Referral Networks Strengthening Laboratory Health Systems in Kenya
To improve access to laboratory testing, supervision and quality assurance, Management Sciences for Health’s (MSH) Strengthening Public Health Laboratory Systems Project in Kenya -- funded by PEPFAR (President’s Emergency Plan for AIDS Relief) through the Centers for Disease Control and Prevention (CDC) -- is supporting the Kenyan Ministry of Health (MOH) in strengthening the national laboratory referral networks.
Health services in Kenya are structured into four hierarchical levels of care: dispensary, health center, district and provincial or national level. The dispensaries and health center provide basic services while the higher levels provide more specialized services, including lab work.
Problems managing the health services system occur throughout, particularly in rational use of health care services and providing equitable assistance to the most vulnerable populations at the dispensary and health center levels. For instance, a patient may be able to access a malaria test at the dispensary but not the results of a routine blood test -- which is available at the district facility.
An effective laboratory referral network will improve accessibility and affordability of services so patients receive the laboratory services at the point they seek care. This will ensure timely diagnosis and clinical as well as public health interventions.
Effective laboratory referral networks are also part of the broader national strategy for health and would help achieve global disease program objectives, including: improved child, maternal, and reproductive health; and reduction in diseases such as HIV & AIDS, malaria, and tuberculosis (TB).
Aligned with the PEPFAR principle of a country-led and country-driven supportive approach to ensure sustainability of the referral networks, a Ministry of Health Technical Working Group was formed to spearhead the development of the referral guidelines and also lead in piloting the referral models in eight facilities from three regions in Kenya: the North-Eastern, Eastern and Coast Provinces. The pilot facilities were selected for being hard to reach areas and possessing difficult terrain.
A draft referral guideline document has been developed, outlining key components in the referral chain that impact specimen and analytical quality as well as health worker safety and turnaround time of results.
There have been remarkable improvements in specimen documentation practices, transport procedures, packaging of specimens, increase in volume and type of laboratory tests requested at referring sites, communication between the facilities and the turnaround time for tests at pilot sites including Makueni, Ijara and Voi Hospitals.