NIJAMSS peer-reviewed article

Cooperative-Led Transformation of Primary Health Care Systems in Kenya

Daniel A. Otwori; Domitila Naomi Kathula; John Cheluget

Abstract: Strengthening primary health care (PHC) systems is central to achieving universal health coverage (UHC), particularly in low- and middle-income countries where health systems face financial, structural, governance and human resource constraints. In Kenya, high out-of-pocket expenditure, inequitable access, workforce shortages, weak community financing and uneven responsiveness continue to undermine PHC performance. This study examined the contribution of cooperative-led approaches to PHC transformation in Kenya, focusing on access, financial protection, service utilisation, community participation and system responsiveness. A mixed-methods cross-sectional design was adopted. Data were collected from 480 cooperative leaders, health practitioners, policymakers and community representatives across selected counties. Quantitative data were analysed using descriptive statistics, chi-square tests and logistic regression, while qualitative data from key informant interviews were analysed thematically. Findings showed that 78% of respondents reported improved access to health services and 72% indicated enhanced financial protection through cooperative-based mechanisms. Cooperative participation was significantly associated with improved PHC access (chi-square = 18.64, p < .001). Cooperative membership also increased the likelihood of PHC service utilisation (OR = 2.35, 95% CI [1.60, 3.45], p < .001). In addition, 69% reported increased community participation and 74% observed improved system responsiveness. The study concludes that cooperative-led approaches can strengthen PHC systems through access, affordability, participation and accountability, but scaling requires supportive policy, infrastructure investment, stronger governance and integration into national and county health strategies.

Keywords: Community participation; Cooperative health models; Health system resilience; Primary health care; Universal health coverage

Journal

Nexus International Journal of Applied Science, Medicine and Social Sciences

e-ISSN

3144-2196

Publication date

August 2026

Volume / Issue

Vol. 1, Issue 2

Paper number

019

Article type

Original Research

Published paper ID

NIJAMSS-V1S2-AUG2026-019

Publisher

Nexus Academic Press

Access

Open Access

Full text PDF: https://www.nijamss.org/archives-download/nijamss-vol-1-series-2-august-2026-paper-019.pdf