Primary Healthcare Facilities' Readiness for Access to Mental Health Services in Selected Counties in Kenya

Abstract

Kenya’s primary healthcare (PHC) system faces a substantial unmet need for mental-health care, with many clients first presenting at Levels 2–4 while services remain sparse, inconsistently financed, and weakly integrated, leading to delayed detection and low uptake. This mixed-methods study examined how financing, human resources, leadership and governance, and infrastructure influence access to mental-health services in public PHC facilities in Kiambu and Makueni Counties. The study population comprised PHC facilities (Levels 2–4) and frontline providers/managers; facilities were sampled proportionally by county and level to yield 179 facilities, and 355 respondents participated, while key informants were selected purposively. Quantitative analysis used logistic regression with standard diagnostics; qualitative data were analyzed thematically. Compared with out-of-pocket payment, insurance increased odds of access (OR=1.82, p=0.014), while lack of risk pooling (OR=0.24, p<0.001) and lack of resource mobilization (OR=0.45, p=0.014) reduced access. On human resources, no mental-health training (OR=0.084, p<0.001), no mental-health skills (OR=0.076, p=0.001), and poor staff distribution (OR=0.382, p=0.046) were associated with lower access. On leadership and governance, absence of capacity building (OR=0.065, p<0.001), policy implementation (OR=0.262, p<0.001), and monitoring and evaluation (OR=0.214, p<0.001) each predicted reduced access. On infrastructure, inadequate physical infrastructure (OR=0.109, p=0.001), health products/technologies (OR=0.360, p=0.001), and ICT (OR=0.277, p=0.002) lowered access. Model performance was acceptable (Nagelkerke R²=0.608; Cox & Snell R²=0.304; Hosmer–Lemeshow χ²=3.076, p=0.215). Qualitative findings triangulated these patterns, highlighting gaps in staff capacity, policy execution and supervision, medicines and supplies, and private counseling space. The study offers an immediately usable PHC screening protocol and a context-specific integration framework. It concludes that improving access will require targeted investments in workforce upskilling, reliable psychotropic supply chains, adequate infrastructure, and strengthened governance. County governments should train medical workers and establish mental-health infrastructure in PHC facilities to mainstream treatment. Future research should extend beyond Kiambu and Makueni to more of Kenya’s 47 counties and include private hospitals.