Readiness of Primary Health Care Diagnostic Laboratory Services to Support UHC Programme in Kenya: A Case Study of Three Counties

Abstract

Medical diagnostic laboratories have always played a significant role in determining clinical decisions. Given that laboratory diagnosis accounts for up to 70% of all medical decisions, reliable laboratory services is therefore critical to basic clinical care and universal healthcare coverage (UHC) programme. Apparently, a pilot UHC programme in four counties ahead of nationwide roll-out was being tested in Kenya from December 2018 to December 2019. Significantly, a reliable laboratory diagnostic service also support a sustainable functional referral system. However, in majority of low to middle income countries (LMICs) and throughout sub-Saharan Africa including Kenya, common infrastructural, technical and human resource deficiencies are endemic, consequently impacting on the coverage of services, quality, availability, affordability and accessibility of diagnostic tests as well as their ability to provide basic clinical care. For that reason, studies to determine the current status of laboratory diagnostic services, especially at the primary health care (PHC), coverage and their readiness to provide basic clinical care as well as in supporting UHC. The purpose of this pilot descriptive study was to investigate the status and readiness of laboratory diagnostic services in three counties in Kenya to support UHC at a resource-limited PHC setting. By use of structured, pretested questionnaires, general observations and key informant interviews, the study-specific information was obtained from participants. The data was analyzed using SPSS statistical package, interpreted, summarized and presented in tables and bar graphs. Based on the WHO-defined three categories of essential diagnostic list (EDL) for UHC at PHC, all the general basic tests were available in the sampled facilities. However, for the disease-specific and infectious diseases-specific tests there were major gaps in their availability. In addition to common infrastructural, technical, human resource deficiencies, only in 3% of the facilities, the more advanced, molecular-based disease-specific and infectious diseases-specific tests were available. This indicated low readiness to provide reliable basic clinical care and to support of UHC programme implementation at PHC level. Therefore, building of capacities of these services at PHC will have a direct impact not only in the diagnosis, treatment and prevention of diseases but also help in the successful up-scaling nationwide of the UHC programme, hence assisting in attainment of the 'Big Four' agenda of UHC, United Nations (UNs) sustainable development goals (SDG) number three (3) on ensuring health for all and promoting well-being for all ages, and the Kenya's Vision 2030 economic blue print.