Understanding Kenya’s Health System
After devolution in 2013, county governments took over healthcare delivery. This means your local dispensary, health center, and county hospital are managed by your county government.
National government handles:
- National referral hospitals (like Kenyatta and Moi Teaching hospitals)
- Health policy and standards
- Health insurance (SHA/SHIF)
County governments handle:
- Dispensaries
- Health centers
- Sub-county hospitals
- County referral hospitals
- Ambulance services
- Public health programs
Types of County Health Facilities
Level 1: Community Health Services
What it is: Services delivered in your community by Community Health Promoters (CHPs) and volunteers.
Services:
- Health education
- Basic first aid
- Referrals to health facilities
- Home visits for mothers and babies
- Disease prevention campaigns
Cost: Free
Level 2: Dispensaries
What it is: Small health facility serving a local area.
Staff:
- Nurses
- Clinical officers
- Lab technicians (sometimes)
Services:
- Outpatient care for common illnesses
- Immunizations
- Antenatal and postnatal care
- Family planning
- Basic lab tests
- Minor wound treatment
- Health education
What they DON’T handle:
- Surgery
- Complicated deliveries
- Serious emergencies
- Specialized care
Cost: Very low (often KES 50-200)
Level 3: Health Centers
What it is: Larger than dispensary, serves several villages or estates.
Staff:
- Clinical officers
- Nurses
- Lab technicians
- Pharmacist or pharmacy technician
Services:
- Everything dispensaries offer, PLUS:
- Normal deliveries (maternity services)
- Inpatient beds (limited)
- More lab tests
- Minor procedures
- TB and HIV services
- Dental services (some facilities)
Cost: KES 200-500 depending on service
Level 4: Sub-County and County Hospitals
What it is: Main referral hospitals in your county.
Staff:
- Doctors (general practitioners and specialists)
- Clinical officers
- Nurses
- Lab staff
- Pharmacists
- Radiographers (X-ray)
Services:
- All primary care services
- Emergency services
- Surgery
- Specialized clinics (diabetes, HIV, mental health, etc.)
- X-rays and scans
- Comprehensive lab services
- Maternity with cesarean section capability
- Inpatient wards
Cost: KES 500-2,000 depending on service (much cheaper than private)
Level 5: County Referral Hospitals
What it is: Main hospital in your county with most services.
Examples:
- Kiambu County Referral Hospital
- Machakos Level 5 Hospital
- Nakuru County Referral Hospital
Services: All Level 4 services plus more specialized care
Level 6: National Referral Hospitals
What it is: Highest level hospitals in Kenya.
Examples:
- Kenyatta National Hospital (Nairobi)
- Moi Teaching and Referral Hospital (Eldoret)
- Coast General Teaching and Referral Hospital (Mombasa)
When to go: Only through referral from county hospital for very specialized care.
How to Access County Health Services
Step 1: Start Local
For most health issues, start at your nearest facility:
- Fever, cough, headache → Dispensary or health center
- Pregnancy care → Health center or county hospital
- Vaccination → Dispensary
- Common injuries → Health center
Step 2: Get a Patient File
First visit to any public facility:
- Register at reception
- Provide your ID number
- Get a patient file/card (usually KES 50-100)
- Keep this file—bring it to all visits
Step 3: Pay User Fees
At most county facilities, you pay small fees:
- Registration/consultation: KES 50-200
- Lab tests: KES 100-500
- X-rays: KES 200-800
- Medication: Varies (often free or subsidized)
Free services:
- Maternal and child health (antenatal, delivery, immunization)
- HIV testing and treatment
- TB treatment
- Family planning
Step 4: See Healthcare Provider
- Wait for your turn
- Explain your symptoms
- Provider examines you
- They may order tests
- You get diagnosis and treatment plan
Step 5: Get Medication
- Take prescription to pharmacy
- Pay for medication (if not free)
- Pharmacist explains how to take medicine
The Referral System
Why Referrals Matter
You can’t just show up at Kenyatta Hospital for a headache. Kenya’s system requires referrals to move from lower to higher levels.
Benefits:
- Ensures appropriate care at right level
- Prevents overcrowding at big hospitals
- Makes healthcare more affordable
How Referrals Work
Step 1: Go to nearest facility (dispensary or health center)
Step 2: If they can’t help, they give you a referral letter
Step 3: Take referral letter to the higher-level facility
Step 4: That facility treats you or refers you higher if needed
When You Need a Referral
- Specialist care (cardiologist, neurologist, etc.)
- Surgery
- Advanced diagnostics (CT scan, MRI)
- Complicated conditions
- National referral hospitals
When You DON’T Need a Referral
- Emergency situations (go straight to hospital)
- Maternal and child health services
- HIV and TB services
- Mental health services (can go directly to county hospital)
Emergency Bypass
In emergencies, go directly to the nearest hospital:
- Severe injuries
- Difficulty breathing
- Chest pain
- Severe bleeding
- Loss of consciousness
- Stroke symptoms
- Severe burns
Don’t wait for a referral in emergencies.
Using SHA/SHIF at County Facilities
What SHA/SHIF Covers
- Outpatient services at all levels
- Inpatient care
- Surgery
- Maternity services
- Emergency care
How to Use It
- Register for SHA/SHIF (if not already)
- Bring your ID when visiting health facility
- Provider verifies your membership
- Receive services (most are covered)
- Pay only for items not covered by SHA/SHIF
Check SHA/SHIF article for full details on coverage.
Common Services at County Facilities
Maternal and Child Health (MCH)
Free services:
- Antenatal care (pregnancy check-ups)
- Delivery
- Postnatal care
- Child immunizations
- Growth monitoring
Where: Health centers and hospitals (dispensaries do antenatal but refer for delivery)
What to bring:
- Mother and child health booklet
- ID card
- Any previous medical records
Chronic Disease Clinics
Available at county hospitals for:
- Diabetes
- Hypertension (high blood pressure)
- Asthma
- Epilepsy
- Mental health conditions
Usually once a week—ask when clinic day is
Services:
- Check-ups
- Medication refills
- Lab tests
- Health education
Often free or very low cost
HIV and TB Services
Free at all county facilities:
- HIV testing
- Antiretroviral therapy (ARVs)
- TB testing and treatment
- Follow-up care
Confidential—your status is protected
Family Planning
Free services:
- Counseling
- Contraceptives (pills, injections, implants, IUDs)
- Sterilization services
Available at: Dispensaries, health centers, hospitals
Mental Health Services
Available at county hospitals:
- Counseling
- Psychiatric care
- Medication
- Support groups
Usually affordable—ask for “mental health department” or “psych unit”
Challenges and How to Navigate Them
Long Waiting Times
Reality: Public facilities are often crowded.
Tips:
- Arrive early (before 8am)
- Bring something to read or do
- Be patient—staff are doing their best
- Emergency cases are seen first
Medication Stock-Outs
Reality: Sometimes medications run out.
What to do:
- Ask when next supply is expected
- Get prescription to buy from private pharmacy
- Check if nearby facility has the medication
- Report persistent stock-outs to county health office
Staff Shortages
Reality: Many facilities are understaffed.
Impact: Longer waits, shorter consultations
What helps: Be clear and concise about your symptoms, ask questions if you don’t understand
Facilities in Poor Condition
Reality: Some facilities need renovations.
What to do:
- Still use them for basic care (care is what matters)
- Report serious issues to county health authorities
- Participate in facility health committees if available
Your Rights as a Patient
You Have the Right To:
- Respectful treatment: No one should be rude or abusive
- Privacy: Exams and consultations should be private
- Informed consent: Understand any procedure before it’s done
- Information: Ask questions and get clear answers
- Choose: Accept or refuse treatment (except in emergencies)
- Complaint: Report poor service or mistreatment
Where to Complain
- Facility in-charge
- County Health Management Team
- County health office
- Kenya Medical Practitioners and Dentists Council (KMPDC) for doctor misconduct
Making the Most of County Health Services
Do:
- Go early in the morning
- Bring your patient file/card
- Bring ID and insurance details
- Write down your symptoms and questions
- Follow treatment instructions
- Keep appointments
Don’t:
- Argue with staff (they’re overworked too)
- Expect private hospital standards
- Skip follow-up visits
- Share medication with others
- Go to Level 5 or 6 hospitals without referral (except emergencies)
Ambulance Services
When to Call
- Life-threatening emergencies
- Severe injuries
- Complications during delivery
- Stroke symptoms
- Severe bleeding
How to Access
Call county ambulance service:
- Usually free or low cost
- Number varies by county (check your county website)
- Also: Kenya Red Cross 1199
Private ambulance services (if county can’t respond):
- St. John Ambulance Kenya
- AAR Healthcare
- Private hospitals
Special Programs
Linda Mama (Free Maternity)
- All deliveries free at public facilities
- Cesarean sections covered
- Complications covered
School Health Program
- Free health screenings in schools
- Deworming
- Vision and dental checks
Immunization Campaigns
- Free vaccinations for children
- Tetanus for pregnant mothers
- Campaigns announced through local administration
Take Action Today
Find Your Nearest Facility
- Ask neighbors or local administration
- Google “dispensary near me” or “health center [your area]”
- Visit and register (even when healthy)
- Save contacts in your phone
Register for SHA/SHIF
- Ensures you can access services when needed
- Covers most costs
- See SHA/SHIF registration article for steps
Know Emergency Numbers
- County ambulance (check your county)
- Kenya Red Cross: 1199
- Emergency: 999 or 112
County health services are your first line of care. They’re affordable, accessible, and handle most health needs. Know your local facilities and use them when needed.