Investment case for primary health care in low- and middle-income countries: A case study of Kenya

Abstract

Background Primary healthcare (PHC) systems attain improved health outcomes and fairness and are affordable. However, the proportion of PHC spending to Total Current Health Expenditure in Kenya reduced from 63.4% in 2016/17 to 53.9% in 2020/21 while external funding reduced from 28.3% (Ksh 69.4 billion) to 23.9% (Ksh 68.2 billion) over the same period. This reduction in PHC spending negatively affects PHC performance and the overall health system goals. Methods We conducted a cost-benefit analysis and computed costs against the economic benefits of a PHC scale-up. Activity-Based Costing (ABC) on the provider perspective was employed to estimate the incremental costs. The OneHealth Tool was used to estimate the health impact of operationalizing PHC over five years. Finally, we quantified Return on Investment (ROI) by estimating monetized DALYs based on a constant value per statistical life year (VSLY) derived from a VSL estimate. Results The total projected cost of PHC interventions in the Kenya was Ksh 1.65 trillion (USD 15,581.91 billion). Human resource was the main cost driver accounting for 75% of the total cost. PHC investments avert 64,430,316 Disability Adjusted Life-Years (DALYs) and generate cost savings of Ksh. 21.5 trillion (USD 204.4 Billion) over five years. Shifting services from high-level facilities to PHC facilities generates Ksh 198.2 billion (USD 1.9 billion) and yields a benefit-cost ratio of 16:1 in 5 years. Thus, every $1 invested in PHC interventions saves up to $16 in spending on conditions like stunting, NCDs, anaemia, TB, Malaria, and maternal and child health morbidity. Conclusions Evidence of the economic benefits of continued prioritization of funding for PHC can strengthen the advocacy argument for increased domestic and external financing of PHC in Kenya. A well-resourced and functional PHC system translates to substantial health benefits with positive economic benefits. Therefore, governments and stakeholders should increase investments in PHC to accelerate economic growth.

The costs and financing needs of delivering Kenya’s primary health care service package

“…With the exception of Mukurweini, the results suggest that there is a need for additional investment to ensure universal coverage of Kenya’s PHC package. To our knowledge, only one other relevant peer-reviewed study on PHC costs has been conducted in Kenya which sought to estimate the investment required for operationalizing a PCN in Kenya over a five-year period ( 4 ). Although the objectives and ingredients of the costing were different (e.g., it included infrastructure and other capital costs), that study found human resources to be the main cost driver of PCN implementation, accounting for 75% of the total cost.…”

“…Building upon this strategy, the GoK’s Primary Care Network (PCN) guidelines aim to improve the overall operational efficiency of primary care service delivery at public facilities ( 3 , 4 ). Taking the form of a “hub and spoke model,” ( Supplementary 2 ) a sub-county hospital serves as the hub to numerous lower-level health centers (level 3), dispensaries (level 2), and community health volunteers (CHVs), responsible for reaching the most remote and disadvantaged populations ( 3 ).…”

“…Following Kenya’s transition to a devolved government system in 2013, county-level governments are responsible for mobilizing the majority of funding for primary and secondary health service delivery ( 11 , 12 ) while the national government provides strategic commodities (e.g., vaccines, family planning commodities, HIV and TB medicines) to primary care facilities. Although there have been incremental increases in health budget allocations ( 4 ), county-level budgets are largely considered “wishlists” and lack local-level input to inform realistic target setting ( 13 ). Moreover, counties report inadequate staff capacity for leading the budgeting process ( 14 ), while political interests continue to play a major role in funding allocations ( 15 ).…”

The role of Primary Health Care, primary care and hospitals in advancing Universal Health Coverage

“…While PHC and primary care services are increasingly talked about, they remain underfunded, misrepresented and misunderstood. [6][7][8][9][10] Most of the world still lacks access to strong primary care services in their local community i.e. high-quality, first-contact care that is comprehensive, coordinated and continuous.…”