Examining the Implementation Experience of Primary Health Care Networks (PCNs) in Kenya: A Qualitative Study

Background : Kenya has identified Primary Health Care Networks (PCNs) as a key reform to strengthen Primary Health Care (PHC) delivery. It has enacted the Primary Health Care Act of 2023 to facilitate their implementation. PCNs were piloted in Kisumu and Garissa counties in Kenya in 2020 and rolled out nationally in 2023. This study examined the implementation experience of the PCN reform in Kenya. Methods : We used a cross-sectional qualitative process evaluation design. We collected data at the national level and five purposefully selected counties using in-depth interviews (n=65) and document reviews between February and June 2024. Participants included stakeholders from the national level (Ministry of Health, development and implementing partners, and the Council of Governors), county level (county health departments, sub-county managers, multi-disciplinary team (MDT) members, facility managers, and frontline health workers), and community level (community health committee chairs and community health workers). We reviewed policy documents and county reports on PCN implementation for document reviews. We analysed the data using a thematic approach. Results : The emergence of PCNs as a policy reform was motivated by a technocratic process that identified underlying challenges in PHC service delivery and proposed PCNs as a solution, as well as political interest and support that facilitated their adoption. The implementation effectiveness of PCNs across the study counties varied, with critical aspects of PCN design, such as the establishment of MDTs and the digitisation of PCNs inadequately implemented. The effectiveness of PCNs was compromised by capacity gaps in key foundational aspects of PHC health systems, including financing, human resources, health commodities, and information systems. PCNs’ effectiveness was further undermined by the limited integration of key health facility functions – financing, human resource management, health commodity supply chains, information systems, and care coordination. Conclusion : Strengthening PCN implementation in Kenya requires investment in policy capacity for effective implementation. Foundational aspects of PHC systems must be reinforced. The PCN design should be refined to enhance the integration and coordination of key health facility functions.