In brief
A 2022 survey of all six substance use treatment facilities in Uasin Gishu County, Kenya found severe gaps in bed capacity (174 beds for 1. 1 million people), opioid medication availability (no facility stocked methadone or buprenorphine), and insurance coverage (only one NHIF-accredited facility), despite adequate...
What this article is about
Quick Answer
A 2022 survey of all six substance use treatment facilities in Uasin Gishu County, Kenya found severe gaps in bed capacity (174 beds for 1.1 million people), opioid medication availability (no facility stocked methadone or buprenorphine), and insurance coverage (only one NHIF-accredited facility), despite adequate counselor and psychologist staffing.
Student takeaways
Key Takeaways
- Of the six substance use treatment facilities surveyed in Uasin Gishu County, five were private-for-profit and one was government-run; the county government itself operated no facility.
- The six facilities together had only 174 beds for a population of about 1.1 million (roughly 16 beds per 100,000 people), with 81% of beds allocated to men and none reserved for children or adolescents.
- None of the six facilities stocked buprenorphine, buprenorphine-naloxone, or methadone; only the single government facility stocked naltrexone or bupropion.
- Out-of-pocket payment was used in all six facilities, only one facility was accredited by the National Hospital Insurance Fund (NHIF), and a 90-day in-patient program cost US$700-2,000.
- All facilities had at least one certified addiction counselor and psychologist, but three of six facilities had no nurse and two had no doctor on staff.
Student summary
Why This Research Matters
Substance use disorders are a serious problem in Uasin Gishu County, Kenya, a region of about 1.1 million people. This 2022 study, published in BMC Health Services Research, asked a simple but important question: what does treatment capacity actually look like on the ground? The research team, led by Florence Jaguga and colleagues, conducted a cross-sectional survey of all six NACADA-accredited substance use treatment facilities in the county between August and November 2021, using a questionnaire they designed themselves to capture services offered, ownership, bed capacity, payment methods, medication stock, and staffing.
The picture that emerged shows a system built almost entirely on private, out-of-pocket care. Only one of the six facilities was run by the national government; the rest were private-for-profit, and the county government itself operated none. All six facilities provided in-patient care, but only two also offered out-patient services. Bed capacity was tight: the six facilities together had just 174 beds for the entire county, working out to roughly 16 beds per 100,000 people. Of those beds, 141 (81%) were allocated to men and only 33 (19%) to women, and none were set aside specifically for children or adolescents. The single government facility accounted for only 16 of the 174 beds; private facilities held the remaining 90.8%.
Medication access was even more limited. Every facility stocked at least one medicine for substance use treatment, but the options were narrow. Four facilities had nicotine replacement therapy, and only the government facility stocked naltrexone or bupropion. None of the six facilities, public or private, had buprenorphine, buprenorphine-naloxone, or methadone, the medications most recommended for treating opioid use disorder. This gap matters because national data cited in the study show rising heroin use in Kenya's Rift Valley region, where Uasin Gishu is located.
Paying for care was a major barrier. Out-of-pocket payment was used in all six facilities, and only one facility was accredited with Kenya's National Hospital Insurance Fund (NHIF); only one had any private insurance arrangement. A typical 90-day in-patient program cost between US$700 and US$2,000, far beyond what most households in the region earn in a similar period, since average Kenyan household income is roughly US$100 per month.
Staffing told a mixed story. Every facility had at least one certified addiction counselor and at least one psychologist, and addiction counseling was the most common credential among the 63 staff surveyed (41.3%). But nurses were present in only half (3 of 6) of the facilities, and two facilities had no doctor at all. Most staff worked full time (90.5%), most were employed in the private sector (71.4%), and the average staff age was about 40 years.
For nursing students, this study is a clear illustration of how service-availability research, sometimes called a facility audit or resource mapping study, can expose gaps that patient-level clinical studies might miss. It is not about whether a particular treatment works; it is about whether the treatment even exists, is staffed, and is affordable where people live. The authors recommend that county and national stakeholders work together to expand bed capacity, train staff in pharmacotherapy (including opioid agonist medications), expand insurance accreditation, and consider community-based or shorter treatment models as more realistic options for a low-resource setting. As a reader, treat the findings as describing one county's system at one point in time, not a general statement about substance use treatment across Kenya or Africa.
Source abstract
Study Overview
Abstract Background Substance use disorders are a major problem in Uasin Gishu County, Kenya. The objective of this study was to describe the existing resources within substance use treatment facilities in the County, with the aim of guiding policy and interventions. Methods This was a cross-sectional study. We collected data from six substance use treatment facilities within Uasin Gishu County between August and November 2021. We used a researcher-designed questionnaire to collect information on: availability of in-patient and out-patient services; facility ownership (private-for-profit vs government-run); bed capacity; mode of payment for services; cost of services; availability of medicines for substance use treatment; and staffing characteristics. Descriptive statistics were used to summarize the data. Results One facility was run by the National government and the rest were private-for-profit. Uasin Gishu County government had no substance use treatment facility of its own. The total number of beds available within the six facilities was 174 against a population of 1.1 million. All six facilities had stocked at least one medication for substance use disorder treatment. None of the facilities had buprenorphine, buprenorphine naloxone, or methadone. Out-of pocket was the most common mode of payment for services with patients paying using this mode in all the six facilities. Only one facility was accredited by the National Hospital Insurance Fund (NHIF). All facilities had at least one certified addiction counselor and at least one psychologist. Half of the facilities did not have a nurse and two did not have a doctor. The qualification held by most staff was addiction counseling with 41.3% of them having achieved this qualification. Conclusion The facilities were well staffed with psychologists and addiction counselors. Gaps were found as regards bed capacity, use of pharmacotherapy, insurance coverage and availability of nursing staff and doctors. We recommend that the County government in collaboration with key stakeholders invests in substance use treatment in order to address the high burden of substance use disorders in Uasin Gishu County.
Evidence appraisal
Main Findings
- Of the six substance use treatment facilities surveyed in Uasin Gishu County, five were private-for-profit and one was government-run; the county government itself operated no facility.
- The six facilities together had only 174 beds for a population of about 1.1 million (roughly 16 beds per 100,000 people), with 81% of beds allocated to men and none reserved for children or adolescents.
- None of the six facilities stocked buprenorphine, buprenorphine-naloxone, or methadone; only the single government facility stocked naltrexone or bupropion.
- Out-of-pocket payment was used in all six facilities, only one facility was accredited by the National Hospital Insurance Fund (NHIF), and a 90-day in-patient program cost US$700-2,000.
- All facilities had at least one certified addiction counselor and psychologist, but three of six facilities had no nurse and two had no doctor on staff.
Practice transfer
Clinical Relevance
- Nurses working in or referring patients to substance use treatment facilities in similar low-resource settings should be aware that opioid agonist therapies (buprenorphine, methadone) may simply not be available locally, which affects treatment planning and harm-reduction counseling.
- Given that half of surveyed facilities lacked any nursing staff, nurses entering this specialty may need to function with substantial clinical autonomy and should seek specific addiction-medicine training rather than assuming physician or specialist backup is present.
- High out-of-pocket costs relative to household income suggest nurses should factor affordability and financial navigation into discharge planning and family counseling, since cost alone may determine whether a patient can complete a recommended treatment course.
- The near-total absence of pediatric/adolescent bed capacity signals a gap nurses in school health or pediatric settings should flag when referring young people with substance use concerns, since local residential options may not exist for this age group.
- Findings support advocating for facility-level integration of substance use screening and brief intervention into primary care and other lower-cost settings, rather than relying solely on residential referral pathways that this study shows are scarce and expensive.
Faculty notes
Educational Relevance
This cross-sectional survey by Jaguga and colleagues (BMC Health Services Research, 2022) offers a useful teaching example of health-services facility mapping, distinct from clinical outcomes or epidemiological prevalence research. The study team surveyed all six NACADA-accredited substance use treatment facilities operating in Uasin Gishu County, Kenya (population approximately 1.1 million) between August and November 2021, using a researcher-designed questionnaire covering ownership, service type, bed capacity, medication stock, payment mechanisms, and staffing.
The findings document a treatment system that is small, privately dominated, and pharmacologically underequipped. Of six facilities, five were private-for-profit and one was run by the national government; the county government operated no facility of its own despite acknowledging the substance use burden in its 2018-2022 County Integrated Development Plan. Total bed capacity was 174 (roughly 16 beds per 100,000 residents), skewed heavily toward male patients (81% of beds) with no dedicated pediatric or adolescent capacity. Only two of six facilities offered out-patient services, meaning residential admission was effectively the default care pathway.
The medication findings are the study's most clinically salient contribution for nursing education: no facility stocked buprenorphine, buprenorphine-naloxone, or methadone, the first-line agents for opioid use disorder in most international guidelines, while only the single government-run facility stocked naltrexone or bupropion. The authors situate this gap against national surveillance data showing increasing heroin use prevalence in the Rift Valley region. Financing barriers compound the pharmacotherapy gap: out-of-pocket payment was the near-universal mode (used in all six facilities), only one facility was NHIF-accredited, and a standard 90-day in-patient stay cost US$700-2,000 against an average household income near US$100/month, pricing residential care out of reach for most residents.
Staffing data (63 providers across the six sites) show adequate coverage of psychologists and certified addiction counselors (present in 100% of facilities) but substantial gaps in nursing (present in only half of facilities) and physicians (absent from two of six). This is directly relevant to discussions of scope-of-practice and task-shifting in low-resource behavioral health settings, and to how nursing students conceptualize interdisciplinary teams when nurses are structurally absent from a care setting.
Methodologically, this is a descriptive, facility-level census rather than a probability sample or patient-outcome study; instructors should have students distinguish this design from prevalence surveys or trials, and discuss why a facility audit is a necessary precursor to policy planning even without individual patient data. The authors note the absence of a standardized national tool for such audits and the likely omission of non-accredited or informal support services, meaning true community treatment capacity may be somewhat undercounted, or, alternatively, that the counted capacity overstates what is formally regulated and quality-assured. Discussion should link the medication and financing gaps to broader health-systems concepts: essential medicines lists, insurance-based universal health coverage design, and the case for community-based, task-shifted, or shortened treatment models the authors propose as more feasible for low-resource settings such as this one.
Critical appraisal
Limitations
- The survey included only NACADA-accredited facilities and likely missed non-accredited services such as informal support groups or NGO-run programs, understating total community treatment capacity.
- No standardized national data collection tool for substance use facility audits existed, so the researcher-designed questionnaire may not be directly comparable to audits from other counties or countries.
- The cross-sectional design captures a single snapshot (August-November 2021) and cannot show how bed capacity, staffing, or medication stock change over time.
Classroom use
Discussion Questions
- Why is a facility-level resource audit like this one a necessary complement to patient-outcome or prevalence studies when planning substance use services for a region?
- What are the clinical and ethical implications of a treatment system in which none of the surveyed facilities stock buprenorphine, methadone, or buprenorphine-naloxone for opioid use disorder?
- How might the near-total reliance on out-of-pocket payment and minimal insurance accreditation shape which patients access substance use treatment in Uasin Gishu County, and who is likely excluded?
- Given that three of six facilities had no nurse on staff, what specific competencies would a nurse need to function effectively as the sole or primary healthcare provider in this kind of setting?
- What does the complete absence of dedicated pediatric or adolescent beds suggest about service planning gaps for younger populations with substance use disorders?
- The authors recommend task-shifting and shorter (6-week) treatment models as more feasible alternatives to 90-day residential programs. What are the potential benefits and risks of shortening standard in-patient treatment length?
- How could Kenya's National Hospital Insurance Fund (NHIF) be restructured to improve accreditation rates among substance use treatment facilities, and what would similar reform look like in a Canadian context?
- What role could primary care or community health workers play in bridging the gap left by minimal out-patient service availability (only 2 of 6 facilities)?
- How should nursing curricula prepare students to practice in settings where interdisciplinary teams (doctors, nurses, psychologists) are inconsistently available, as documented in this study?
- What further research would be needed to determine whether the bed capacity and staffing gaps identified here translate into worse treatment outcomes for patients in Uasin Gishu County?
Knowledge check
Quiz
1. What type of study design was used to examine substance use treatment facilities in Uasin Gishu County?
- Randomized controlled trial
- Cross-sectional study
- Longitudinal cohort study
- Case-control study
Rationale: The abstract states: 'This was a cross-sectional study. We collected data from six substance use treatment facilities within Uasin Gishu County between August and November 2021.'
2. How many substance use treatment facilities were surveyed in the study?
- Three
- Six
- Ten
- Twelve
Rationale: The abstract states data were collected 'from six substance use treatment facilities within Uasin Gishu County.'
3. What was the total number of treatment beds across all six facilities, and what population did this serve?
- 174 beds for a population of 1.1 million
- 500 beds for a population of 1.1 million
- 50 beds for a population of 500,000
- 174 beds for a population of 500,000
Rationale: The abstract states: 'The total number of beds available within the six facilities was 174 against a population of 1.1 million.'
4. Which of the following medications was available in at least one of the six facilities?
- Methadone
- Buprenorphine-naloxone
- Naltrexone
- Buprenorphine
Rationale: Per the full text, naltrexone was stocked at the government facility, while 'none of the facilities had buprenorphine, buprenorphine naloxone, or methadone,' per the abstract.
5. What was the most common mode of payment for services across the facilities?
- National Hospital Insurance Fund (NHIF)
- Private insurance
- Out-of-pocket payment
- Government subsidy
Rationale: The abstract states: 'Out-of pocket was the most common mode of payment for services with patients paying using this mode in all the six facilities.'
6. How many of the six facilities were accredited by the National Hospital Insurance Fund (NHIF)?
- Zero
- One
- Three
- All six
Rationale: The abstract states: 'Only one facility was accredited by the National Hospital Insurance Fund (NHIF).'
7. According to the study, what staffing gap was found in half of the facilities?
- No psychologist
- No addiction counselor
- No nurse
- No administrative staff
Rationale: The abstract states: 'Half of the facilities did not have a nurse and two did not have a doctor.'
8. What qualification did the largest proportion (41.3%) of surveyed staff hold?
- Nursing degree
- Psychiatry certification
- Addiction counseling
- Medical degree
Rationale: The abstract states: 'The qualification held by most staff was addiction counseling with 41.3% of them having achieved this qualification.'
9. Who ran most of the substance use treatment facilities identified in the study?
- The county government
- Private-for-profit entities
- The national government exclusively
- Non-governmental organizations
Rationale: The abstract states: 'One facility was run by the National government and the rest were private-for-profit. Uasin Gishu County government had no substance use treatment facility of its own.'
10. What is one recommendation made by the study authors to address the identified gaps?
- Close private facilities and rely solely on government care
- County government should invest in substance use treatment in collaboration with key stakeholders
- Discontinue the use of addiction counselors
- Eliminate out-patient services entirely
Rationale: The abstract concludes: 'We recommend that the County government in collaboration with key stakeholders invests in substance use treatment in order to address the high burden of substance use disorders in Uasin Gishu County.'
Study cards
Flashcards
What was the objective of this study?
To describe the existing resources within substance use treatment facilities in Uasin Gishu County, Kenya, to guide policy and interventions.
What study design was used?
A cross-sectional survey.
Over what time period was data collected?
Between August and November 2021.
How many facilities were surveyed?
Six substance use treatment facilities, all NACADA-accredited.
How were most of the six facilities owned and operated?
Five were private-for-profit; one was run by the national government. The county government operated none.
What was the total bed capacity across all six facilities?
174 beds, serving a population of about 1.1 million (roughly 16 beds per 100,000 people).
How was bed capacity distributed by sex?
81% of beds (141) were allocated to men and 19% (33) to women; no beds were reserved specifically for children or adolescents.
How many of the six facilities offered out-patient services?
Only two of the six facilities offered out-patient services; all six offered in-patient care.
Which opioid use disorder medications were absent from all six facilities?
Buprenorphine, buprenorphine-naloxone, and methadone were not stocked at any of the six facilities.
Which medications were stocked, and where?
Nicotine replacement therapy was available at four facilities; naltrexone and bupropion were available only at the single government-run facility.
What was the most common payment method for services?
Out-of-pocket payment, used in all six facilities.
How many facilities were accredited by Kenya's National Hospital Insurance Fund (NHIF)?
Only one of the six facilities was NHIF-accredited.
What was the approximate cost range for a 90-day in-patient program?
US$700 to US$2,000, which the authors note is out of reach for most households given average incomes near US$100/month.
What staffing was present in all six facilities?
At least one certified addiction counselor and at least one psychologist.
What staffing gaps were identified?
Half of the facilities had no nurse, and two facilities had no doctor.
What was the most common staff qualification, and what proportion held it?
Addiction counseling certification, held by 41.3% of surveyed staff.
What did the authors conclude the facilities were well-equipped with?
Psychologists and addiction counselors.
What gaps did the authors highlight in their conclusion?
Bed capacity, use of pharmacotherapy, insurance coverage, and availability of nursing staff and doctors.
What did the authors recommend to address these gaps?
That the county government, in collaboration with key stakeholders, invest in substance use treatment to address the county's high burden of substance use disorders.
Why is this study a good example of a facility audit rather than a clinical outcomes study?
It describes what resources, staffing, and services exist at the facility level rather than measuring patient treatment outcomes or effectiveness.
Search-ready answers
Frequently asked questions
What was this study about?
It was a cross-sectional survey describing the resources, staffing, and services available at all six substance use treatment facilities in Uasin Gishu County, Kenya, conducted between August and November 2021.
How many substance use treatment beds exist in Uasin Gishu County, and is that enough?
The six facilities together had 174 beds for a population of about 1.1 million, or roughly 16 beds per 100,000 people, a level the authors identify as a significant gap in capacity.
Are opioid addiction medications like methadone or buprenorphine available in Uasin Gishu County treatment facilities?
No. According to the study, none of the six surveyed facilities stocked buprenorphine, buprenorphine-naloxone, or methadone.
Who owns and runs substance use treatment facilities in Uasin Gishu County?
Five of the six facilities are private-for-profit and one is run by the national government; the county government itself operates no facility of its own.
How do patients pay for substance use treatment in this county?
Out-of-pocket payment was used in all six facilities, and only one facility was accredited by Kenya's National Hospital Insurance Fund (NHIF).
How much does substance use treatment cost in Uasin Gishu County facilities?
A typical 90-day in-patient program costs between US$700 and US$2,000, which the study authors note exceeds what most households in the region can afford.
Do these treatment facilities have enough nurses and doctors?
No. Half of the six facilities had no nurse on staff, and two had no doctor, though all facilities had at least one addiction counselor and psychologist.
What staff qualifications were most common at these facilities?
Addiction counseling certification was the most common qualification, held by 41.3% of the staff surveyed.
What did the study recommend to improve substance use treatment access?
The authors recommend that the county government collaborate with key stakeholders to invest in substance use treatment services to address the region's high burden of substance use disorders.
Is this study's findings generalizable beyond Uasin Gishu County?
Not necessarily. The survey covered only six NACADA-accredited facilities in one Kenyan county at a single point in time, so findings describe that specific system and may not apply directly elsewhere.