{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:08:13Z","timestamp":1787886493647,"version":"build-2784847793"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T00:00:00Z","timestamp":1679529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Primary healthcare (PHC) systems attain improved health outcomes and fairness and are affordable. However, the proportion of PHC spending to Total Current Health Expenditure in Kenya reduced from 63.4% in 2016\/17 to 53.9% in 2020\/21 while external funding reduced from 28.3% (Ksh 69.4 billion) to 23.9% (Ksh 68.2 billion) over the same period. This reduction in PHC spending negatively affects PHC performance and the overall health system goals.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a cost-benefit analysis and computed costs against the economic benefits of a PHC scale-up. Activity-Based Costing (ABC) on the provider perspective was employed to estimate the incremental costs. The OneHealth Tool was used to estimate the health impact of operationalizing PHC over five years. Finally, we quantified Return on Investment (ROI) by estimating monetized DALYs based on a constant value per statistical life year (VSLY) derived from a VSL estimate.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The total projected cost of PHC interventions in the Kenya was Ksh 1.65 trillion (USD 15,581.91 billion). Human resource was the main cost driver accounting for 75% of the total cost. PHC investments avert 64,430,316 Disability Adjusted Life-Years (DALYs) and generate cost savings of Ksh. 21.5 trillion (USD 204.4 Billion) over five years. Shifting services from high-level facilities to PHC facilities generates Ksh 198.2 billion (USD 1.9 billion) and yields a benefit-cost ratio of 16:1 in 5 years. Thus, every $1 invested in PHC interventions saves up to $16 in spending on conditions like stunting, NCDs, anaemia, TB, Malaria, and maternal and child health morbidity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Evidence of the economic benefits of continued prioritization of funding for PHC can strengthen the advocacy argument for increased domestic and external financing of PHC in Kenya. A well-resourced and functional PHC system translates to substantial health benefits with positive economic benefits. Therefore, governments and stakeholders should increase investments in PHC to accelerate economic growth.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283156","type":"journal-article","created":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T18:06:30Z","timestamp":1679594790000},"page":"e0283156","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Investment case for primary health care in low- and middle-income countries: A case study of Kenya"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6750-9480","authenticated-orcid":true,"given":"Daniel","family":"Mwai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agatha","family":"Olago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Kimani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Njuguna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Njiraini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Wangia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Easter","family":"Olwanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Mwaura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Rotich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,23]]},"reference":[{"key":"pone.0283156.ref001"},{"issue":"Suppl 3","key":"pone.0283156.ref002","doi-asserted-by":"crossref","first-page":"e001188","DOI":"10.1136\/bmjgh-2018-001188","article-title":"Alma Ata after 40 years: Primary Health Care and Health for All\u2014from consensus to complexity","volume":"3","author":"S. B. Rifkin","year":"2018","journal-title":"BMJ Glob. Heal."},{"key":"pone.0283156.ref003","volume-title":"World health statistics 2018: monitoring health for the SDGs, sustainable development goals","author":"WHO","year":"2018"},{"issue":"10009","key":"pone.0283156.ref004","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1016\/S0140-6736(15)00949-6","article-title":"Primary health care and the Sustainable Development Goals","volume":"386","author":"L. M. Pettigrew","year":"2015","journal-title":"Lancet"},{"key":"pone.0283156.ref005","first-page":"1","article-title":"Kenya Primary Health Care Strategy Framework: 2019\u20132024","author":"K. MoH","year":"2020","journal-title":"Http:\/\/Ipfkenya.or.Ke\/,"},{"key":"pone.0283156.ref006","unstructured":"MoH, \u201cREPUBLIC OF KENYA MINISTRY OF HEALTH Primary Health Care Primary Health Care KENYA PRIMARY HEALTH CARE,\u201d 2019."},{"key":"pone.0283156.ref007","unstructured":"\u201cREPUBLIC OF KENYA MINISTRY OF HEALTH PRIMARY HEALTH CARE NETWORK GUIDELINES,\u201d 2021."},{"key":"pone.0283156.ref008","unstructured":"\u201cPrimary Health Care Improvement Global Stakeholder Meeting\u201d."},{"issue":"2","key":"pone.0283156.ref009","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/JAC.0b013e3181994221","article-title":"The impact of primary healthcare on population health in low-and middle-income countries","volume":"32","author":"J. Macinko","year":"2009","journal-title":"J. Ambul. Care Manage."},{"key":"pone.0283156.ref010","first-page":"1","article-title":"Kenya Community Health Strategy 2020\u20132025","author":"MOH Kenya","year":"2020"},{"key":"pone.0283156.ref011","article-title":"Building the economic case for primary healthcare: A Scoping Review, Technical Seriers on Primary Healthcare","author":"M. Anderson","year":"2018","journal-title":"World Heal. Organ."},{"issue":"5","key":"pone.0283156.ref012","doi-asserted-by":"crossref","first-page":"e715","DOI":"10.1016\/S2214-109X(22)00005-5","article-title":"The Lancet Global Health Commission on financing primary health care: putting people at the centre","volume":"10","author":"K. Hanson","year":"2022","journal-title":"Lancet Glob. Heal."},{"key":"pone.0283156.ref013","unstructured":"\u201cExploring the Costs and Benefits of Investing in Primary Health Care to Advance Vertical Outcomes | Results for Development.\u201d https:\/\/r4d.org\/projects\/exploring-costs-benefits-investing-primary-health-care-advance-vertical-outcomes\/ (accessed May 18, 2022)."},{"issue":"1","key":"pone.0283156.ref014","doi-asserted-by":"crossref","first-page":"e001497","DOI":"10.1136\/bmjgh-2019-001497","article-title":"Measuring primary healthcare expenditure in low-income and lower middle-income countries","volume":"4","author":"N. Vande Maele","year":"2019","journal-title":"BMJ Glob. Heal."},{"issue":"11","key":"pone.0283156.ref015","doi-asserted-by":"crossref","first-page":"e1500","DOI":"10.1016\/S2214-109X(19)30416-4","article-title":"Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study","volume":"7","author":"K. Stenberg","year":"2019","journal-title":"Lancet Glob. Heal."},{"issue":"10156","key":"pone.0283156.ref016","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1016\/S0140-6736(18)32389-4","article-title":"Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in Health","volume":"392","author":"D. A. Watkins","year":"2018","journal-title":"The Lancet"},{"key":"pone.0283156.ref017","unstructured":"Republic of Kenya Ministry of Health, \u201cNational and County Health Budget Analysis, FY 2020\/21,\u201d no. April, 2022."},{"key":"pone.0283156.ref018","unstructured":"\u201cInvestment Case and Financing Recommendations\u201d."},{"key":"pone.0283156.ref019","first-page":"2013","article-title":"Primary Healthcare Network Guidelines","author":"Ministry of Health Kenya","year":"2021","journal-title":"Nuevos Sist. Comun. e Inf."},{"key":"pone.0283156.ref020","unstructured":"T. Kenya, \u201cThe Kenya Health Strategic and Investment Plan, 2014\u20132018 The Kenya Health Strategic and Investment Plan,\u201d 2014."},{"key":"pone.0283156.ref021","unstructured":"WHO, \u201cOneHealth.\u201d https:\/\/www.who.int\/tools\/onehealth (accessed Dec. 14, 2022)."},{"key":"pone.0283156.ref022","unstructured":"Global Innovation Fund, \u201cPractical Impact: GIF\u2019s approach to impact measurement,\u201d 2019."},{"issue":"2","key":"pone.0283156.ref023","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1017\/bca.2017.12","article-title":"Income elasticities and global values of a statistical life","volume":"8","author":"W. K. Viscusi","year":"2017","journal-title":"J. Benefit-Cost Anal."},{"key":"pone.0283156.ref024","first-page":"1","article-title":"The Gates Reference Case: What it is, why it\u2019s important, and how to use it","author":"NICE International","year":"2014"},{"issue":"8","key":"pone.0283156.ref025","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1136\/jech-2016-208141","article-title":"Return on investment of public health interventions: a systematic review","volume":"71","author":"R. Masters","year":"2017","journal-title":"J Epidemiol Community Heal."},{"key":"pone.0283156.ref026","unstructured":"\u201cThe Investment Case for Community Health in Kenya,\u201d 2018."},{"key":"pone.0283156.ref027","unstructured":"P. Henry, B. Katy, M. Na\u2019im, Q. Claire, and G. Meghan, \u201cStrengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations,\u201d no. July, 2015."},{"key":"pone.0283156.ref028","unstructured":"\u201cThe Role of Economic Evaluation in Strengthening Health Systems Economic evaluation\u201d."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T18:06:46Z","timestamp":1679594806000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283156"}},"subtitle":[],"editor":[{"given":"Wenhui","family":"Mao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,3,23]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0283156","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,23]]}}}