Examining the emergence and implementation experience of Primary Health Care Networks (PCNs) in Kenya: a qualitative process evaluation.

backgroundKenya has identified Primary Health Care Networks (PCNs) as a key reform to strengthen Primary Health Care (PHC) delivery and enacted the Primary Health Care Act of 2023 to support their implementation. PCNs were piloted in Kisumu and Garissa counties in 2020 and rolled out nationally in 2023. However, little is known about how PCNs are being implemented across diverse county contexts. This study examined the emergence and implementation experience of the PCN reform in Kenya.

methodsWe used a cross-sectional qualitative process evaluation design. We collected data at the national level and in 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 review. We analysed the data using a thematic approach.

resultsThe 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 varied across the study counties, with critical aspects of PCN design, such as the establishment of MDTs and the digitisation of PCNs, being inadequately implemented. The effectiveness of PCNs’ implementation may have been constrained by capacity gaps in key foundational aspects of PHC health systems, including financing, human resources, health commodities, and information systems. Moreover, the implementation effectiveness of PCNs may have been undermined by the limited integration of key health facility functions, including financing, human resource management, health commodity supply chains, information systems, and care coordination.

conclusionStrengthening PCN implementation in Kenya requires investment in policy capacity to ensure effective implementation. The 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.