Devolution of health actually working

[RV Pundit]

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From my facebook Elija

The health docket is one of the main sectors that were decentralized through the 2010 constitution. But, how has the entire health system improved in the country since devolution? Which counties have recorded progress?
For the next couple of days, I will focus on answering this question with the available data
Quality Health system is hinged on six main building blocks as defined by the World Health Organization, and these include; service delivery, health workforce, health information system, access to essential medicines, financing and then leadership/governance
Today, I focus on the first building block; that is service delivery which again has multiple indicators but I will focus on the number of health facilities per 100,000 people (the standard is 10,000 people, but I focus on 100,000 to make the change visible)
The data used in this analysis is based on the National Facility Master Databases (2012 and 2020) by the MoH
At the national level, the number of health facilities (Level 2 through Level 6) have increased by 55% from 8,012 to 12,394 (all type of facilities, Public, Private, FBOs, NGOs etc).
However, worth to note is that the highest increase has been recorded in the private sector where private health facilities have increased by 90% during this period, while the public health facilities have increased by 45%
Public health facilities remain the majority, estimated as 5,878 (47%) of all health facilities followed closely by the Private health facilities estimated as 5,118 (41%)
Back to our indicator, in 2012; a population of 100,000 people was being served by 11 public facilities nationally, and there has been no change in 2020 where the same population is being served by 12 public health facilities
However, considering all facilities regardless of the owner, there has been a good increase on the number of facilities serving a population catchment of 100,000 with the 2020 estimate being 26, and increased from 21 in 2012 (this change is mainly driven by the high growth in the private health care)
At the county level; Makueni has recorded the highest increase in the number of public health facilities doubling them from 119 to 238, followed by Turkana County increasing from 65 to 179 and then Kitui comes third with an increase of 94 from 240 to 339
On the tail end is Mombasa were the number of public health facilities increased by 4, and then Taita Taveta with an increase of 5 and then Lamu where the increase was 9. Tana River and Kiambu occupies the 4th and 5th last with public health facilities increasing by 10 and 14 respectively
On the flip side, Nairobi, Kiambu and Nakuru records the highest increase in the Private Health Facilities increasing by 401, 243 and 185 respectively
Considering the public health facilities only, Baringo, Kitui, Elgeyo Marakwet, Lamu and Marakwet have the highest number of public health facilities serving 100,000 people. On the flip side, Bungoma, Trans Nzoia, , Kiambu, Mombasa and Nairobi records the lowest number of public health facilities serving 100,000 people
The counties which have recorded the largest improvement in this indicator at the public health sector level are Turkana, Makueni, Tharaka Nithi, West Pokot, Kitui and Mandera; while the counties which have made the slowest growth in this indicator at the public health sector are Kiambu, Narok, Taita Taveta, Kajiado, Busia and Isiolo
However, regardless of the facility owner, Tharaka Nithi, Laikipia, Makueni, Turkana and Mandera have recorded the largest improvement in this indicator, while Kirinyaga, Elgeyo Marakwet, Lamu, Marsabit and Mombasa have recorded the lowest improvement
By 2020, the counties with the highest number of facilities per 100,000 regardless of the facility owners are Nyeri, Kirinyaga, Tharaka Nithi, Kitui and Laikipia; while the counties with the lowest concentration of facilities per 100,000 people are Kakamega, Busia, Mandera, Narok and Bungoma
In summary, while Nyeri and Kirinyaga Counties records the highest concentration of health facilities, Tharaka Nithi and Laikipia recorded the highest improvement in the number of health facilities serving 100,000 people in the 8 years span. Nevertheless, Turkana and Makueni have recorded the highest improvement in this indicator at the public health sector; while Nairobi and Kiambu have recorded the highest growth in the private health care

[RV Pundit]

Still on the health system, today I focus on the 2nd indicator under the health service delivery, and this is the number and distribution of inpatient bed per 10,000 people

Nationally, the average inpatient bed density is at 13.8 (regardless of the HF owner) which is below the target of WHO target of 25 beds per 10,000 people

At the county level, the highest inpatient bed density is found in Isiolo with an estimate if 32 beds per 10,000 people. The other top 5 counties include Nyeri and Embu (31), Kisumu and Kirinyaga (28)

On the bottom end is Trans Nzoia (10), West Pokot and Wajir (9), Kilifi (😎 and Kwale (7) and overall, 39 counties are below the WHO Threshold of 25 beds per 10,000 people and thus only 8 counties are above the global threshold

However, focusing on the Public Health Facilities; none of the counties meet the threshold of 25 per 10,000. Nyeri leads nationally with 20 HFs per 10,000 followed by Isiolo (19) and Embu (18)