Designing Primary Health Care Network Service Delivery Models in Makueni County, Kenya to Increase Access to Primary Health Care
Strong primary health care (PHC) can speed up a country’s journey towards universal health coverage (UHC) rapidly, effectively, and efficiently. The current COVID-19 pandemic has shown that all countries, particularly the lower- and middle-income countries (LMICs), need to deliver comprehensive PHC services in alignment with countries’ needs, whether maternal and child health services, infectious diseases or non-communicable diseases. This exerts pressure on PHC teams on the ground and necessitates a review of PHC service delivery models from the traditional to an integrated patient-centred, quality and preventive primary healthcare.
On December 16, the Joint Learning Network’s PHC Financing and Payment Collaborative facilitated a virtual discussion on designing integrated service delivery models to increase access to PHC in alignment to current country needs. DR Kiio S. Ndolo, the Director of Medical Services from the government of Makueni County, Kenya shared his experience on developing the PHC provider network (PHCPN) model in Makueni County. The trigger for the change was a major health system reform i.e., the decentralisation of the health system in Kenya.
This was followed by an engaging discussion by several participants sharing their own country experiences. Several key lessons emerged as the success factors of the model:
- There is a shared vision by the leadership provided at the “hub” level and respected by everyone. The model is implemented so that the role of each player and stakeholder, as well as different levels of service provider, is clear. In this way, the inclusion of all the available resources e.g., through private sector engagement, can address capacity issues.
- Financial management is key to the success of the model. Funding is made largely by available public resources, through government budget mechanism and donor contribution. Financial and non-financial incentives for the providers can help sustain the model e.g. retention of funds is allowed at the facility level, income generating activities allowed at the community health unit, and stipends for the volunteers. Purchasing arrangement is made clear and health care providers in the spokes are supported by the accountant at the hub.
- The structure of the PHC delivery system is a patient-centred, hub and spoke model, with clear and greater involvement of the community volunteers to make the PHC services effective. The model emphasizes the integration of different levels of care with a clear referral rules and procedures to ensure quality and continuity of care.
- The monitoring system is essential and supported by supervisory tools and mechanisms e.g., review meetings, data quality and supervision.
The take-away message is that in designing a service delivery model, changes in the organisation of the delivery system and financial arrangements are needed to sustain a successful implementation to achieve health system goals for which it is designed. In addition, early stakeholder involvement is critical to ensure buy-in and limit implementation resistance.
This post was written by Dr. Kamaliah Noh and Kiio S. Ndolo.