Table of Contents
Kenya’s health sector is one of the 14 devolved functions managed by the 47 county governments, as provided in the fourth schedule of the 2010 constitution. There are 6 levels of healthcare in Kenya. The first 5 are managed at the county level, and the sixth level is managed by the national government. In this system, the patient may move from one level to the next using referral letters.
The 6 levels of healthcare in Kenya are organized as follows:
- Level 1: Community level
- Level 2: Health dispensaries
- Level 3: Health centers and maternity
- Level 4: Sub-county hospitals
- Level 5: County referral hospitals
- Level 6: National referral hospitals
Level 1: community level
This level comprises all community-based demand creation activities, i.e., identifying cases that need to be managed at a higher level of care as defined by the health sector. These activities are run by community health assistants (CHA) and community health volunteers.
Services offered at level 1 hospitals include:
- Treatment of minor ailments, e.g., diarrhea
- Tuberculosis screening
- Home visits
- Contact tracing of TB defaulters
- Screening for malnutrition
- Malaria rapid tests
- Blood pressure and blood sugar testing
- HIV testing
- Health talks with pregnant women
- Issuance of referral letters to a higher-level health facility.
Level 2: Health dispensaries
This includes dispensaries, clinics, and public and private providers. They are primarily run and managed by nurses with oversight from sub-county health management teams
Services offered at level 2 hospitals include:
- Outpatient services
- VCT services
- Tuberculosis services
- Lab services
- Well baby clinics
- Antenatal and postnatal service
- Pharmacy
- Curative treatments
- Issue referral letters to other facilities
Level 3: Health centers and maternity
Health centers typically serve populations of approximately 30,000 to 50,000 people.
Government organizations, NGOs, and faith-based organizations primarily own them. The health center is staffed by clinical officers, nurses, pharmaceutical technologists, a health record and information officer, a public health officer, a nutritionist, a driver, a housekeeper, and supporting staff.
All the health center staff report to the clinical officer in charge, except the public health officer and technician, who are assigned to a geographical area rather than a health unit and report to the sub-county public health officer, even though they have an officer in the health Center.
The Health Centre has the following departments:
- An administration block where the patient registers and all corresponding resources are managed.
- An outpatient consultation room where patients are seen and examined by clinical officers
- Inpatient wards where very sick patients can be admitted. The wards are divided into male, female, and pediatric wards with a newborn unit.
- A laboratory where diagnostic tests are done
- Pharmacy
- Minor theater where minor surgical procedures are done, e.g., circumcision and manual vacuum aspiration.
- Maternity
- Maternal and child health (MCH)
- Kitchen and catering
Level 4: sub-county hospitals
These are public, private, faith-based, or division hospitals. Sub-counties in the country have sub-county hospitals, which act as referral centers for smaller units. They usually have the resources to provide comprehensive medical services.
They are managed by medical superintendents who are doctors. They offer services at level III hospitals, X-ray services, and theater services, and issue referral letters to other services.
Level 5: County referral hospitals
These are county referral hospitals, run by chief executive officers (CEOs) who are medics. Their capacity varies, but they typically have between 100 and 500 beds, depending on the county.
They also research health. They offer services not offered by other health services, including ultrasound, CT scan, surgery, pharmacy, physiotherapy, orthopedic, and occupational therapy. They issue referral letters to other facilities.
Level 6: National referral hospital
Kenya has several national referral hospitals, including four teaching and referral hospitals and one specialized facility.
Examples of level 6 hospitals include:
- Mathare National Hospital
- Kenyatta National Hospital
- Moi teaching and referral hospital
- Kenyatta university teaching and research referral hospital
- National Spinal Injury Hospital
These hospitals serve Kenyan citizens and patients across East and Central Africa.
Mathare Teaching and Referral Hospital offers specialized mental services.
Kenyatta National and Moi Teaching and Referral offer specialized consultation in curative care.
National Spinal Injury Referral offers specialized services in orthopedics and spinal injury.
Kenyatta University Teaching, Referral and Research Hospital provides specialized consultation and is a hub for medical research.
Conclusion: Levels of healthcare in Kenya
There are 6 levels of healthcare in Kenya, each vital in ensuring citizens can access the care they need, from basic community services to highly specialized treatment. This tiered approach helps streamline patient referrals, ensuring that each person receives the appropriate level of attention depending on their condition. With counties managing the first five levels and the national government overseeing the sixth, the system reflects Kenya’s commitment to decentralizing health services and bringing care closer to the people. Understanding how each level works helps patients, caregivers, and stakeholders navigate the system more effectively and promote better health outcomes nationwide.
