Strengthening Primary Healthcare: Easing the Burden on Bungoma County Referral Hospital

Primary health care is the essential health care made accessible, acceptable and affordable through full participation of individuals, families and communities.

Article 43 (1) of the Kenyan constitution grants the highest attainable standard of healthcare as a basic right for all Kenyans without discrimination. This is further guaranteed to all Kenyans through the Act of parliament 13 of 2023 under which reproductive, maternal and child health is highly prioritized in line with the third global goal.

Bungoma being one of the counties with a large population, the need to have functional primary care systems is inevitable. Bungoma County Director of Health Doctor Caleb Watta says that the department of health has realized commendable strides since the Primary Health Care program was launched late last year.

He notes that the department has embarked on streamlining effective services at the lowest levels of care so that Bungoma County Referral Hospital handles more chronic conditions.

He cites that since the community health promoters were equipped, the peripheral facilities have started realizing an upward trajectory of patients, which he says will help contain diseases earlier.

In addition, he says community health promoters have been empowered as the foot soldiers hence making screening of the community more convenient. However, he says replenishment of medical commodities remains a setback since the department heavily relies on the exchequer to procure pharmaceuticals despite it being irregularly released.

He says a focus to stronger primary health care will enhance revenues and give the department ample time to replenish medical commodities.

Our level 1, level 2 and level three faculties are now the main focus of health care since we are transitioning to a level where all can access health services with minimal barriers including long travel time, huge expenditures on treatment and referral challenges,” he said.

Doreen Kinanga, the Primary Health Care coordinator in Bungoma also reiterates that the department has focused on strengthening the linkage between levels of facilities by ensuring there is smooth flow of information from level 1 up to the referral hospital.

She says the department is gearing towards a preventive and promotive approach where CHPs can handle minor ailments, conduct community outreaches as the department makes use of the reverse referral approach to respond to critical conditions.

She adds that under Primary Health Care, there is a clear follow up mechanism which ensures the patients recover fully before they are left.

In addition, PHC provides room for proper Networking between levels of care hence reducing time taken for patients to receive medical attention. Irene Nafula, one of the community health promoters says their working conditions have been improved tremendously since they were fully recognized at a level of care but appeals for more sensitization to residents in the communities.

“The challenge we experience is that most people in the communities still believe that our work is entirely immunization so most of them want to go to hospital for minor conditions which we can manage,” she said.

Her sentiments were reiterated by Stephen Wamalwa who coordinates a team of CHPs in Bungoma township who said most residents rush to BCRH whenever they fall ill, asking the public to trust low level facilities.

A young mother called Jane Masika-not her real name says she got HIV before she got pregnant for her first child. She says her journey was not easy because she used to travel all the way from East Sang’alo to Bungoma County Referral Hospital for her antenatal care.

This was not due to lack of services closer to her but she only trusted the BCRH, 15KM away from her home.

“I never believed that I could get quality services at my closest health centre,” she said.

Upon establishment of Primary Health Care units, she says she now receives her services at Mechimeru health centre where she can just walk in any time and be attended to.

The mother of a four-year-old HIV negative son says there are many women like her who can save on the travel cost and time wastage if the Government invests more in strengthening Primary Health Care.
Another 26-year-old mother of two says who sought anonymity says she comfortably receives her family planning services at Milo Dispensary.

She says availing such services across all peripheral facilities will help guarantee reproductive rights for many young people who need access to family planning. To spearhead the success of Primary Health Care in the country, Civil society organizations are also playing an integrated part.

RMNCAH Network is a grassroot organization that champions for Reproductive, Maternal, Neonatal, Child and Adolescent health in Bungoma County. Through the ongoing project, Vital Signs Profile for Stronger Primary Healthcare, the organization has successfully supported the domestication of the Vital Signs Profile tool for the county department of health.

Through this special tool, the department can now measure Primary Health Care performance and track the process. Project coordinator Moses Ouma says the organization also advocates for increased health allocation towards Primary Health Care citing that RMNCAH remains the biggest beneficiary of a strong PHC system.

“We are also supporting this initiative through key interventions such as sensitization of the community through local radios, championing for formulation of RMNCAH and PHC friendly policies and engaging stakeholders on the importance of Primary Health Care,” he said.