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.
Publication details
Article URL: https://www.nijamss.org/articles/nijamss-v1s2-aug2026-019/
Full-text PDF: https://www.nijamss.org/articles/nijamss-v1s2-aug2026-019/full-text.pdf
References
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Citation
Dr. Daniel A. Otwori; Dr. Domitila Naomi Kathula; Prof. John Cheluget. Cooperative-Led Transformation of Primary Health Care Systems in Kenya. Nexus International Journal of Applied Science, Medicine and Social Sciences, Vol. 1, Issue 2, August 2026.