Overview
Healthcare in Kenya is offered by three main providers: public hospitals, mission not for profit hospitals, and private hospitals. Individuals decide where to seek care based on accessibility and affordability. The health system is structured in a step-wise manner so that complicated cases are referred to higher levels, but there is little support for people with diabetes, even at higher levels.

What happens if you need to see a doctor?
In order to see a clinician (in this case a healthcare worker, not necessarily a qualified doctor) one has to first decide where to seek care. Factors like distance, cost, availability of the required service are considered. A person then has to present themselves to the health facility chosen, and in all cases will have to pay a fee to see the clinician, and also pay for all tests ordered and for all medicines prescribed. In the public facilities, the cost is much lower than the private facilities but often times both tests and medication are unavailable. This leads to a referral for the medication and tests in private facilities, which is much more expensive. In order to see a specialist in public facilities, one has to be referred to the higher level facilities, of which there are few, and a booking for a visit could be set as far as three months away. When one goes t the clinic on the day, most of the day is spent in long queues.

Who decides what medicines the doctor prescribes?
The Pharmacy and Poisons Board (PPB or the Board in short) is the Drug Regulatory Authority of Kenya. The Board regulates the Practice of Pharmacy and the Manufacture and Trade in drugs and poisons. What is prescribed in hospitals is largely determined by what is in stock at the time. Other factors that come into play are the aggressive drug representatives in marketing their products to providers.

Practically, what is it like to live with type 1 Diabetes in Kenya?
All supplies needed for management of type 1 diabetes have to be paid for out of pocket and other than mixed insulin, which is at times in stock in the public hospital pharmacies for a fee, all other supplies have to be bought from the private sector. Insulin pumps are unavailable across the country. Glucometers, strips and ketone strips are very costly and only stocked in big commercial pharmacy outlets, and therefore even if one has the resources, they must travel to big towns to purchase them.

People with type 1 diabetes need to be treated in facilities that have at least a trained doctor equivalent to a GP. Since these are few, it means months of waiting, long distance travel, long queues and higher cost of consultation and other care. To see a specialist, one has to be referred to the national hospitals - there are only two in the whole country so these kinds of referrals are rarely done. Access to nutritionist and diabetes educators is available only in the referral hospitals and rarely in county hospitals.

What about getting admitted to hospital?
To get an admission in all the hospitals, one has to pay a deposit, provide their national health insurance card (which only 3% of the population have), or go through a long laborious waiver process. All services provided in the inpatient period are billed and must be paid for by the patient unless they have an insurance cover.

How does diabetes care vary throughout the country?
Diabetes care in Kenya is widely variable in all aspects. There is no standard package of care adopted although there are guidelines. Given that all costs of care are paid by the patient (and even if insured, insurance companies don’t cover the cost of supplies other than drugs) there is variability depending on availability of income and funds of each individual. Variability across different locations and care levels is also broad since many of the necessary services are not uniformly and consistently available. For example a blood sugar test or access to a nutritionist could be available in a few places but not others.

Many thanks to our contacts at AMPATH in Kenya for providing this information.