Mobile Clinics: An Innovative Model Of Health Service Delivery
By Joan Kwereba co-authored by Kaushal Shah
“Mobile healthcare delivery is an innovative model of health service delivery that can provide a wide
variety of services to vulnerable populations.”
By Ms. Joan Kwereba, co-authored by Ms. Kaushal Shah
Although access to care has increased in Kenya in recent
years, barriers continue to persist, particularly among populations living in resource-limited areas.
Mobile clinics can improve access by serving as a vital link between the community and clinical facilities.
While mobile health clinics can strengthen Kenya’s healthcare sector, additional work is needed to
advance the availability of this important resource.
A mobile clinic is a customised motor vehicle that travels to communities to provide healthcare.
They deliver a wide variety of health services and may be staffed by a combination of physicians,
nurses, community health workers, and other health professionals. They include customised
vehicles, motor bikes or rickshaws.
The value in mobile clinics lie primarily in their mobility, their ability to be flexibly deployed and customised to fit the evolving needs of populations and health systems, and their ability to link
clinical and community settings.
Mobile health clinics can serve an important role in health system strengthening, providing care
to some of the most vulnerable populations. Strengthening service delivery is crucial to the
achievement of the health-related Sustainable Development Goals (SDGs), which include the
delivery of interventions to reduce child mortality, maternal mortality and the burden of
HIV/AIDS, tuberculosis and malaria. Ensuring availability of health services that meet a minimum
quality standard and securing access to them are key functions of a health system. In this article,
we discuss the value proposition of mobile health clinics in improving healthcare service delivery
in Kenya – ultimately facilitating Universal Health Coverage.
Universal Health Coverage is a government priority
Universal Health Coverage (UHC) is about ensuring people have access to necessary healthcare services, when and where they need them, without suffering financial hardship. Access to quality health services, including prevention, promotion, treatment, rehabilitation, and palliative services, to attain UHC has become a major goal for reform in many countries and a priority of the World Health Organization (WHO).
Universal Health Coverage (UHC) is about ensuring people have access to necessary healthcare services, when and where they need them, without suffering financial hardship. Access to quality health services, including prevention, promotion, treatment, rehabilitation, and palliative services, to attain UHC has become a major goal for reform in many countries and a priority of the World Health Organization (WHO).
In 2013, the national government of Kenya became devolved into the current forty-seven
counties. This saw the decentralisation of certain services, including health service provision, as a
way of improving the health status of Kenyans. In December 2018, President Uhuru Kenyatta
adopted affordable healthcare for all and linked the attainment of UHC as one of the big four
priority agenda. This was done with the aspiration that all Kenyans will be able to use the
essential services they need for their health and well-being through a single unified benefit
package, without the risk of financial catastrophe.
Barriers to healthcare persist
Despite Kenya’s weak health status that is characterised by under-resourced and under-staffed healthcare facilities, there has been significant progress in dealing with issues such as high child and maternal mortality rates. However, three disease domains – communicable diseases, non- communicable diseases, and violence/injuries – all contribute to the high disease burden in the country. The disease burden varies from county to county. The top diseases consuming revenue include HIV/AIDS, 2018 reproductive health, malaria, communicable diseases, vaccine- preventable diseases, and respiratory diseases.
Despite Kenya’s weak health status that is characterised by under-resourced and under-staffed healthcare facilities, there has been significant progress in dealing with issues such as high child and maternal mortality rates. However, three disease domains – communicable diseases, non- communicable diseases, and violence/injuries – all contribute to the high disease burden in the country. The disease burden varies from county to county. The top diseases consuming revenue include HIV/AIDS, 2018 reproductive health, malaria, communicable diseases, vaccine- preventable diseases, and respiratory diseases.
The Kenyan public health system has six levels of hierarchy i.e.,
- Level 1, community services
- Level 2, dispensaries, and clinics
- Level 3, health centres, maternity, and nursing homes
- Level 4, sub county hospitals and medium sized private hospitals
- Level 5, county referral hospitals and large private hospitals
- Level 6, national referral hospitals and large private teaching hospitals
Only 63% of Kenyans have access to government health services located within an hour of their
homes with the health facilities unequally distributed across the forty-seven counties. Rural
health in Kenya faces the main challenge of low density of health professionals and healthcare
infrastructure. This has caused large distances between patients and services thus bringing about
a breakdown in patient care pathways. The central and western region of Kenya have the highest
number of facilities to match their high population numbers, followed by the coastal region.
Northern Kenya continues to suffer from lack of adequate health facilities in the region to reach
the population. In Turkana, for example, some residents must travel for two days to access a
health facility.
Mobile clinics can improve access to healthcare
Mobile clinics offer support in preventive and primary care as well as preventing emergency cases by providing access to early diagnosis, treatment, and interventions of medical issues before complications arise. These services would fall under either level 1 or level 2 in the Kenyan health system.
Mobile clinics offer support in preventive and primary care as well as preventing emergency cases by providing access to early diagnosis, treatment, and interventions of medical issues before complications arise. These services would fall under either level 1 or level 2 in the Kenyan health system.
Mobile health clinics can serve an important role in the Kenyan healthcare system, providing care
to some of the most vulnerable populations. Specifically, in Kenya, mobile clinics can offer flexible
and viable solutions for treating remote areas of the country, isolated and vulnerable groups as
well as newly displaced populations. The large disparities in the number of health facilities
between urban and rural areas creates a need for mobile clinics especially in hard-to-reach
settlements. Mombasa and Nairobi have the most facilities with counties in northern Kenya i.e.,
Marsabit, Isiolo, Samburu, Wajir and Mandera having the fewest number of health facilities. This
market is still in its early stages with room for more market players to enter.
Mobile clinics can also be deployed to deliver healthcare services during emergencies such as
natural disasters and disease outbreaks. Other settings that are in most need of medical care and
therefore are in high demand locations for mobile clinics are refugee camps, major entry or
border points, export processing zones (EPZs) and mining sites.
Case Study: The Beyond Zero Initiative
The First Lady of Kenya, Mrs Margaret Kenyatta, launched the ‘Beyond Zero Initiative’ in January 2014 which has delivered more than 50 mobile clinics to every county in Kenya. The clinics have resulted in increased access to and uptake of healthcare services.
The First Lady of Kenya, Mrs Margaret Kenyatta, launched the ‘Beyond Zero Initiative’ in January 2014 which has delivered more than 50 mobile clinics to every county in Kenya. The clinics have resulted in increased access to and uptake of healthcare services.
The fully kitted mobile clinics have provided almost half a million integrated services. The services
include antenatal and postnatal services; HIV testing, treatment, and care; immunization, basic
treatment for common ailments, reproductive health cancers screening and treatment (where
applicable). Immunisation of children is in demand in the Beyond Zero mobile clinics. The key
advocacy messages of Beyond Zero -regular cancer screening, knowing one’s HIV status, taking
your antiretroviral drugs if one is HIV positive, exclusively breastfeeding a baby up to six months,
ensuring full immunization of children – have reached over fourteen million Kenyans.
Each county is responsible for the running and managing of their mobile clinics under the county health department. The national government disseminates a budget to the county governments who are then responsible to allocate the money to areas they deem as a priority. While mobile
clinics do offer improved healthcare service delivery, overall healthcare funding gaps have created operational issues in certain counties. County governments are willing to engage with private stakeholders to provide access to healthcare services.
Each county is responsible for the running and managing of their mobile clinics under the county health department. The national government disseminates a budget to the county governments who are then responsible to allocate the money to areas they deem as a priority. While mobile
clinics do offer improved healthcare service delivery, overall healthcare funding gaps have created operational issues in certain counties. County governments are willing to engage with private stakeholders to provide access to healthcare services.
Challenges to the rollout of mobile clinics
There are limitations and challenges to the mobile healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into Kenya’s healthcare system. While these clinics can be effective at closing care gaps and promoting health equity – mobile health clinics can drive more fragmented care. Mobile health clinics may also encounter difficulties sustaining themselves. The mobile part of the clinic can create some spatial limitations for equipment or number of patients served. It could also be difficult to recruit clinicians to serve inside of these mobile clinics.
There are limitations and challenges to the mobile healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into Kenya’s healthcare system. While these clinics can be effective at closing care gaps and promoting health equity – mobile health clinics can drive more fragmented care. Mobile health clinics may also encounter difficulties sustaining themselves. The mobile part of the clinic can create some spatial limitations for equipment or number of patients served. It could also be difficult to recruit clinicians to serve inside of these mobile clinics.
Opportunities for the private Sector
During the 2017 election, President Uhuru Kenyatta outlined an agenda centred on four pillars for his second and final term. The Big Four agenda focuses on food security, affordable housing, affordable healthcare for all, and increased manufacturing. Opportunities for increasing access to healthcare exist given the increased focus on these four areas. The rollout of mobile clinics could facilitate the president’s commitment in increasing accessibility to health services to achieve UHC.
During the 2017 election, President Uhuru Kenyatta outlined an agenda centred on four pillars for his second and final term. The Big Four agenda focuses on food security, affordable housing, affordable healthcare for all, and increased manufacturing. Opportunities for increasing access to healthcare exist given the increased focus on these four areas. The rollout of mobile clinics could facilitate the president’s commitment in increasing accessibility to health services to achieve UHC.
The private sector can leverage on the government’s readiness and support of public-private
partnerships to enter the mobile clinics market in Kenya. Opportunities for the private sector to
invest in this area include engaging with individuals who have ben disenfranchised from
traditional healthcare, providing services in difficult terrains, providing outreach services
focussed on specific diseases, provide services in strategic locations such as refugee settlements
and border entry points, provide COVID-19 pandemic support such as testing and vaccines and
provide specialist services.
Currently, most mobile clinics in Kenya are run by non-governmental organisations (NGOs) and international partners such as the WHO, with support from local facilities. A partnership model
would also allow for different business models: fee for service, public and private sector contracts and would potentially also allow for the use of established healthcare service delivery models.
With a focus on service delivery, financing, products and supply chains, data, information and
technology, human resources, and leadership and governance, we leverage our expertise to address the most pressing public health challenges.
In relation to the use of mobile clinics to improve health service delivery in Kenya, we have worked with organisations in the private sector looking address health system challenges in the country and looking to sustainably roll out mobile clinics via partnerships with development organisations already on the
ground.
Organisations in the private sector have the capacity for efficiency and sustainability which can be harnessed to meet important social objectives. Our linkages with the private sector can be leveraged to deliver essential health services, educate health professionals, obtain knowledge and lessons learned,
provide financing for, procuring and distributing essential commodities, and hold governments
accountable for results.
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