Expert Insight

Race to Health For All: PHC Measurement lessons from the land of long distance runners

As a country famous for its long-distance runners, Kenya is now rapidly accelerating its pace towards achieving Universal Health Coverage (UHC). At the highest political level, UHC formed part of the big four development agenda learning lessons from select pilot counties and now will have a full roll-out across all 47 counties. Just like running towards getting the gold medal, Kenya is introducing systems that track the performance of its primary health care (PHC) facilities with a strong belief this would lay the foundation for UHC by 2030.

Kenya’s journey to UHC and strengthening PHC is like steeplechase. There are many hurdles to overcome. The national Ministry of Health Community Health Policy 2020-2030, notes on the numerous challenges which touch on community health, high rates of maternal health and child mortality, communicable diseases, and increasingly, noncommunicable diseases. A snippet of health indicators show that how people are affected by poor health service provision varies considerably across counties and income quintiles. Primary health care holds the key to unlocking these health challenges. But how do decision makers know where to start in improving primary health care without information on where the PHC systems require strengthening?

“The services at our local dispensary are not bad, although there are some shortfalls. When we come here, at times there is no medicine and at night it is difficult since there is no doctor available to attend to mothers. There is no proper maternity unit and if we had this hospital would really be of great benefit to us.” - Nanjala*, a patient in Bungoma, Kenya.

We met Nanjala, a woman in her late twenties waiting for services at one of the local dispensaries, a primary facility. This facility is managed by the county government. Usually, Nanjala would have travelled more than 30 kilometres to access services at the county referral hospital. The waiting queues for services would be long there. Not to mention the financial hardship she would endure having to pay for transport. County government health teams, through community health volunteers have informed mothers like Nanjala that the government has brought services closer by reviving old dispensaries, which in many cases are located very close to the communities.

The VSP journey in Kenya
The vital signs profiles (VSP) were introduced following the Astana Global Conference on PHC in 2018 to provide a snapshot of primary health care systems’ performance. Its dashboard visualizes data, showing where systems are strong and where there are challenges. The VSP assesses four key areas of the health system: PHC financing, performance, capacity, and equity.  The Kenya national Ministry of Health adopted and contextualized the VSP tool at both national and county levels.

Bungoma county health department collaborated with the Evidence for Action (E4A)- MamaYe project to actualize the domestication of VSPs in the county. After a discussion of the tool with a broad range of local representatives, Bungoma County Health leadership formed a taskforce which accommodated local grassroots civil society networks. This taskforce would then spearhead the process of adapting the VSP tool and contextualise it to the needs of Bungoma County recognising unique health challenges affecting different counties in Kenya.

A key output of this taskforce was the design of a roadmap which guides stakeholders on how to prioritize VSP indicators, adapt a county specific VSP tool, validate and disseminate the tool in a way that ensures that its data is entered, analysed and used to inform decision making. 

“We have achieved a great milestone in domesticating the VSP tool for Bungoma. We are happy that the county has shown commitment to use the tool in measuring PHC. This is going to measure the impact of the county’s investment in PHC. It fosters accountability among county government and the community by showcasing outputs of health investments. I hope decision makers in health will use the VSP tool to make critical decisions to strengthen PHC in Bungoma.” - Mr. Kimetto Tumo, Chair of the VSP Taskforce

The involvement of the Bungoma RMNCAH Network, a coalition of grassroots civil society organizations, and the media in the process of adapting VSPs for Bungoma demonstrated commitment of the county to promote accountability of PHC.

“The VSP tool will be used in our advocacy for PHC resource mobilization. By understanding the health performance across all the 4 domain areas, the department of health can evaluate its status and justify its outcomes and help plan better for the future service provision” - Samuel Nakitare, the Chairperson, Bungoma RMNCAH Network.

As the 75th World Health Assembly (WHA) meeting is bringing together world leaders between 22-28 May, we are asking governments around the world to prioritize launching mechanisms that enable health systems to effectively measure investments in PHC.  

This opinion piece is part of a blog series by the Allies Improving PHC for the 75th World Health Assembly that aims to highlight Primary Health Care as the foundation for achieving universal health coverage, health security and healthier populations globally. Pieces will be posted throughout the week of the 75th World Health Assembly, read more here.