The number of health facilities represents the quantity of health infrastructure investment. There are about 5,000 facilities in Kenya. Hospital classification in Kenya is commonly based on the agency that owns the health facility. The players in the health sector are the Government, which manages public health institutions, faith—based organisation (FBOs) and non- governmental organisations (NGOs) and private investors.
Forty eight per cent of the health facilities are run by the Government, 35 per cent are managed by the private sector 15 per cent by FBOs and NGOs two per cent.
Hospitals in Kenya are structured in levels, with complicated cases being referred to a higher level.
Gaps in the system are filled in by private and church run units.
The levels are:
- Dispensaries and private clinics
- Health centres
- Sub-district hospitals and nursing homes
- District hospital and private hospitals
- Provincial hospitals
- National hospitals
Dispensaries in Kenya
The Government runs dispensaries across the country and are the lowest point of contact with the public. These are nine and managed by enrolled and registered nurses who are supervised by nursing officers at the respective units.
They provide outpatient services for simple ailments, such as common cold and ﬂu, uncomplicated malaria and skin conditions. Patients who cannot be managed by the nurses are referred to health centres. Dispensaries are at the lowest level of the public health system and are the first point of contact with patients. They are staffed by enrolled nurses, public health technicians, and dressers (medical assistants). The enrolled nurses provide antenatal care and treatment for simple medical problems during pregnancy such as anaemia and occasionally conduct normal deliveries. Enrolled nurses also provide basic outpatient curative care.
Health centres in Kenya These are medium—sized units which cater for a population of about 80,000 people. Some are run by mission hospitals, with clinical officers as the team leaders. They provide a wider range of services, such as basic curative and preventive services for adults and children, as Well as reproductive health services. They also provide minor surgical services such as incision and drainage. They augment their service coverage with outreach services, and refer severe and complicated conditions to the appropriate level, such as the district hospital. .
A typical health centre is staffed by at least a clinical officer, nurses, health administration officer, medical technologist, pharmaceutical technologist, health information officer, public health officer, nutritionist, driver, housekeeper and supporting staff
Public health officers and technicians are deployed to a geographical area rather than to a health unit and report to the district public health officer.
A health centre has the following departments;
- An administration block for the registration of patients, handling of correspondence and resource management.
- Out— patient consultation rooms.
- In-patient Wards which are divided into male, female and pediatric units.
- Laboratories for diagnostic tests, such as blood slides for malaria parasites, sputum AFB, urinalysis, full haemogram, stool ova and cysts, blood sugar, Elisa and CD4 counts in comprehensive care centres for HIV and Aids patients.
- Minor theatre for minor surgical procedures, e.g. circumcision, stitching Wounds and manual vacuum aspiration.
- Maternal and child health.
- Kitchen and catering services.
- Students’ hostels for rural health training centres.
Sub – district hospitals in Kenya
These are similar to health centres, with the major difference being addition surgery units for Caeserian section and other more complicated procedures. Many are managed by clinical officers. A good number have a medical officer and a wider range of surgical services.
District Hospitals in Kenya
Each district in the country has a district hospital, which is the coordinating and referral centre for the smaller units. They usually have the resources to provide comprehensive medical and surgical services.
District hospitals are the facilities for clinical care at the district level.
They are the ﬁrst referral hospital and form an integral part of the district health system.
A district hospital should provide the following:
- Curative and preventive care and promotion of health of the people in the district;
- Quality clinical care by a more skilled and competent staff than those of the health centres and dispensaries;
- Treatment techniques such as surgery not available at health centres;
- Laboratory and other diagnostic techniques appropriate to the medical, surgical, and outpatient activities of the district hospital;
- Inpatient care until the patient can go home or back to the health centre;
- Training and technical supervision to health centres; as Well as resource centre for health centres at each district hospital;
- Twenty-four hour services;
The following clinical services:
- Obstetrics and gynaecology;
- Child health;
- Surgery, including anaesthesia;
- Accident and emergency services;
- Non—clinical support services;
- Referral services; _
- Contribution to the district-wide information generation, collection planning, implementation and evaluation of health service programmes.
They are managed by medical superintendents.
Provincial Hospitals in Kenya
Kenya had eight provinces each with a provincial hospital, Which Were the referral point for the district hospitals. These are regional centres which provide specialized care, including intensive care, life support and specialist c0nsultations.
Provincial hospitals form a secondary level of health care for their location. They provide services to a geographically well-defined area. They provide specialized care, involving skills and competence not available at district hospitals, which makes them the next level of referral after district hospitals. Their personnel include medical professionals, such as general surgeons, general medical physicians, paediatricians, general and specialized nurses, midwives and public health staff.
National Hospitals in Kenya
There are two national hospitals in Kenya namely: —
- Kenyatta National Hospital (KNH)
- Moi Teaching and Referral Hospital (MTRH); and
Kenyatta National Hospital and Moi Referral and Teaching Hospital are the referral and teaching hospitals in Kenya. They are centres of excellence and provide complex health care requiring more complex technology and highly skilled personnel. They have a high concentration of resources and are relatively expensive to run. They also support the training of health workers at both pre-service and in-service levels.
Apart from health care, teaching and referral hospitals contribute in providing solutions to local and national health problems through research, as well as contributing to policy formulation. They provide both basic and post~ graduate training for health professionals.
Nursing Homes in Kenya
These private institutions are owned by individuals or churches and offer services similar to those available at a sub—district or district hospital. Private maternity homes fall under the governance of the Kenya Registered Midwives Association (KRMA). Some maternity and nursing homes are run by other health care professionals, such as doctors and clinical officers. Working in close collaboration with the Reproductive Health and Child Health Divisions of the Ministry of Health, they offer reproductive and family planning services. In addition, some child Welfare activities are carried out on their premises by health staff of public health facilities
Private Clinics in Kenya
These may be registered by the Clinical Officers Council, the Nursing Council or the Medical Practitioners and Dentists Board, depending on the proprietor’s qualifications.
A clinical officer wishing to register a clinic requires 10 years of experience. They are usually small units, often with a medical laboratory, which offer a wide range of services, depending on the training level of the proprietors.
Mission Hospitals in Kenya
The missionaries played a very key role in provision of healthcare in Kenya before independence which led to establishment of mission hospitals that have continued to serve the Kenyan population to date.