Availability and Quality of Antenatal and Pediatric Clinical Services at Primary Healthcare Facilities in Western Kenya: An Application of the Primary Care Assessment Tool

Child mortality remains unacceptably high in Western Kenya and >60% of children who die access primary healthcare facilities in the immediate period prior to their death. This study aimed to assess the availability and quality of antenatal and pediatric clinical services at primary healthcare facilities within the catchment area of an ongoing childhood mortality surveillance program. This study employed a cross-sectional design using the standardized Primary Care Assessment Tool (PCAT) in Siaya and Kisumu counties in Western Kenya. Ten primary healthcare facilities were randomly selected in each county. The PCAT was administered to clinicians and caregivers of pediatric patients via REDCap. Qualitative responses were reviewed, coded, and analyzed thematically to complement quantitative findings. A total of 57 healthcare providers and 99 caregivers participated in the survey. Most healthcare providers were female (77.2%), with a median age of 36 years; one-third were bedside nurses (33.3%) and nearly one-third were clinical officers (31.6%). Most caregivers were mothers (90.9%), female (93.9%), with a median age of 27 years. Nearly half of caregivers (47.4%) reported waiting less than 30 minutes for services, but most perceived limited availability of after-hours care. Delivery services (64.6%), breastfeeding support (63.6%), and postpartum depression support (61.6%) were less available compared to other services. Continuity of care was limited, with only 31.6% of providers stating they "definitely" knew their patients lives. While referral letters were commonly issued (91.2%), less than half of providers (45.6%) reported that transportation support was available for referrals. Primary healthcare services in Western Kenya were generally accessible for pediatric and antenatal care but limited for postnatal care. Referral systems suffered from suboptimal coordination and transportation. Strengthening postnatal service delivery, improving availability of ambulances, and enhancing knowledge about patients are urgent priorities for improving care quality and availability.