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

Abstract

IntroductionFor many Kenyans, high-quality primary health care (PHC) services remain unavailable, inaccessible, or unaffordable. To address these challenges, the Government of Kenya has committed to strengthening the country’s PHC system by introducing a comprehensive package of PHC services and promoting the efficient use of existing resources through its primary care network approach. Our study estimated the costs of delivering PHC services in public sector facilities in seven sub-counties, comparing actual costs to normative costs of delivering Kenya’s PHC package and determining the corresponding financial resource gap to achieving universal coverage.MethodsWe collected primary data from a sample of 71 facilities, including dispensaries, health centers, and sub-county hospitals. Data on facility-level recurrent costs were collected retrospectively for 1 year (2018–2019) to estimate economic costs from the public sector perspective. Total actual costs from the sampled facilities were extrapolated using service utilization data from the Kenya Health Information System for the universe of facilities to obtain sub-county and national PHC cost estimates. Normative costs were estimated based on standard treatment protocols and the populations in need of PHC in each sub-county.Results and discussionThe average actual PHC cost per capita ranged from US$ 9.3 in Ganze sub-county to US$ 47.2 in Mukurweini while the normative cost per capita ranged from US$ 31.8 in Ganze to US$ 42.4 in Kibwezi West. With the exception of Mukurweini (where there was no financial resource gap), closing the resource gap would require significant increases in PHC expenditures and/or improvements to increase the efficiency of PHC service delivery such as improved staff distribution, increased demand for services and patient loads per clinical staff, and reduced bypass to higher level facilities. This study offers valuable evidence on sub-national cost variations and resource requirements to guide the implementation of the government’s PHC reforms and resource mobilization efforts.

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

“…Recent studies conducted in Afghanistan ( 38 ), Ethiopia ( 31 ), and Kenya ( 32 ) have similarly examined the actual and normative costs of PHC service packages. Consistent with our research, they revealed substantial resource gaps between existing PHC resources and the financial requirements to provide quality PHC services to all those who need them.…”

“…In accordance with the World Health Organization’s PHC Measurement Framework and Indicators ( 30 ), key metrics that can be analyzed in the PHC-CAP Tool include inpatient and outpatient services per clinical staff, daily service output per clinical staff, cost per input, cost per service, total cost, and cost per capita—contingent on data availability. Aside from Nigeria, the PHC-CAP Tool has also been used in five additional countries, including Ethiopia ( 31 ) and Kenya ( 32 ).…”

“…Per capita actual costs for Kaduna and Kano were determined by dividing the total cost of each estimate for each state by the respective populations. This approach of approximating total actual PHC costs in a geographic area by extrapolating from a sample of health facilities has been employed in several previous studies ( 31 , 32 , 37 , 38 ).…”

“…The financial resource gaps for PHC services in Kaduna and Kano were calculated as the difference between actual and normative costs ( 31 , 32 , 37 , 38 ). We calculated resource gaps using actual estimates 1 and 2 described above.…”

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage

“…Normative costs represent the resources needed to deliver PHC services in the health facilities in the area of interest with reasonable quality and efficiency. Normative costs (22) and Nigeria (23).…”