Unmet need for primary healthcare and associated individual and household-level factors in Kenya: results from a national survey

OBJECTIVE: To determine the prevalence of unmet need for primary healthcare and associated individual and household-level factors in Kenya. DESIGN: The data for this study are drawn from the 2016 Kenya Integrated Household Budget Survey (KIHBS). A multistage sampling technique involving a systematic selection of clusters at the national level and final selection of households was used. SETTING: This study was conducted in Kenya. The KIHBS is a nationally representative survey on a wide range of indicators to assess the progress made in improving the living standards of the population at the national level. PARTICIPANTS: A total of 9447 households comprising 15 539 household members who reported a sickness or injury over the 4 weeks preceding this survey were included in this study. The study respondents comprised of the household heads. PRIMARY OUTCOME MEASURE: The primary outcome of this study is unmet need for primary healthcare defined as an unexpressed demand for primary healthcare following a reported sickness or injury over the 4 weeks preceding this survey. RESULTS: About one in every five study participants experienced an unexpressed demand for primary care. The odds of having unmet need for primary healthcare were 68% higher among participants without health insurance coverage compared with those with health insurance (adjusted OR 1.68; p<0.001; 95% CI 1.34 to 2.09) and 45% higher among households headed by single or unmarried persons compared with the those who were in a marital union (adjusted OR 1.45; p<0.05; 95% CI 1.06 to 1.98). CONCLUSIONS: Our findings show that there is still a considerable unexpressed demand for primary care services despite widespread implementation of Universal Health Coverage (UHC) in Kenya, with households without a health insurance cover bearing the highest burden. Therefore, the design of UHC reforms in Kenya should focus on embedding social health protection to escalate the demand for primary healthcare services.