Assessing the availability and readiness of health facilities to provide post-abortion care in Kenya: Results from a nationwide Health Facility Survey, 2023

Background Understanding a health system’s capacity to provide post-abortion care (PAC) offers crucial insights into the strengths, gaps, and weaknesses in delivering high-quality PAC services. In Kenya and elsewhere, inadequate data limits the ability of policy actors to prioritize critical interventions and investments for improving maternal healthcare. This study examined the capacity of health facilities in Kenya to provide PAC. Methods This paper uses data from a 2023 health facility survey conducted across a nationally representative sample of health facilities in Kenya to explore the capacity of health facilities to provide PAC. Data were collected on PAC signal function indicators, including the availability of services, equipment, supplies, and staffing over the last six months, and the readiness to provide PAC on the day of the survey. A descriptive analysis was conducted to estimate the proportion of facilities that meet the criteria for availability and readiness for each individual signal function definition and report these findings by facility level and ownership (public vs. private). Results Using the availability criteria, we estimate that 18.3% of primary-level health facilities meet the definition for basic PAC, and 24.1% of referral health facilities meet the definition for comprehensive PAC. These proportions drop when using the more stringent readiness definition (basic PAC for primary health facilities = 3.3%, comprehensive PAC for referral health facilities = 7.2%). The most significant drivers of reduced PAC availability and readiness include the inability to provide at least three types of short-acting contraceptives post-abortion, a lack of providers on-staff who are trained on PAC, and the inability to provide surgical operations among referral facilities. Conclusion Our findings confirm the need to enhance PAC services in Kenya by addressing the existing gaps in service provision. There is a need to pursue the full implementation of the PAC standards and assessment tools that streamline facility staffing, training, and supply of PAC commodities and equipment at all levels.