The Health System

Kenya’s Health Structure and The Six Levels of Hospitals– an Overview

The media has been flooded by news of medical negligence, overcrowding in hospitals and in some instances, successful procedures that bring hope to Kenyans.

Some hospital managers have however complained that they are overwhelmed because people do not go to the right facilities near them for the services they require, instead they go to referral hospitals which are meant for more serious cases.

Issues of which government funds and manages which hospitals have also  come up since the devolution of healthcare.

RoGGKenya has simplified these issues so you can understand the structure of the hospitals.This article will also help journalists in Kenya and the general public to hold government accountable where their right to health is violated.

Kenya’s Health sector is one of the 14 devolved functions managed by the 47 county governments as provided in the Fourth Schedule of the 2010 Constitution.

County health facilities and pharmacies, ambulance services, promoting primary health care, licensing and controlling facilities that sell food to the public and veterinary services are some of the health-related roles the 47 counties manage.

County health facilities and services include county referral hospitals, sub-county health facilities, environmental health services, communicable disease control, nutrition, family planning, maternal and child health plus Health Education.

There are six different levels of health care facilities. The first five are managed on the county level, the sixth level by the national government. In this system the patients may move from one level to the next by using a referral letter.

LEVEL 1 – Community Facilities
They are run by certified medical clinical officers.

Some of the services:

  • Treatment of minor ailments like diarrhoea
  • Tuberculosis (TB) screening, home visits, contact tracing of TB patients and tracing of TB defaulters
  • Screening of malnutrition
  • Malaria rapid test
  • Blood pressure and blood sugar testing
  • HIV testing
  • Health talks with pregnant women and observations of signs of danger
  • Issuance of referral letters to other facilities

LEVEL 2 – Health Dispensaries

These facilities are run by clinical officers:

The dispensaries in the cities act like a health centre (see level 3), with the difference that the dispensary does not have in-patient facilities.

These are some of the services you will expect in a dispensary:

  • Outpatient services
  • VCT services
  • Tuberculosis services
  • Laboratory Services
  • Well baby Clinics
  • Antenatal and Postnatal services
  • Pharmacy
  • Counselling services
  • Curative treatment
  • They issue referral letters to other facilities

LEVEL 3 – Health Centres

These are small hospitals with minimal facilities, yet they offer services like the big hospitals. They are run by at least one doctor, clinical officers and nurses.

These are some of the services they offer:

  • Maternity in-patient services with a ward
  • Curative services
  • Laboratory services
  • Dental
  • Counselling
  • Pharmacy
  • TB Clinics
  • Diabetes & hypertension clinics
  • Comprehensive care clinics for patients living with HIV
  • Baby well clinics
  • Antenatal and postnatal services
  • They issue referral letters to other facilities

LEVEL 4 – County Hospitals

These are hospitals that offer holistic services and are ran by a director who is a medic and at best a doctor by profession

In many counties there’s just one hospital but in larger cities like Nairobi there are two

They have in principle the same services as the Level 3 hospitals, plus X-Ray services They issue referral letters to other facilities

LEVEL 5 – County Referral Hospitals

These are the county referral hospitals formerly the provincial hospitals. They are run by Chief Executive Officers who are  medic by profession and have over 100 beds capacity for their in-patient. They are also do research about health.

In Nairobi Mama Lucy Hospital and Mbagathi Hospital both double up as county referral hospitals and Level 4 hospitals.

Services include what other hospitals offer, plus

  • Ultrasound
  • CT-Scan
  • Surgery
  • Pharmacy
  • Physiotherapy
  • Orthopaedics
  • Occupational Therapy
  • They issue referral letters to other facilities


LEVEL 6 – National Referral Hospitals

In Kenya there are three Teaching and Research referral hospitals: Mathare Hospital, Kenyatta National Hospital, Moi Teaching and Referral Hospital and the National Spinal Injury Referral Hospital. Their range of services is the same as of on Level 5, but they offer specialised treatments to patients and are not only accessed by Kenyans but do serve East Africa and Central Africa.

Mathare Teaching and Referral Hospital offers specialized mental services. Kenyatta National Hospital and Moi Teaching and Referral hospital offer specialized consultations in curative care.

National Spinal Injury Referral offers specialized services in orthopedic and spinal injuries.
The national government manages these three hospitals.

Health Care Management by the National Government

The national government is tasked with financing counties for all sectors including the health department to operate effectively and smoothly.

The National Government is also in charge of Kenya Medical Supplies Agency (KEMSA), National Hospital Insurance Fund (NHIF), National Quality Control Laboratory (NQCL) and National blood Transfusion Services.

However, the Health Cabinet Secretary at the national level is the executive head of the sector in the country, deputized by the Principal Secretary as the ministry’s accounting officer, then the Director of Medical Services.

The Director of Medical Services plays a key role in the sector by coordinating and overseeing six Health departments including Preventive and Promotive Health, Curative and Rehabilitation Services, Standards and Quality Assurance and Regulations.

Other departments are Health Sector Coordination and inter-governmental control, Administrative Services and Policy, Planning and Health Financing.

The Health ministry, according to the Constitution, is tasked with coming up with appropriate measures to ensure the sector functions effectively.

The ministry is linked to Parliament through the National Assembly and Senate’s departmental committees on Health.

The two committees oversight the ministry and also push its agendas in the House for adoption and enactment after the Presidents signs them into law.

Health Care Management by the Counties

At the county level, the Health docket is under the Chief Executive Committee (CEC) member, equivalent to a minister, appointed by the governor.

The Health CEC is answerable to the governor and the County Assembly through its County Executive Health Committee composed of Members of County Assembly (MCAs).

The Health CEC ensures there is effectiveness and proper coordination in the sector in the manner the County Health Management Team, the County Hospital Management Team, the Sub-County Health Management Team, the Primary Care Facility Management Team and the Community Unit discharge their duties.

Apart from the public health facilities falling under the county and national governments management, there are also private hospitals run by individuals or organizations and faith-based hospitals in Kenya’s Health sector.

Read more on the Health Sector Structure in Kenya

By Winnie Kamau and Samuel Kisika

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