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There is a need for targeted investments to improve healthcare delivery in Kenya. This has been underscored through the Diagnostics for Universal Health Coverage (Dx 4 UHC) Tracker project, which assessed the capacity of diagnostic services across four counties, revealing a capacity index of 52.9% across all level 2 to 6 public health facilities of Kenya’s healthcare infrastructure.

The project was a collaborative effort between diverse local health authorities (in Kilifi, Kisumu, Nakuru, and Nyeri counties), the Foundation for Innovative New Diagnostics (FIND), and researchers based at the Digital Health applied Research Centre (DHARC) of Jomo Kenyatta University of Agriculture and Technology (JKUAT). The African Institute for Development Policy (AFIDEP) supported the project in knowledge translation.

The project’s study approach was comprehensive yet focused, investigating diagnostic capacity for triage, communicable diseases (CDs), non-communicable diseases (NCDs), and diseases related to maternal health. The study also surveyed the staffing and skills mix in the health facilities, as well as the profile and needs of patients visiting these facilities.

The capacities for CDs, NCDs, triage and maternal health diagnostic services were weighted and combined to formulate an insightful capacity index, which encapsulates the readiness of healthcare facilities to provide accurate and timely diagnoses – a cornerstone of effective treatment and care. The different indices are presented in a user-friendly dashboard for easy access for county and national-level health stakeholders.

The study has revealed gaps in Kenya’s healthcare system that is impacting on patient care and health outcomes. Dr Fredrick Oluoch, Director of Public Health and Sanitation in Kisumu County stated: “The dashboard articulates the resource needs at each level of health service delivery in the country. The high congestion at higher levels were due to inadequate staffing and a lack of basic diagnostics at the primary healthcare level, with patients preferring to go to hospitals where they could get complete diagnosis and treatment. The dashboard is a tool that enables us to advocate for resources and efficiently allocate these resources, thereby increasing access to healthcare for all and having services within the reach of every citizen.”

Ms Christine Mumbi, Health Records and Information Officer for Nyeri County, indicated that it was privilege for Nyeri to be part of the study, describing it as a ‘game-changer’. “No other study has been done to justify resource allocation for diagnostics in healthcare,” she said. “With the findings of this study, we now have data for decision-making, and will no longer rely on estimates. We know exactly what we have, and can map out the capacity needs for investments.”

Despite dedicated efforts and strides made in other areas, NCD diagnostic testing capacity poses a considerable challenge across all four counties with an aggregated score of 25.3% and disparities evident across levels. The study highlighted the complexity of obtaining imaging services, with CT scans, for instance, only available in level 5 facilities. Level 2 and 3 facilities demonstrated capacities below 20%, while level 4 facilities were shown to be at 50%. Specialised equipment, costly reagents, and expertise are needed within the country’s healthcare system as the burden from NCDs continues to rise.

Triage capacity, an essential gateway for patient care allows health providers to prioritise care according to urgency. All health facilities have triage units, with an aggregated capacity of 75.5%. Level 2 facilities have the lowest capacity, and Nakuru county reported the highest variability due to missing pulse oximeters and selective investigation practices.

The study revealed a mixed scenario regarding diagnostic testing for communicable diseases. Communicable diseases contribute the highest disease burden in the country, and these respective health facilities have an aggregated capacity index of 51.5%. Capacities ranged from nearly 100% for HIV and malaria diagnostic testing to significantly lower capacities for meningitis, dengue, chikungunya, and a number of the haemorrhagic fevers. Despite the pressing concern of chronic hepatitis B virus (HBV) infections causing liver cirrhosis and cancer, diagnostic capacity is around 30%, highlighting a need for focused efforts.

The diagnostic capacity for maternal health–related cancers, such as breast and cervical cancers, stood at 59.3%. Prognosis for these two cancers is greatly impacted by early detection. Yet, most of the facilities in the counties could only offer screening services for these cancers, with only level 5 facilities having the capacity for confirmatory tests, implying that early detection is considerably reduced in community settings.

Dr Haji Masuko, Family Physician in Kilifi County stated, “Political goodwill is needed for upgrades especially at level 2 and 3 health facilities. Through the use of the dashboard, the county aims at mobilising more resources using tangible evidence availed to them, and so citizens are assured of enhanced laboratory services in the health facilities they visit.”  Dr Elizabeth Kiptoo, Director of Public Health in Nakuru County also noted that given the information provided by the dashboard, there is a need to conduct further studies to cover all of the county’s health facilities. “The county will have a comprehensive and clear picture of the correct status of health facilities in terms of diagnosis, with the data provided used for planning and streamlining the county’s work plan, mobilising more resources from the County Assembly, and expanding services to areas that are underserved,” she stated.

As Kenya’s healthcare landscape evolves, the insights from this study will undoubtedly guide transformative changes to support the country’s move towards universal health coverage and ensure a healthier, more resilient nation for generations to come.