Retrieval-Augmented Clinical Benchmarking for Contextual Model Testing in Kenyan Primary Care: A Methodology Paper

Large Language Models (LLMs) hold promise for improving healthcare access in low-resource settings, but their effectiveness in African primary care contexts remains under-explored. We present a rigorous methodology for creating a benchmark dataset and evaluation framework focused on Kenyan Level 2-3 (dispensary and health center) clinical care. Our approach leverages retrieval-augmented generation (RAG) to ground questions and answers in Kenya's national clinical guidelines, ensuring content aligns with local standard-of-care. The guidelines were digitised, chunked, and indexed for efficient semantic retrieval. Gemini Flash 2.0 Lite was then prompted with relevant guideline excerpts to generate realistic clinical questions, multiple - choice answers, and reasoning scenarios with source citations in English and Swahili. We engaged Kenyan physicians in a co - creation process to refine the dataset's relevance and fairness, and instituted a blinded expert validation pipeline to review for clinical accuracy, clarity, and cultural appropriateness. The resulting Alama Health QA dataset comprises thousands of regulator-aligned question-answer pairs spanning common outpatient conditions in English and Swahili. Beyond standard accuracy metrics, we propose innovative evaluation measures targeting clinical reasoning, safety, and adaptability (e.g. Initial results highlight significant performance gaps in state - of-the - art LLMs when confronted with localized scenarios, echoing recent findings that LLM accuracy on African medical questions lags behind performance on U.S. benchmarks. Our work demonstrates a pathway for dynamic, locally-grounded benchmarks that can evolve with guidelines, providing a crucial tool for safe and effective deployment of AI in African healthcare. Advances in large language models have spurred interest in their potential to augment medical services, especially in low-and middle -income countries facing clinician shortages(Bekbolatova et al., 2024). By handling routine queries or providing decision support, LLMs might help bridge gaps in healthcare access across Africa.