Kenya’s health sector continues to battle uneven access to reliable care, with a new national review showing that four out of every ten medical facilities still lack key tools and systems needed to serve patients safely and effectively.
The findings point to deep gaps between hospitals and lower-level centres, with rural areas carrying the heaviest burden.
The 2024 Kenya Health Facility Assessment: Quality of Care and Human Resources for Health Report evaluated 3,605 facilities, covering every county and all public Level 4 and 5 hospitals.
The review shows that many communities, especially in remote and underserved regions, cannot consistently access proper diagnostic services and standard clinical procedures.
Health Cabinet Secretary Aden Duale presided over the launch of the report, which shows that 41 counties have already sought laboratory machines through the National Equipment Service Programme (NESP).
The programme replaced the earlier Medical Equipment Service initiative in December 2023 and runs on a model where counties access equipment, along with servicing and upgrades without paying upfront, instead settling costs based on use.
Health Director General Patrick Amoth said the results highlight wide variations across facilities.
“The Structures Index, which quantified the extent to which health facilities are equipped with necessary building blocks to enable delivery of effective, safe, and patient-centred care, was 61 per cent,” Amoth said. “Generally, hospitals and faith-based organisations or NGO facilities had higher scores compared to primary level and public facilities.”
On clinical standards and administrative processes, hospitals and private facilities performed better than Levels 2 and 3 public centres, with the overall Process Index also standing at 61 per cent.
The report shows strong quality improvement structures in higher-tier hospitals, with 92 per cent of Level 5 facilities having quality teams. This dropped to 85 per cent in Level 4 and 63 per cent in Level 3 centres.
Urban facilities scored 76 per cent, ahead of rural ones at 62 per cent. Over the past two years, 20,044 health workers have received training on improving care delivery, with Level 5 hospitals contributing 25 per cent of those trained.
Safety checks for patients remain mixed. While 73 per cent of facilities conducted general death reviews, only 34 per cent reviewed surgical deaths. Maternal and newborn audits were stronger at 84 per cent.
“Surgical adverse events—deaths and infections within 24 hours of surgery—are at 28 per cent. The infection rate for all eight antimicrobial-resistant priority pathogens examined stood at nine per cent,” Amoth said.
However, most facilities are not yet fully monitoring antibiotic use or drug resistance trends. Only 38 per cent tracked antibiotic use, 32 per cent audited prescriptions, and more than half — 56 per cent — did not conduct surveillance for World Health Organisation priority pathogens.
All Level 5 hospitals conducted formal deaths audits, compared to 58 per cent of Level 2 facilities. Public hospitals registered 96 per cent performance, while private facilities recorded 64 per cent.
Between October and December 2023, 427 maternal deaths were reported, and 98 per cent were reviewed, while 76 per cent of 4,094 newborn deaths were audited.
Audit performance for surgical-related deaths stood at 35 per cent, with private facilities at 45 per cent and public centres at 24 per cent. By levels, 83 per cent of Level 5 facilities reviewed surgical deaths, followed by 51 per cent at Level 4 and 22 per cent at Level 3.
