A descriptive survey of substance use treatment facilities in Uasin Gishu County Kenya

Abstract

Background Substance use disorders are a major problem in Uasin Gishu County, Kenya. The objective of this study was to describe the existing resources within substance use treatment facilities in the County, with the aim of guiding policy and interventions. Methods This was a cross-sectional study. We collected data from six substance use treatment facilities within Uasin Gishu County between August and November 2021. We used a researcher-designed questionnaire to collect information on: availability of in-patient and out-patient services; facility ownership (private-for-profit vs government-run); bed capacity; mode of payment for services; cost of services; availability of medicines for substance use treatment; and staffing characteristics. Descriptive statistics were used to summarize the data. Results One facility was run by the National government and the rest were private-for-profit. Uasin Gishu County government had no substance use treatment facility of its own. The total number of beds available within the six facilities was 174 against a population of 1.1 million. All six facilities had stocked at least one medication for substance use disorder treatment. None of the facilities had buprenorphine, buprenorphine naloxone, or methadone. Out-of pocket was the most common mode of payment for services with patients paying using this mode in all the six facilities. Only one facility was accredited by the National Hospital Insurance Fund (NHIF). All facilities had at least one certified addiction counselor and at least one psychologist. Half of the facilities did not have a nurse and two did not have a doctor. The qualification held by most staff was addiction counseling with 41.3% of them having achieved this qualification. Conclusion The facilities were well staffed with psychologists and addiction counselors. Gaps were found as regards bed capacity, use of pharmacotherapy, insurance coverage and availability of nursing staff and doctors. We recommend that the County government in collaboration with key stakeholders invests in substance use treatment in order to address the high burden of substance use disorders in Uasin Gishu County.

Residential and inpatient treatment of substance use disorders in Sub-Saharan Africa: a scoping review

“…Two other barriers to care that emerged in the literature were gender, with women consistently accessing SUD treatment at lower rates [ 22 – 24 , 26 , 34 , 36 – 39 ] and linguistic and ethnic discordance between treatment-seekers and providers [ 38 , 39 ]. A general lack of availability of services was attributed to multiple factors, including a paucity of investment on the part of regional and national governments [ 40 , 42 , 43 , 45 ]. This review also found that across countries psychiatric facilities are treating a large volume of patients with SUD, or those with SUD and a cooccurring psychiatric illness [ 18 , 19 , 21 , 23 – 31 ].…”

“…A heavy reliance on out-of-pocket payments was also observed in a psychiatric hospital treating patients with SUD, where more than 70% of patients paid out of pocket [ 23 ]. The cost barrier to treatment was echoed by a study of people who use heroin in three Kenyan cities, who reported a strong desire to receive residential treatment but inability due to an average cost of 114 USD per month [ 42 ]. Financial barriers were also shown to hinder treatment access in South Africa [ 41 , 43 ].…”

“…Data from a survey of treatment centers in Uasin Gishu County, Kenya also indicates a limited bed capacity, where the authors found just 16 beds per 100,000 people in this county [ 42 ]. The authors noted that there were no beds dedicated to children or adolescents, and only one-third of beds were allocated for women needing SUD treatment.…”

“…The authors noted that there were no beds dedicated to children or adolescents, and only one-third of beds were allocated for women needing SUD treatment. The authors call for further government investment to address the low density of SUD services available for residents in this county [ 42 ]. This call for further government investment in services was echoed in the literature from South Africa, particularly as a remedy for groups that are underrepresented in treatment settings [ 41 , 43 ].…”