Transforming Diagnostics in Kenya: The Success of the Diagnostic Network Optimisation

In recent years, Kenya’s Ministry of Health (MOH), in collaboration with the US President’s Emergency Plan for AIDS Relief (PEPFAR), has undertaken significant efforts to optimise the nation’s diagnostic networks, making essential health services more accessible and efficient for all Kenyans. Historically, HIV viral load (VL) and early infant diagnosis (EID) testing services were provided exclusively in 12 centralised research and reference laboratories serving the country’s 47 counties, with approximately 1.3M VL and 120,000 EID tests provided annually. Yet, as the demand for testing grew across multiple diseases—including HPV, and HBV with a prevalence of 39% and 7.8%, respectively as well as Covid 19, the need for a more decentralised, responsive network became evident. This realisation sparked the Diagnostic Network Optimisation (DNO) initiative to increase testing access, reduce turnaround times, and strengthen community health outcomes nationwide.

Decentralising for Better Access: Confronting the Challenges

While decentralising diagnostic services promises many benefits, it also presents unique challenges. Setting up a network of regional testing facilities in a resource-limited environment requires substantial funding, consistent government support, advanced equipment, extensive training, and infrastructure upgrades. Recognising these challenges, Kenya’s MOH collaborated with county leadership, the Council of Governors, and other key stakeholders to develop a sustainable decentralisation plan.

Progress and Achievements: Milestones in Decentralised Testing

Since launching the decentralisation initiative, Kenya has achieved several key milestones that underscore the impact of decentralisation on health service delivery:

• KUTTRH and Kiambu County: By 2023, KUTTRH began processing diagnostic tests for Kiambu County (VL tests of 29,437 in 2023 and 41,793 in 2024, 23% of tests from KNH) with an average turnaround (TAT) of 3 days, significantly reducing the testing burden on the national referral hospital, Kenyatta National Hospital (KNH).
• Migori CRH and the Lake Region: In March 2024, Migori County Referral Hospital (CRH) began handling tests for Migori and Homabay counties (VL tests of 97,787 in 2024, 35% tests from AMPATH and KEMRI Kisumu) with an average TAT of 3 days. This shift has alleviated the workload at AMPATH and KEMRI Kisumu and provided quicker access to test results within the Lake Region.
• Kisumu CRH Activation: Kisumu County Referral Hospital (CRH) was activated in September 2024, assuming responsibility for testing within Kisumu County (VL tests of 5003 in 2024) with an average TAT of 2 days. This step further reduced reliance on KEMRI Kisumu and enhanced local testing capacity.
• Upcoming Role of Busia CRH: Scheduled for activation in November 2024, Busia County Referral Hospital (CRH) to serve the residents of Western Kenya.

The early results from KUTTRH and Migori CRH illustrate the effectiveness of these decentralisation efforts. For instance, the average turnaround time (TAT) for test results has been reduced from the initial seven days to just two, a notable improvement that enables faster care for conditions like HIV, where timely monitoring is essential.

The Power of Collaboration: Building a Foundation for Future Success

The success of Kenya’s Diagnostic Network Optimization initiative speaks to the potential of collaborative, decentralised healthcare approaches. By working closely with county governments and securing stakeholder buy-in, the MOH has created a model that is both sustainable and scalable. County officials have played an active role in the program, helping align resources, staffing, and community support with the broader goals of the decentralisation initiative.

Amref Health Africa’s Sustainable Laboratory Quality Systems (SLQS) project greatly supported this collaborative approach, which has been instrumental in mobilising resources and building the capacity needed to sustain the progress of decentralisation. Dr Denis Wanyama, director of the SLQS project, expressed his pride in the initiative’s early successes, noting, “Through the SLQS project, Amref has been able to support Kenya’s decentralisation efforts in diagnostic services, allowing health facilities across the country to provide timely, essential testing. This initiative addresses urgent health needs and creates a foundation for a resilient healthcare system that can respond to diverse public health challenges. We are proud to see these early results and remain committed to supporting Kenya’s journey toward accessible healthcare for all.”

Path Forward: Optimizing and Sustaining Health Access Across Kenya

Kenya’s decentralization of molecular diagnostic services is still in its early stages, but its successes have already set a solid foundation for future growth. By decentralising essential diagnostic services, the MOH has reduced logistical barriers that once limited access to life-saving tests, especially in rural and underserved areas. For example, with Migori CRH was batching samples and incurring transport costs associated with shipping samples to AMPATH 262 km away and has been reduces to zero KM. Homabay samples were being transported to KEMRI Kisumu over a distance of 130.5 km and are now being shipped to Migori – a distance of to 73 km. The ongoing work in Kisumu, Migori, Busia, and other counties represents a critical shift toward a healthcare model that is more equitable, timely, and responsive to the needs of all Kenyans. 

As the decentralization initiative moves forward, the MOH will continue to monitor its impact, track cost efficiencies, and gather data to inform further optimisation. Sustained commitment from the government, support from donors, and continued infrastructure investment will be essential to achieving a resilient, accessible healthcare system that can adapt to Kenya’s evolving healthcare landscape. 

Sustainable Laboratory Quality Systems (SLQS) project is a five-year project funded by Center for Disease Control (CDC) Kenya aimed at strengthening laboratory systems for HIV, TB epidemic control.

Kenneth Ndiege – Technical Advisor VL/EID and Biosafety; Noel Odhiambo – Senior Technical Advisor SLQS; Anne Maina – Data Officer – SLQS and Edna Mosiara – Communications Officer