Logan Reid
Kenya's healthcare system is structured in a stepwise manner, with complicated cases referred to a higher level. The country has six levels of healthcare, with levels 4, 5, and 6 being referral hospitals. Level 4 hospitals are sub-county hospitals and medium-sized private/mission hospitals. Level 5 hospitals are county referral hospitals and large private/mission hospitals. Level 6 hospitals are national referral hospitals and large private teaching/mission hospitals. There are 57 public hospitals in Kenya, including 7 national referral hospitals, 47 county referral hospitals, and 2 sub-county hospitals.
| Characteristics | Values |
|---|---|
| Number of public hospitals | 57 |
| Number of national referral hospitals | 7 |
| Number of county referral hospitals | 47 |
| Number of sub-county hospitals | 2 |
| Number of private hospitals | 103 |
| Number of mission hospitals | 58 |
| Number of NGO hospitals | 12 |
| Number of national hospitals | 5 |
| Number of tiers in the healthcare system | 6 |
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What You'll Learn
Kenya has 7 national referral hospitals
The Kenya Health Policy 2014–2030 outlines the requisite activities to achieve the government's health goals. The policy is aligned with the Constitution of Kenya and global health commitments. The healthcare system is structured in a stepwise manner, with complicated cases referred to a higher level.
The six tiers of healthcare in Kenya are as follows:
- Community health services: This level includes community-based demand creation activities and the identification of cases that need to be managed at higher levels of care.
- Primary care services: Dispensaries, health centres, and maternity homes for both public and private providers.
- County referral services: Hospitals operating within and managed by a given county, including former district hospitals and public and private facilities.
- Sub-County Hospitals, Nursing Homes, and medium-sized private hospitals.
- County Teaching and Referral Hospitals, large private, and faith-based hospitals.
- National Teaching and Referral Hospitals.
Some examples of referral hospitals in Kenya include the Mathari National Teaching and Referral Hospital, the Jaramogi Oginga Odinga Teaching and Referral Hospital, and the Kisii Teaching and Referral Hospital.
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There are 47 county referral hospitals
Kenya has 47 counties, and each county has at least one county referral hospital. These hospitals are also known as Level 5 hospitals and are managed by the county government. They are the referral points for district hospitals and provide specialised care, including intensive care, life support, and specialist consultations.
County referral hospitals are an essential part of Kenya's healthcare system, which is structured in a step-wise manner. Patients are required to move from one tier to the next using a formal referral letter. This system aims to ensure that complicated cases are referred to higher-level facilities, with private and church-run units filling the gaps.
The county referral hospitals are an important tier in the healthcare system, providing specialised services to those who need them. These hospitals are equipped with the necessary resources to offer comprehensive medical and surgical services, typically managed by medical superintendents.
Some examples of county referral hospitals in Kenya include the Mbagathi County Referral Hospital, Nyeri County Referral Hospital, and Vihiga County Referral Hospital. These hospitals play a crucial role in serving their respective counties and ensuring access to specialised healthcare for the local population.
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Kenyatta National Hospital is a national referral hospital
Kenyatta National Hospital (KNH) is a national referral hospital in Nairobi, Kenya. It was established in 1901 as the Native Civil Hospital and later renamed King George VI Hospital in 1952. Following Kenya's independence from the British, it was renamed Kenyatta National Hospital. With over 6,000 staff members, it is the largest referral and teaching hospital in the country, serving as an educational facility for the Kenya Medical Training College, Nairobi campus, and the University of Nairobi College of Health Sciences. It is also the oldest hospital in Nairobi and the largest hospital in Kenya and East Africa, with a bed capacity of 1,800. The hospital is located 3.5 kilometres west of Nairobi's central business district and covers 45.7 acres.
Kenyatta National Hospital is a public, tertiary, referral hospital for the Ministry of Health. It is classified as a Level 6 hospital, which means it is a national referral hospital that provides highly specialised services. Kenya's healthcare system is structured so that complicated cases are referred to higher-level facilities. Kenyatta National Hospital is equipped to provide specialised care, including intensive care, life support, and specialist consultations. It also offers short certificate courses and higher diploma courses in specialised nursing through its School of Nursing.
The hospital is administered by a 10-person board of directors, including a non-physician, non-executive board member, George Ooko, and CEO Dr Evanson Kamuri. The principal of the College of Health Sciences of the University of Nairobi and representatives from the Ministry of Finance and Health also sit on the board. Kenyatta National Hospital is known for its advanced specialisation in medical services, attracting affiliations from many other institutions.
The hospital serves as a teaching facility for various institutions due to its advanced specialisation. It is also a research hub, as evidenced by its establishment of the Training Institute for Specialised Nursing (TISN), which offers Kenya Registered Critical Care, Oncology Perioperative, and Nephrology Nursing Programs. Kenyatta National Hospital plays a crucial role in the country's healthcare system, providing comprehensive medical and surgical services as a national referral centre.
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Referral letters are required to move between tiers
Kenya's healthcare system is structured in a tiered system, with six levels of healthcare in total. The first five tiers are managed at the county level, while the sixth tier is overseen by the national government. In this system, patients are required to move from one tier to the next using a formal referral letter.
Referral letters are a crucial component of Kenya's healthcare system, facilitating the smooth transition of patients between different tiers of care. These letters ensure that patients receive the appropriate level of care for their specific needs. Without a referral letter, patients may encounter challenges in accessing the necessary healthcare services, particularly at higher tiers.
The referral process in Kenya typically involves a patient being referred from a lower-level health facility to a higher-level one. For example, a patient may be referred from a primary care facility at the county level to a tertiary care facility at the national level. This referral process helps to ensure that patients receive the specialised care they need, which may not be available at lower tiers.
To obtain a referral letter, patients typically need to be assessed by a healthcare professional at their current tier of care. This could be a general practitioner, a specialist, or another relevant healthcare provider. The healthcare professional will evaluate the patient's condition and determine if they require a higher level of care. If a referral is deemed necessary, the healthcare professional will provide the patient with a referral letter, which they can then present at the next tier of care.
It is important to note that the referral process in Kenya may vary depending on the specific circumstances and healthcare facilities involved. Additionally, the enforcement of referral guidelines has been shown to reduce the number of direct referrals to higher-tier facilities, particularly for lower tiers. This streamlining of the referral process aims to prevent overcrowding at tertiary facilities and ensure that patients receive appropriate care at the right tier.
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Referral processes in Kenya are sometimes ineffective
Kenya's healthcare system is structured in a stepwise manner, with complicated cases referred to a higher level. The country has 57 public hospitals, including seven national referral hospitals, 47 county referral hospitals, and two sub-county hospitals. There are also 103 private hospitals, 58 mission hospitals, and 12 NGO hospitals in Kenya. However, referral processes in Kenya are sometimes ineffective due to various factors.
Firstly, inappropriate utilization of tertiary health facilities by patients results in congestion in referral hospitals. Many patients self-refer, bypassing lower-level health facilities that could effectively manage their simple medical conditions. This leads to overcrowding, long waiting times, and strained staff resources. To address this issue, Kenya enforced national referral guidelines to streamline the process and reduce direct referrals to Kenyatta National Hospital (KNH). As a result, lower-tier health facilities significantly reduced direct referrals to KNH, with an increase in referrals from higher levels.
Secondly, ineffective referral networks in low- and middle-income countries like Kenya hinder hypertensive patients' access to evidence-based therapies, increasing cardiovascular mortality and morbidity. The STRENGTHS study aims to improve referral processes by engaging stakeholders through the International Association of Public Participation framework. Early stakeholder engagement has facilitated collaboration in updating care protocols with timely and appropriate referrals.
Moreover, inadequate financing for operations and maintenance of referral services remains a challenge. This has impacted the country's progress towards achieving universal social health protection coverage, which entails providing effective access to affordable and quality healthcare services. Innovative and cost-effective solutions are being explored through partnerships with the government and stakeholders to improve the referral process for hypertension control in western Kenya.
Lastly, the success of the referral system relies on effective engagement with key stakeholders involved in policy formulation, provision, and consumption of public healthcare services. These include the Ministry of Health, healthcare providers, communities, and patients. By involving stakeholders early, researchers can explain research objectives, build consensus, and shape interventions to enhance the referral process. This collaborative approach has proven beneficial in western Kenya, emphasizing the importance of timely and appropriate referrals.
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Frequently asked questions
There are 52 referral hospitals in Kenya. This includes seven national referral hospitals, 44 county referral hospitals, and one public psychiatric referral hospital.
Hospitals in Kenya are classified into six levels. Level 6 hospitals are national referral hospitals and large private teaching/mission (faith-based) hospitals. Level 5 hospitals are county referral hospitals and large private/mission hospitals. Level 4 hospitals are sub-county hospitals and medium-sized private/mission hospitals. Level 3 includes county referral services, Level 2 includes primary care services, and Level 1 includes community health services.
The Kenyatta National Hospital (KNH) is a national referral hospital in Kenya. It is a tertiary teaching and referral hospital that serves as the apex of the health sector referral system in the country.
