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.