CHALLENGES

Kenya, an East African lower middle-income country, is working towards achieving universal health coverage (UHC) for its citizens. With a general decline in economic growth, the government has been struggling to provide accessible and comprehensive primary health care services. Challenges include poor health infrastructure, pressing shortages of health care workers (0,2 physicians per 1 000 people); low equipment and essential drug availability; and a high burden of communicable and non-communicable disease (World Health Organization, 2015a; PHC Performance Initiative, 2015). As part of its goal to achieve UHC, the Kenyan Government has encouraged the development of the private sector (Chuma & Maina, 2014). Of outpatient health care services, 30,1% are provided by private clinics and hospitals (Ministry of Health, Government of Kenya, 2014). Private sector utilization in Kenya is not only for the upper-income tier but even among the poor it is an important source of health care. Of the poorest quintile of Kenyans, 47% report first seeking care from a private facility when a child is sick, believing that the quality is superior to that received in public health care facilities (Marek et al., 2005; Barnes et al., 2010).

INTERVENTION

LiveWell Clinics (LiveWell), formerly Viva Afya Ltd, was launched as a private, for-profit company in 2009 in response to the need for accessible and affordable primary health care for people from the urban low- and emerging middle class in Nairobi, Kenya. It is organized as a hub-and-spoke primary health care model, and is located in the low-income, densely populated urban areas of Nairobi. LiveWell aspires to create a sustainable and profitable business by focussing on attaining high patient volumes at a low profit margin, and delivering operations in an efficient way. By 2015, the model comprised five larger hub clinics and seven smaller spoke health centres. The hub clinics provide comprehensive primary health care services, including laboratory, pharmacy and dental services. These clinics have a clinical officer, a lab technician, a nurse, a pharmacist, a receptionist and a visiting obstetric specialist. Smaller spoke health care centres have a clinical officer or nurse, and a receptionist. In 2014, the clinic chain provided 56 000 clinical consultations. On average, about 6 000 customers per month receive consultations, diagnostic procedures or pharmaceuticals.

CASE INSIGHTS

To support appropriate private sector engagement in enhancing primary health care service delivery and achieving universal health coverage, there is a need for greater focus on non-state actors who have succeeded in delivering care through innovative, affordable and accredited means. Across Sub-Saharan Africa, a range of newer private organizations have been established to improve primary health care delivery. LiveWell shows that it is possible for private companies to do so in affordable and high quality ways through a strong focus on patient experience, innovative staffing models, a combination of medical and business skills, standardization of processes, alternative financing streams and collaboration with other public or private organizations.