Kenya has made significant strides in strengthening its primary health care (PHC) system through the development and piloting of the country’s first comprehensive tool for assessing the functionality of primary care networks (PCNs). This milestone is part of the implementation of key PHC reforms following the enactment of the Primary Health Care Act in 2023, which laid a strong foundation for expanding equitable access to health services nationwide.
PCNs are clusters of health facilities linked administratively and clinically to improve operational efficiency of the network to deliver coordinated, person-centered care in a modified “hub and spoke” model (Figure 1). Their core objective is to ensure that all Kenyans receive timely and appropriate care across all levels of the health system. Counties such as Kisumu and Makueni have already achieved full PCN coverage, demonstrating the transformative potential of this model in improving health outcomes.
Figure 1: The primary care network “hub and spoke” model.
Source: Kenya Primary Health Care Guidelines, 2021.
As PCN implementation continues to gain momentum, stakeholders—including county governments, the Ministry of Health, and development partners—identified a critical gap: the lack of a standardized tool to evaluate how well PCNs are functioning and their impact on population health.
To address this, the Ministry of Health’s Divisions of Primary Care Networks and Monitoring and Evaluation, in collaboration with PATH and other partners, developed a comprehensive PCN functionality measurement tool. This tool is designed to provide actionable insights into the performance of PCNs, guide improvements in PHC service delivery, and inform policy decisions.
Kenya’s first comprehensive PCN functionality measurement tool
Speaking during a learning session on tools for measuring and monitoring PHC system readiness at the recent International Conference on Primary Health Care (ICPHC) 2025, Dr. Hellen Kiarie, Head of the Division of Monitoring and Evaluation at the Ministry of Health, introduced the PCN Functionality Tool as a comprehensive, three-tiered assessment instrument.
She explained that the tool evaluates performance at the county, PCN, and facility levels, and the evaluations are primarily completed by multidisciplinary teams led by family physicians stationed across PCNs.
Panelists at a PATH-led session on tools for measuring and monitoring PHC system readiness at ICPHC 2025 (L-R): Gaurav Bhattacharya, Akash Malik, Kimberly Green, Hellen Kiarie, Katharine Shelley, Fatou Fall, and Harsh Mangla. Photo: ICPHC.
Dr. Kiarie further noted that the tool assesses key indicators such as leadership, management, and governance; human resources for health; infrastructure; service delivery; referral systems; and health information management systems. It also supports counties in strengthening PHC reporting mechanisms and generating evidence to guide PCN scale-up.
Between April and September 2025, the tool was piloted in six counties—Makueni, Migori, Nyeri, Garissa, Nairobi, and West Pokot—with two PCNs selected in each. The pilot demonstrated the tool’s ability to collect data in areas that are often difficult to measure, such as population profiling. It also promotes collaborative completion by teams, enabling deliberative scoring and shared accountability.
Despite its strengths, Dr. Kiarie acknowledged that the pilot surfaced challenges, particularly the high turnover of primary users. This underscored the need for continuous sensitization and training on PHC and the PCN model to ensure consistent and effective use of all three components of the tool.
She also emphasized the Ministry’s commitment to ongoing refinement of the tool, including the recent removal of indicators deemed irrelevant or overly complex. These improvements aim to enhance usability and ensure the tool remains responsive to evolving needs.
“The Ministry of Health is keen to strengthen PHC measurement systems to improve quality, guide policy and resource allocation, enhance accountability, and achieve better health outcomes and universal coverage.”— Salim Hussein, Head, Department of Primary Health Care, MOH - Kenya
Driving integration and accountability through measurement
At PATH, we believe that strong, data-driven systems are key to equitable, people-centered care. Kenya’s PCN Functionality Tool aims to not only determine the extent to which PCNs have been operationalized in line with national guidelines but also evaluate how these networks are improving service delivery. The evidence generated will help counties improve coordination and strengthen community health outcomes.
According to Melissa Wanda, Policy and Advocacy Manager at PATH and lead for Kenya’s PHC advocacy efforts, the development of the PCN Functionality Tool came at a critical moment for the country’s health system. She noted that the need for a robust measurement tool was timely, as it provides a foundation for planning, tracking progress, and enabling accountability. Melissa emphasized that the tool has the potential to break silos, enhance integration, and generate evidence that can be used by policymakers, frontline health workers, and civil society organizations.
“At PATH, we champion innovation that turns data into action for stronger, people-centered health systems. This tool is a timely innovation that will strengthen planning, accountability, and integration across Kenya’s health system.”— Melissa Wanda, Policy and Advocacy Manager, PATH
Previous attempts to measure PHC in Kenya included the Vital Signs Profile (VSP)—a tool developed by the Primary Health Care Performance Initiative (PHCPI) to track performance of PHC systems. The VSP was followed by the PHC Progression Model, a subset of the VSP, a structured, mixed-methods assessment tool developed by PHCPI to evaluate the foundational capacity of a country’s PHC system.
The PCN Functionality Tool is a new tool developed through a consultative process led by the Ministry of Health’s Divisions of Primary Care Networks and Monitoring and Evaluation and drew insights from both the VSP and the PHC Progression Model.
Institutionalization of the tool
Looking ahead, the Ministry of Health envisions institutionalizing the PCN Functionality Tool across all counties. Its accessibility and ease of use positions it as a key resource for annual performance reflection, ideally becoming a standard component of end-of-financial-year reviews. As more counties adopt the tool, it is expected to play a pivotal role in strengthening Kenya’s PHC system and advancing the country’s commitment to universal health coverage.
As Kenya continues to invest in strengthening its PHC system, the PCN Functionality Tool stands out as a simple yet transformative innovation.
PATH reaffirms its commitment to supporting Kenya’s pursuit of equitable, people-centered PHC, recognizing this tool’s potential to help counties move toward more integrated, accountable, and data-driven service delivery.
