Investing in Primary Healthcare: Challenges in Achieving Universal Health Coverage in Kenya

The Kenyan constitution in Article 43(1)(a) clearly states that every Kenyan has a right to "to the highest attainable standard of health, which includes the right to health care services, including reproductive health care". The Kenyan constitution equally recognises the role of the government in eliminating barriers to health care access in Article 56. This was further affirmed in December 2017, when the president of the Republic of Kenya, H.E. Uhuru Kenyatta pronounced the "Big Four Agenda", among them affordable health care for all under the flagship of Universal Health Coverage (UHC). As a signatory to the Alma Ata Declaration of 1978, Kenya has continued to make significant strides towards improving the health status of its people. Given that health care services are devolved in Kenya, and with the inclusion of universal health coverage as one of the 'Big Four' agenda pillars in Kenya's socioeconomic transformation, there is seemingly a great need to shift the focus from the often costly and inaccessible curative services to promotive and preventive health services. In order for the successful and efficient implementation of Universal Health Coverage, there need to be strong primary health care as the foundation of the health system. With the renewed commitment of the Government of Kenya to provide health care for all of its citizens under the flagship of UHC, investing in Primary Health Care is now more crucial than ever. The study sought to understand the challenges that Kenya faces in its journey to achieving UHC, with particular reference to primary health care. The study was guided by the following specific objectives: to determine the factors contributing to primary health care, to investigate the factors affecting the delivery of primary healthcare in Kenya, and to investigate the viability of achieving UHC in Kenya, in relation to primary health care. This study adopted a mixed method approach to obtain data. Secondary data was obtained from an analysis ofhealth reports and the country's health strategy framework. Primary data was collected using questionnaires which contained both open and close ended questions. Respondents were carefully selected using purposive sampling method. The respondents were direct implementers of primary health care in Kenya. The data was analysed using content analysis and the results presented in prose form, as well as the use of pie-charts and tables. The study established that the challenges that Kenya faces in achieving UHC include human resources challenges, lack of accreditation of health facilities, dilapidated health infrastructure, limited coverage by the NHIF, lack of a proper health information management system, improper governance, fraud and insufficiency of finance or funding. The study concluded that although primary health care has had a great impact on the progress of universal coverage within the two counties that were under study- Isiolo and Kiambu, the journey to achieving UHC still seems distant under the prevailing conditions and is currently not viable. For the country to be fully viable for achieving Universal Health Coverage with relation to primary health care, there must be in place full implementation of the community health strategy, a fully functional referral system, increased financing for health, increased investment for human resources for health and expansion of scope from NHIF to focus more on primary health. Since, the study was predominantly conducted in two out of forty-seven counties: Isiolo and Kiambu counties, it is recommended that similar studies be conducted in more counties across Kenya, with particular emphasis on the 4 UHC pilot counties to provide more information on the health situation in Kenya.