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Universal health coverage (UHC) is more than a policy; it’s a promise of accessible and high-quality healthcare for every Kenyan citizen. Despite the government’s commitment to achieve UHC by 2022, coverage currently stands at just over 50%. A study conducted by researchers at the Digital Health Applied Research Centre (DHARC) of Jomo Kenyatta University of Agriculture and Technology (JKUAT) paves the way in advancing healthcare in Kenya by focusing on a crucial yet often overlooked aspect – diagnostics.

The Diagnostics for Universal Health Coverage (UHC) Tracker (Dx 4 UHC Tracker) project, a joint effort between the Ministry of Health Kenya (MoH-K), county governments of Nyeri, Kisumu, Nakuru and Kilifi, Foundation for Innovative New Diagnostics (FIND), and DHARC-JKUAT, consolidates a wealth of diagnostic-related data, offering an interactive and comprehensive overview of diagnostics in the country. The researchers are the first group to locally track the growth of diagnostics overtime, revealing the dearth of information and investments in this area that is vital for clinical decision-making and health outcomes.

Through extensive data collection from all of Kenya’s level 2 to 6 public health facilities, the study which was conducted over 12 months in 2022 and 2023, tracked changes in diagnostic availability, capacity allocation, and quality indicators for maternal health, triage, communicable and non-communicable diseases. Dr Jane Akinyi, a researcher at JKUAT, noted: “We wanted to find out how realistic is the country’s ability to achieve UHC. For the country to achieve UHC, we must first get it right at the diagnostic level.” Diagnostic confirmatory tests facilitate appropriate therapy for speedy and full patient recovery, while reducing negative outcomes such as antimicrobial resistance.

The inception of the Dx 4 UHC Tracker project can be traced back to a previous study by researchers at JKUAT which centred on diagnostic network optimisation for maternal and child health in Nyeri and Kisumu counties. The study exposed critical gaps, including financing of diagnostic services as a primary concern. With an aspiration to address these gaps and align efforts with Kenya’s UHC roll out, the Tracker project was envisioned. Each county selected for this new study – Nyeri, Kisumu, Nakuru, and Kilifi – has a unique disease-burden profile, allowing the project to capture the full spectrum of healthcare challenges across the country.

No project is without its challenges. At the heart of the diagnostic dashboard developed through the Dx 4 UHC Tracker project is data. From diagnostic service capabilities to accessibility of health facilities by the citizens, this dashboard captures a broad spectrum of information processed and visualised into user-friendly graphs, maps and charts. However, data quality was a continuous concern throughout the project, as well as an uneven understanding of how health workers use and understand data across the different counties.

Despite the hurdles, the study has revealed disparities in investments across different health facility levels, underlining the need for equitable resource allocation in the health sector. County governments are using the dashboard, and requesting an expansion of its scope. “Policymakers can use the platform to allocate resources strategically and direct funds where they are most needed. Administrators can also monitor the distribution of diagnostic equipment and human resource to ensure efficient use,” stated Dr Fredrick Oluoch, Director of Public Health and Sanitation for Kisumu County.

Dr Haji Masuko, Family Physician in Kilifi County also stated, “As the counties roll out primary care networks (PCN) for UHC across Kenya, it should be clear that there is no UHC without diagnostics. Resources must be made available to support diagnostic services. The regulatory bodies should also support task shifting in addressing the human resource gap in the different counties.”

The diagnostic dashboard now represents a significant stride towards a more advanced and effective healthcare system by enabling healthcare stakeholders to make informed decisions and drive better healthcare provision and patient outcomes. To guarantee its sustainability, technical working groups (TWGs) for diagnostics within counties are being organised, with the project team providing support. Dr Leyla Abdullahi, Senior Research and Policy Analyst at the African Institute for Development Policy (AFIDEP) which supported the project in knowledge translation noted that these “TWGs can serve as a useful platform through which counties learn from each other as they use the diagnostics dashboard.” She also encouraged counties to “take all opportunities to share the tool and document lessons from its use as it provides evidence at all levels to advocate for resources to address diagnostic gaps in Kenya.”

Professor Simon Karanja, Principal Investigator of the project and Chief scientist of DHARC- JKUAT noted “the Dx 4 UHC Tracker project offers invaluable insights for future researchers and healthcare advocates. Its scalability to additional counties showcases its potential for nationwide impact. By fostering partnerships and data-driven decisions, the study empowers the Ministry of Health and counties to bridge diagnostic gaps effectively.” To further advance diagnostics, the researchers recommend counties develop data repositories,and enhance peer-to-peer learning and use within the counties through the Maarifa Centre.