Repositioning Public Health Officers in Kenya’s Devolved Health System: A Policy Analysis to Strengthen Primary Health Care and Advance Universal Health Coverage

Abstract

William Nyabola Okedi*

Background: Health systems in low- and middle-income countries are prioritizing primary health care (PHC) to advance universal health coverage (UHC) and health security. In Kenya, devolution has restructured governance and service delivery, creating both opportunities and coordination challenges. Within this context, Public Health Officers (PHOs)—key to environmental health, disease prevention, and health promotion—remain insufficiently defined and underutilized. This study examines the policy and institutional factors shaping the positioning of PHOs in Kenya’s devolved health system.

Methods: A qualitative-dominant mixed-methods policy analysis was conducted. Data were collected through a structured online survey of 40 purposively selected stakeholders, including PHOs, county health managers, clinicians, and academics, alongside a review of national policy documents and legal frameworks. The Walt and Gilson policy analysis triangle guided the analysis of policy content, context, actors, and processes. Quantitative data were analyzed descriptively, while qualitative data were analyzed thematically.

Results: Findings reveal persistent role ambiguity, weak policy recognition, and fragmented integration of PHOs within county health systems. Despite competencies central to PHC—such as environmental health management, disease prevention, and community health promotion—PHOs are often marginalized within clinically oriented models. Key constraints include unclear reporting structures, limited participation in decision-making, policy gaps, and restricted career progression, compounded by institutional silos and underinvestment in preventive services.

Conclusions: Repositioning PHOs is critical for strengthening PHC and achieving UHC. Policy reforms should prioritize role clarity, insti- tutional integration, and investment in preventive health to enhance system resilience and equity.

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