A descriptive survey of substance use treatment facilities in Uasin Gishu County Kenya

For nursing students

Study summary

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.

For educators

Teaching and appraisal notes

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.