
Amlodipine tablet/capsule
Amoxicillin [capsule]
Haloperidol tablet
Carbamazepine tablet
Mebendazole (tablet)
Carvedilol tablet
Simvastatin tablet/capsule
Amoxicillin (disp caps)
Oral rehydration salts
Gryseofulvin tablet
Fluoxetine cap
Gentamicin injection
Clotrimazole topical
Diazepam injection
Oxytocin injection
Amoxicillin Clavulanic (augmentin) tablet
Ampicillin Injection [VIAL]
Ceftriaxone injection [vial]
Magnesium sulphate
Salbutamol [inhaler]
Insulin regular
Beclometasone inhaler
0 100 200 300 400

Procurement price Patient price
Figure 120: Prices of medicines (procurement vs. patient) across facilities types, Kenya 2018
Dispensaries
Health Centres
Public Primary Hospitals
Medical Clinics
Secondary & Tertiary Hospitals
Private/NGO/FBO Primary Hospital
0 50 100 150 200

mean price (per unit)
Procurement price Patient price
4.6 Advanced diagnostic services and diagnostic equipment

4.6.1 Advanced diagnostic services
The performance of counties in availability of urine dipstick was generally high. Ten counties reported the highest
availability at 100% while two counties had the lowest performance of below 30%.
70
Figure 121: Percentage of hospitals that offer advanced diagnostic services (N=411), Kenya 2018
4.6.2 High level diagnostic equipment

The mean availability of high-level diagnostic equipment nationally was 41%, while the ultrasounds was the most
available diagnostic equipment at 62% and the least available diagnostic equipment was CT scan at 13%.
Figure 122: Percentage of hospitals that have high level diagnostic equipment available (N=411), Kenya 2018
5 Quality and safety

5.1 Systems for Quality of Care
5.1.1 Quality improvement team
Slightly above half (53%) of facilities countrywide have QI teams. Higher level facilities had more QI teams
compared to lower level facilities. 95% of all the secondary and tertiary hospitals had QI teams compared to 43%
of dispensaries and medical clinics.
71
Figure 123: Availability of quality improvement teams/committees by facility type and managing authority, among facilities that
conducted routine QA activities (N=1105), Kenya 2018
5.1.2 Budget for QI activities

Nationally, a dedicated budget line for QI activities was available at 42% of facilities.
Figure 124: Availability of a dedicated budget line for QI activities by facility type and managing authority among facilities that provided
budget / funding information (N=1278), Kenya 2018
5.1.3 Health workers’ continuous professional development (CPD) system

Generally, 44% of facilities have a system in place for regular (at least quarterly) continuous medical education to
ensure professional development of medical officers, nurses and clinical officers.
72
Figure 125: Availability of CPD systems by facility type and managing authority (N=2927), Kenya 2018
5.1.4 Adverse event reporting system

Nationally, 40% of health facilities with inpatient services countrywide had a system for identifying and monitoring
adverse event such as patient falls and hospital acquired infections. A review of performance by health service
delivery level shows that the majority of secondary and tertiary hospitals (90%) had a system for identifying and
monitoring adverse events while only 3% of dispensaries had such a system.
Figure 126: Availability of functional adverse reporting systems in facilities with inpatient services by facility type and managing authority
(N=811), Kenya 2018
5.1.5 Infection control monitoring system

One third (30%) of facilities countrywide had infection control monitoring systems and Availability of infection
control monitoring systems was variable across counties. The tendency of health facilities to monitor adherence to
IPC guidelines increased with the level of health facility. Only 23% of dispensaries, 28% of medical clinics, and
37% of health centers monitored adherence compared to 61% of primary hospitals and 80% of secondary and
tertiary hospitals.
73
Figure 127: Availability of infection control monitoring systems by facility type and managing authority (N=2927), Kenya 2018
5.2 Monitoring of quality of care at the facility level

5.2.1 System for verification of health worker licenses
Slightly over a third (39%) of health facilities in Kenya reported that they routinely verify their health professionals’
license and registration status. Further, 23% of public facilities had a system in place for verification of health
workers’ licenses.
Figure 128: Availability of systems for verification of health worker licence by facility type and managing authority (N=2927), Kenya 2018
5.2.2 Process for performance review based on data on facility services, outcomes, or patient
feedback
Almost half (49%) of facilities in Kenya routinely reviewed their performance based on facility data or patient
feedback. The majority of hospitals had a system in place for performance review. Health centers and dispensaries
had lower availability of these systems.
74
Figure 129: Availability of systems for performance review based on data by facility type and managing authority (N=2927), Kenya 2018
5.2.3 Supportive supervision system for health workers

Nationally, most (71%) health facilities reported that they had received a supportive supervision visit within the
past three months. While the majority of public facilities (85%) had received supportive supervision in the last
three months, this was not the case for private facilities which was much lower at 53%.
Figure 130: Availability of supportive supervision visit within the past three months by facility type and managing authority (N=2927),
Kenya 2018
5.2.4 System for including community representation on management committees

Just about half (49%) of health facilities in the country reported a system for community representation on
management committees.
75
Figure 131: Availability of systems for including community representation on management committees by facility type and managing
authority (N=2927), Kenya 2018
5.2.5 Systems for measuring patient experience of care

Only 38% of facilities had systems in place for measuring patient experiences. A higher proportion of hospitals
had systems in place compared to health centres, dispensaries and medical clinics.
Figure 132: Availability of systems for measuring patient experience of care by facility type and managing authority (N=2927), Kenya 2018
5.2.6 Inpatient mortality reviews

Nationally, 38% of facilities with inpatient services conduct inpatient mortality reviews. While all referral hospitals
(secondary and tertiary hospitals) reported that they conducted mortality reviews, the proportion among primary
hospitals and health centres with inpatient capabilities was much lower at 69% and 34% respectively. There was a
marked disparity by managing authority, with only 30% of private sector facilities reporting availability of mortality
and morbidity reviews compared to government (43%) and NGO/FBO facilities (52%).
76
Figure 133: Availability of inpatient mortality reviews among facilities with inpatient services by facility type and managing authority
(N=811), Kenya 2018
5.2.7 Systematic monitoring on the use of medicines

Nationally, 51% of facilities have systematic monitoring on the use of medicines. While there was little variation in
the availability of systematic monitoring on the use of medicines by managing authority (i.e. governmental vs. non-
governmental), hospitals demonstrated higher availability of systematically monitoring the use of medicines as
compared to primary care facilities.
Figure 134: Availability of systematic monitoring on the use of medicines by facility type and managing authority (N=2927), Kenya 2018
5.3 Facility adherence to standards

5.3.1 Facility participates in external accreditation licensing
Nationally, only 24% of facilities countrywide participated in periodic external accreditation process. Government
owned facilities were less likely to have participated in an external accreditation process (17%) compared to
NGOs/FBOs (30%) facilities and private facilities (31%).
77
Figure 135: Availability of participation in external accreditation by facility type and managing authority (N=2927), Kenya 2018
5.3.2 Proper disposal of sharps waste

Nationally, 70% of health facilities had proper disposal of sharps waste available. There was little variation in the
availability of proper disposal of sharps waste by facility type (64% - 76%) and by managing authority (65% - 77%).
Figure 136: Availability of proper disposal of sharps waste by facility type and managing authority (N=2742), Kenya 2018
5.3.3 Pharmaceutical commodity storage conditions

Nationally, only 22% of health facilities had adequate pharmaceutical commodity storage conditions. Only
secondary and tertiary hospitals scored above 50% for availability of adequate pharmaceutical commodity storage
conditions which presents a grim picture about pharmaceutical commodity storage conditions across all facility
types.
78
Figure 137: Availability of adequate pharmaceutical commodity storage conditions by facility type and managing authority (N=2767),
Kenya 2018
5.3.4 Vaccine storage conditions

Nationally, 77% of facilities have adequate vaccine storage condition.
Figure 138: Availability of adequate vaccine storage conditions by facility type and managing authority (N=2118), Kenya 2018
5.3.5 Outbreak preparedness plans

Nationally, only 4% of facilities have outbreak preparedness plans
79
Figure 139: Availability of outbreak preparedness plans by facility type and managing authority (N=2927), Kenya 2018
5.3.6 Guidelines on identifying and managing drug use problems

Nationally, 39% of facilities have guidelines on identifying and managing drug use problems. There was significant
variation by facility type. Most (80%) of the secondary and tertiary hospitals, public primary hospitals (70%), and
private/NGO/FBO hospitals had scored above 65% while health centres, dispensaries, and medical clinics all
scored below 50%.
Figure 140: Availability of guidelines on identifying and managing drug use problems by facility type and managing authority (N=2927),
Kenya 2018
80
6 Management and Finance
6.1 Management systems to support facility functionality, efficiency, and accountability
Two thirds (67%) of facilities reported having a core management team responsible for oversight of the day to day
functioning of the facility, while half of the facilities (52%) reported having core management team structured as
per norms and standards. Furthermore, 37% of facilities reported having a routine system for including community
representation for some aspects of the management teamwork. Additionally, 28% of the facilities had conducted a
meeting in the quarter preceding the survey. Only 21 % of the facilities had a functional community unit.
Figure 141: Percentage of facilities with management systems to support facility functionality, efficiency, and accountability (N=2927),
Kenya 2018
Figure 142: Map of availability of core management teams by county, Kenya 2018
6.2 Implementation of systems to improve accountability

Slightly above half (53%) of facilities reported having a system for determining clients’ opinions. Despite the
requirement for management teams to routinely review client’s feedback, only 18% of facilities reported reviewing
or reporting on client opinions routinely.
81
Figure 143: Percentage of facilities with systems to improve accountability (N=2927), Kenya 2018
6.3 Facility-level external supervision for management

Generally, majority (94%) of facilities reported receiving external supervision such as from the sub county, county
or national level. There were however gaps in documentation with only 59% of facilities reporting having
documentation of the supervisory visits received within the last three months.
Figure 144: Percentage of facilities with facility-level external supervision (N=2927), Kenya 2018
6.4 Drug management systems

6.4.1 Main source of pharmaceutical commodity supplies
Over half (52%) of facilities reported KEMSA as their main source of routine pharmaceutical commodity supplies.
Secondary and tertiary hospitals as well as public primary hospitals reported KEMSA to be the main source at 58
% and 89 % respectively
82
Figure 145: Percentage of facilities utilizing various sources as the main source of pharmaceutical commodity supplies among facilities
that stock pharmaceutical commodities (N=2618), Kenya 2018
6.4.2 Pharmaceutical commodity reporting systems

Nationally, majority of health facilities (73%) had records showing pharmacy commodities received, disbursed, and
the balances. Only about a half of facilities (54%) had evidence to show that they regularly removed expired or
unusable drugs
Figure 146: Percentage of facilities with pharmaceutical commodity reporting system indicators among facilities that stock
pharmaceutical commodities (N=2505), Kenya 2018
6.5 Infection prevention and control monitoring system

Nationally, 38 % of health facilities have IPC guidelines. The least available were guidelines for cleaning facilities
and personnel trained an IPC course both at 15% of facilities. Secondary and tertiary facilities reported an 85%
availability of IPC guidelines while dispensaries and medical clinics reported 39% and 31% respectively
Figure 147: Percentage of facilities with infection prevention and control monitoring indicators (N=2927), Kenya 2018
83
6.6 Systems for maintenance and repair
Below half (43%) of health facilities reported undertaking preventive and corrective maintenance for any systems
and only 10% of facilities had systems for corrective maintenance of medical equipment. Only 13 counties (28%)
reported facilities carry out preventive and corrective maintenance for any systems.
Figure 148: Map of availability of preventative and corrective maintenance for infrastructure by county, Kenya 2018
6.7 Facility use of information for management

6.7.1 Systems for ensuring quality of routine data
About half (47 %) of the facilities reported to have routine and systematic process for checking the quality of data
compiled for reports. Only 10% of facilities had policy guidelines for data quality checking while about a quarter of
facilities had data improvement plans and teams (26% and 23% respectively). Only 10% of the health facilities
have a written policy/guideline for data quality checking.
84
Figure 149: Map of availability of systems for checking quality of reported data by county, Kenya 2018
6.7.2 Evidence of use of service information and data for planning and management
Nationally, 34% of facilities have a routine process for performance review based on data on facility services,
outcomes, or patient feedback. Evidence of use of patient survey data was found in 15% of the facilities while
evidence of use of mortality data was found in 14% of the facilities. Implementation of employee satisfaction
surveys was the least implemented at 11% of facilities. 28% of facilities had evidence for use of HMIS reports (e.g.,
numbers of patients, numbers by diagnoses).
Figure 150: Percentage of facilities with evidence of use of service information and data for planning and management (N=2927), Kenya
2018
85
6.8 Systems for monitoring indicators of quality of inpatient care
6.8.1 Systems for monitoring indicators of quality of inpatient care
Nationally, 59 % of facilities reported to be having a system for identifying and monitoring adverse events, such as
patient falls or infections. About 73% of facilities conducts death reviews for some proportion of deaths.
Figure 151: Percentage of hospitals with systems for monitoring indicators of quality of inpatient care among hospitals with inpatient
services (N = 392), Kenya 2018
Figure 152: Map of availability of systems for reporting adverse events by county, Kenya 2018
6.8.2 Facility monitoring of case fatality rates

28 % of health facilities reported monitoring of case fatality rates for any specific diagnoses. By facility type,
performance ranged from 17% in public primary hospitals to 48% in secondary facilities.
86
Figure 153: Percentage of hospitals monitoring case fatality rates (N=392), Kenya 2018
6.8.3 Facility monitoring of inpatient cases

Of 33% of facilities reported to monitor deaths within 30 days of admission for any identified. 35% of facilities
monitored admissions for conditions where quality outpatient follow-up can reduce the need for hospitalization
Figure 154: Percentage of hospitals with systems for monitoring indicators of quality of inpatient care, Kenya 2018
6.9 Adverse event reporting guidelines

A third of facilities (31%) had guidelines on submission of adverse events while a quarter (25%) reported
documenting the review process for compiled reports on adverse events. 23% of the facilities had notes/reports
that show evidence of review and plan of action for the reports about adverse events.
87
Figure 155: Percentage of hospitals with guidelines for adverse event reporting among hospitals with inpatient services (N=392), Kenya
2018
6.10 Use of unique patient identifiers

While most facilities (90%) were using unique patient ID numbers for any patients, utilization of same ID from
year to year was only in a third (33%) of facilities. Half (50%) of facilities utilized a standardized set of forms or
electronic data entry screens to comprise a complete medical record for each patient.
Figure 156: Percentage of facilities using unique patient identifiers (N = 2927), Kenya 2018
6.11 Accountability for user fees

Nationally, 40% of facilities reported charging user fees for any outpatient services and 16% charged for any
inpatient services. Regarding the managing authority, only 10% of government facilities were charging user fees
with majority being hospitals. Despite the policy directive to abolish user fees in public primary health care
facilities, a sizeable percentage of health facilities in the counties continue to charge user fees.
36% of the facilities posted user fees for outpatient services anywhere for patients to see while 34% of the facilities
posted user fees for inpatient services for patients to see.
88
Figure 157: Percentage of facilities with user fees for outpatient and inpatient services, Kenya 2018
6.12 Financial accountability

Of 47 % of facility reported having received an annual external audit of facility accounts. 52% of the facilities has a
budgeted annual work plan (2018/19).
Figure 158: Percentage of facilities with budgeted work plans and external audits of facility accounts, Kenya 2018
89
Figure 159: Map of availability of budgeted annual work plans by county, Kenya 2018
6.13 Health insurance coverage

6.13.1 Health insurance for inpatients
In 17% of facilities, only between 1% and 25% of inpatients had any kind of health insurance. In 14% of facilities,
between 76% and 99% of patients had insurance, while only 6 % of facilities reported to have received 100 of
inpatient services in the facility had any type of health insurance.
Figure 160: Percentage of facilities with inpatient services where inpatients have health insurance (N=594), Kenya 2018
6.13.2 Health insurance for outpatients

In almost one fifth of facilities, only between 1% and 25% of outpatients had any kind of insurance, and only 2
percent of facilities reported to have received 100 of outpatient services in the facility had any type of health
insurance.
90
Figure 161: Percentage of facilities with inpatient services where inpatients have health insurance (N=1038), Kenya 2018
7 Community module
The services that expected to be delivered through the community health services are available albeit in a
suboptimal manner. Several barriers limit the accessibility of health services at community and health facility level.
These include costs associated with travel to the health facilities, and negative attitudes of some health workers at
the facility level. The readiness to provide services is undermined by several structural and organizational barriers
that should be addressed to promote the functionality of the community health services and prepare the path for
universal health coverage. Overall, there are glaring gaps in the implementation of the community health services
with noticeable disparities across the counties in relation to the number of functional CHUs, CHVs, CHCs and the
CHEWs. Together, these gaps compromise the readiness to deliver community health services and ultimately,
access and utilization of services provided at level 1 and 2 of the healthcare systems.
8 Cross-cutting country performance: inequities

The lowest inequalities were observed in specific service readiness (Concentration coef = 0.02145 and Gini Coef =
0.04995) with the highest inequalities being experienced in the general service availability distribution across the
counties. The top three domains’ distributions to address include the general service availability, quality of care as
well as Management and Finance.
91
Lorenz curve
Figure 162: Lorenz curve for the seven KHFA indices, Kenya 2018
1.0
General service readiness
General service availability
Specific service availability
Specific service readiness
0.8 Quality of Care
Management and Finance
HHFA Overall Index
0.6
L(p)
0.4
0.2
0.0
0.0 0.2 0.4 0.6 0.8 1.0
Figure 163: Variation in the overall KHFA index by county, Kenya 2018
The main source of the inequality was due to health workforce distribution across the counties (concentration
coefficient = 0.02624 and Gini Coefficient = 0.26976). On the other hand, health services infrastructure and
service utilization were found to have a more even distribution. Therefore, in order to improve general service
availability equity, it will be useful to have equitable distribution of the health workforce across the counties.
92
Lorenz curve
Figure 164: Lorenz curve for the general service availability index and index components, Kenya 2018
1.0
Health.Services.Infrastructure.Index
Health.Workforce.Index
Service.Utilization.Index
General.Service.Availability.Index
0.8
0.6
L(p)
0.4
0.2
0.0
0.0 0.2 0.4 0.6 0.8 1.0
9 Conclusions and recommendations

9.1 Conclusions
 Most of the essential services were available. However, availability was affected by a number of missing
components in every service package. For instance, infrastructure was available but with inadequate
staffing.
 General service availability: health facility infrastructure is in place in all counties thought witnessing low
utilization levels
 Inequalities were also witnessed across the counties in the general service availability distribution with the
contributory factor being health workforce.
 The most impressive services that were beyond an availability of 75% include family planning, ANC, care
for low birth weight and sick newborns, child health preventive and curative care services, malaria
services, HIV/AIDS counselling and testing, PMTCT services, sexually transmitted infections and basic
surgery.
 The lowest availability, below 25%, was cervical cancer, breast cancer, prostate cancer, colorectal cancer,
mental and neurological care, palliative care, rehabilitation care, and blood transfusion.
9.2 Service Readiness

 There was evidence that most of the facilities were ready to offer services with more than two thirds of
the tracer items available.
 Despite being ready, health facilities are not maintaining all the tracers as a package, as witnessed by
extremely low proportions of the health facilities with all the tracers under respective service areas.
 An impressive readiness of tracer items, above 75%, was witnessed in the areas of family planning
services, Malaria services, as well as HIV/AIDS counselling and testing.
 Low levels of readiness of tracer items, below 25%, was observed in postnatal care for mothers and
newborns, breast cancer, colorectal cancer, and basic surgery.
93
9.3 Quality and Safety
 The quality of health service delivery across the country is generally inadequate based on the parameters
covered in the survey.
 Wide variations exist across the counties between levels and types of care, in private, NGO/FBO and
private facilities in both urban and rural area.
 There is therefore need for targeted interventions to improve quality of care based of the needs of the
different counties.
9.4 Management and Finance

 There was evidence of management practices starting from the management systems that were in place in
a majority of the facilities, guidelines and what was found to be practiced on the ground.
 However, the levels of these practices are rather low.
9.5 Community systems

 The services that expected to be delivered through the community health services are available albeit in a
suboptimal manner. Several barriers limit the accessibility of health services at community and health
facility level. These include costs associated with travel to the health facilities, and, negative attitudes of
some health workers at the facility level.
 Overall, there are glaring gaps in the implementation of the community health services with noticeable
disparities across the counties in relation to the number of functional CHUs, CHVs, CHCs and the
CHEWs.
 Together, these gaps compromise the readiness to deliver community health services and ultimately,
access and utilization of services provided at level 1 and 2 of the healthcare systems.
94
95

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KENYA HARMONIZED

Purpose of the Survey

1. To provide external validation of information on service availability and readiness

2 General Service Availability

2.1 Health infrastructure Figure 1: Health facility distribution, Kenya 2018

The national average inpatient bed density is at 13.3 which is

2.2 Health Workforce

Availability of registered nurses averaged at 0.69 Clinical Officers 3

An average of 0.43 PHO’s were available against

2.3 Service utilization

Service availability index

Figure 6: General service availability index, Kenya 2018

3.1 Basic amenities

Figure 7: Mean availability of basic amenities by county, Kenya 2018

3.2 Basic equipment

3.3 Standard precautions for infection prevention

3.4 Diagnostic capacity

3.5 Essential medicines

3.6 General service readiness

4 Service specific availability and readiness

4.1 Reproductive, Maternal, Neonatal, and Child Health services

4.1.2 Antenatal care

4.1.3 Basic emergency obstetric and newborn care (BEmONC)

4.1.4 Comprehensive emergency obstetric and neonatal care (CEmONC)

4.1.5 Essential medicines for mothers

4.1.6 Post-abortion care

Figure 22: Map of post-abortion care availability by county, Kenya 2018

4.1.7 Postpartum care for mothers and newborns

4.1.8 Care for low birth weight and sick newborns

4.1.9 Routine child immunization

Figure 27: Map of child immunization availability by county, Kenya 2018

4.1.12 Adolescent health

4.2 Communicable diseases

Figure 34: Availability of communicable disease services (N = 2927), Kenya 2018

4.2.2 Tuberculosis diagnosis and treatment

4.2.4 HIV/AIDS and STIs

4.2.5 HIV/AIDS counselling and testing

4.2.6 HIV/AIDS care and support services

4.2.7 HIV/AIDS antiretroviral prescription and client management services

Figure 51: Map of ARV service availability by county, Kenya 2018

Figure 53: Map of ARV readiness by county, Kenya 2018

4.2.8 PMTCT Services

Figure 55: Map of PMTCT availability by county, Kenya 2018

Figure 57: Map of PMTCT readiness by county, Kenya 2018

4.2.9 Pediatric HIV services

Figure 61 Map of pediatric HIV readiness by county, Kenya 2018

4.2.10 Sexually transmitted infection services

4.2.11 Neglected tropical diseases

4.3 Non-communicable disease services

Figure 66: Availability of non-communicable disease services (N = 2927), Kenya 2018

4.3.2 Cardiovascular disease services

Figure 69: Map of CVD availability by county, Kenya 2018

4.3.3 Chronic respiratory disease (CRD)

Figure 71: Map of CRD availability by county, Kenya 2018

4.3.4 Cervical cancer

Figure 74: Map of cervical cancer availability by county, Kenya 2018

4.3.5 Breast cancer

4.3.6 Prostate cancer