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FEATURE STORYDecember 12, 2023

Transforming health care in Kenya’s communities for a more prosperous, resilient future


Janeffer Sarinke, a mother and health promoter in Shompole, holds her daughter. She delivered a healthy baby safely at the Shompole health facility and can now share her experience with others in her community.

Photo: Davasha Photography / GFF

The hallway of the Shompole Dispensary—a primary health care center in rural Kenya—buzzes with women and children. In the newly renovated maternity wing, mothers breastfeed their newborns and the midwives are busy making sure everyone is well taken care of. Outside, community health promoters meet with families to provide advice on family planning, nutrition, and immunization. 

Not long ago, the same health center looked dramatically different. The maternity wing lacked beds and equipment and faced shortages of both medicines and skilled medical staff. This made it difficult to provide safe and effective health services to the community.

While health outcomes in rural clinics have been improving across Kenya, the pace of progress has been slow, especially in remote areas still lagging behind the national average. Efforts under the Transforming Health Systems for Universal Care Project (THS-UCP), led by Kenya’s government, in partnership with the World Bank’s International Development Association (IDA), the Global Financing Facility for Women, Children and Adolescents (GFF), and Japan’s International Cooperation Agency and other partners have helped narrow this gap.

Investing in primary care at the community level

Janeffer Sarinke, a mother and health promoter in Shompole, notes that a few years ago her community could not easily access health services. Located in one of the most arid parts of Kenya, her village is particularly vulnerable to climate and economic shocks. Prolonged droughts have resulted in a loss of crops and livestock, which are the main sources of income for many families. This made it more difficult for her to spend money on transportation to visit the nearest health facility, more than 20 kilometers away. Many women were giving birth at home, which often resulted in serious health complications, and children missed critical vaccinations.

But with the renovated maternity wing and more skilled nurses available in the dispensary, things have changed.

I am happy with the new health services introduced to my community. Even if we come at 2 a.m., we find doctors who provide us with very good care,” Janeffer says.

With project support, the government launched a program that trains community health promoters to share information about good health practices, including family planning.

Janeffer is one of them.

In the past, we did not have enough knowledge of family planning,” she says. “Now, women and adolescent girls know their options and are empowered to seek proper care and go on to complete their education and raise healthy families.”

The Shompole Dispensary is one of many health centers providing quality services to communities across the vast county of Kajiado. Over the past few years, the county has gone from having less than 10 health centers to about 154, with visible impact. Between 2014 and 2022, deliveries in institutions countywide have jumped from 62 to 85%, while use of modern contraceptives has increased from 45 to 57%. In 2022, access to pre- and post-pregnancy care and nutritional care to reduce stunting has passed the national average.

Prioritizing hard-to-reach communities

With many communities facing barriers in access to care, the government took steps to ensure no one is left behind in the journey toward better health.

In 2016, leveraging its partnership with the GFF and the World Bank, the Government of Kenya led the development of a national investment framework as a road map for universal health coverage. The framework prioritized 20 counties, including Kajiado, whose residents rarely went to hospitals because they either lived too far away or could not afford the services. Each county designed its own health plan and  engaged with local leaders, youth advocates, and civil society representatives to understand the specific needs of underserved communities.

Counties also committed to increasing domestic resources for health: In 2021, nearly 80% of Kenya’s 48 counties allocated at least 30% of their budget to health, a massive jump from only 19% in 2015.

More domestic resources, complemented by financing from development partners, helped fund priority investments in each county. For example, Narok county opened more than 20 new health facilities and equipped them with what they most needed—new delivery beds, solar systems, and water tanks to ensure adequate supplies of electricity and water. This helped expand access: From 2014 to 2022, countywide births in institutions increased from 39 to 69% and vaccination among children under two years of age increased from 66 to 75%.

Narok also prioritized civil registration services to help remote households register child births. Through a pilot project supported by the GFF, agents were deployed to more than 20 communities. Within two months, almost 10,000 birth registrations were recorded and more than 8,000 birth certificates issued, a requirement for children to be able to access social benefits, including health care and education.

It is great having access to this facility because I don’t live far from it and the services are affordable,” says Naomi Negeo, a resident of Narok County.  In Naomi’s community, people had to travel for days to reach the nearest county hospital 100 kilometers away. But now, the renovated Leshuta Dispensary in Narok County has the capacity to serve over 15,000 people from nearby villages.

Reginah Keshe, a graduate of Kenya’s nurse training program, was deployed to the Leshuta Dispensary. The training equipped her with the knowledge to educate her community about good health practices. Photo: Nansia Constantinou/GFF

Services have been adapted in ways to meet the needs of women, children, and adolescents. A special nurse training program, supported by the project, provides scholarships for nursing students selected from these communities and deploys the nurses in health centers with very few skilled professionals.

Continuing need to build on progress

The comprehensiveness of these efforts has helped transform communities. Now, fewer women are dying from complications associated with pregnancy or birth, more children are growing up strong and healthy, and fewer adolescent girls are giving birth.   

Between 2014 and 2022:

  • Under-five and infant mortality rates reduced by 21% and 18%, respectively.
  • Adolescent birth rate reduced by 24%
  • Under-five stunting reduced by 31%

Challenges remain, however, especially with stillbirths and neonatal and maternal mortality rates, which are still high. With sustained efforts and partner support, Kenya is committed to ensuring more lives can be saved and the right to health can be fully realized.


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