Report lays bare sorry state of Kenyan health infrastructure

An assessment of Kenya’s 12,375 public and private hospitals has returned a sorry verdict, with key services missing.

Public hospitals in a country of more than 50 million people have only 779 intensive care and high dependence unit beds, the Health Facility Census Report says.

The 779 make 34 per cent of the 2,304 critical beds in the country. Only 25 public hospitals offer ICU services while 28 government health insttutions provide HDU services.

“A total of 381 private and public hospitals offer critical care services, with 217 or 1.8 per cent providing HDU and 164 offering ICU,” the report says.

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“Nationally, there are 899 ICU adult beds, 196 ICU paediatric beds and 258 ICU neonatal beds at public and private hospitals. A total of 951 HDU adult beds and 275 HDU cots were reported.”

The report shows that continuous positive airway pressure (CPAP) machines that use mild air pressure to keep breathing airways open while a patient is sleeping are the least available critical care items, with most services being provided by private hospitals.

“Critical care services should be scaled up in consideration of the epidemiologic transition and increased violence, injuries and accidents,” the report says.

It adds that only 12 counties have the required core health worker (nurses, doctors, clinical officers) numbers per population.

These are Nairobi, Tharaka Nithi, Nyeri, Lamu, Vihiga, Mombasa, Uasin Gishu, Laikipia, Taita Taveta, Kirinyaga, Embu and Kisumu.

“Nurses are the most available cadre at 80, 94 and 99 per cent at Levels Two, Three and Four hospitals respectively. The least available are radiographers and dental personnel. Only one per cent of Level Two hospitals have all the requisite health cadres, two per cent of Level Three and 36 per cent of Level Four,” the report adds.

The Ministry of Health says Level Two and Three hospitals lack key basic equipment like pulse oximeters, nebulisers and oxygen.

According to the report, the density of primary health care hospitals nationally is high, at 2.4 per 10,000 population.

A third (36 per cent ) of Level Two and 79 per cent of Level Three hospitals provide laboratory services.

“Photodynamic therapy (PDT), a treatment that involves light-sensitive medicine and a light source to destroy abnormal cells, malaria and dipstick for urinalysis are available at almost all Level Two and Three hospitals that provide laboratory services,” the report says.

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“Sputum test for TB and haemogram are available at only a third of Level Two hospitals and 55 and 47 per cent of Level Three respectively.”

The report establishes that availability of most tracer drugs is lowest at Level Two hospitals as more than half do not have benzypenicillin injection, insulin and metformin and magnesium sulphate.

According to the census, slightly more than half the hospitals provide pharmacy services (57 per cent). Of these, only a small proportion have the full basket of tracer medicines at six per cent and tracer non-pharmaceutical supplies (15 per cent).

“Average availability for tracer drugs and non-pharmaceuticals is 62 and 73 per cent respectively. In terms of non-pharmaceuticals, solusets for fluids, sunction catheters and nasal prongs for oxygen delivery are not widely available,” it says.

“Only 40 per cent of hospitals and 25 per cent Level Two hospitals have these items. Investments need to be scaled up (at the Kenya Medical Supplies Agency) to ensure 100 per cent availability of tracer drugs.”

Drugs for managing mental health conditions are missing at most primary hospitals, while carbamazepine is only available at 32 per cent of Level Two and 45 per cent of Level Three hospitals.

Less than half of hospitals in Kenya offer maternity services, with only a third providing emergency obstetric care.

“Despite a majority of hospitals having adequate delivery beds and packs, there are critical gaps. Only 40 per cent of the hospitals offer blood transfusion while 54 per cent have a source of oxygen,” it says.

“Access to newborn health services is low at 12 per cent, with overall availability of equipment at hospitals offering newborn services being good. Only about half of the hospitals offering newborn care have continuous positive airway pressure machines.”

The census says most hospitals that provide specialised outpatient services offer obstetrics/gynaecology (69 per cent), paediatrics (61 per cent), general surgery (57 per cent) and internal medicine (57 per cent).

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A minority provide renal services (21 per cent), cardiology (18 per cent), neurology (15 per cent), endocrinology (11 per cent) rheumatology (11 per cent) and cardiothoracic/vascular surgery (seven per cent).

“One in every five hospitals assessed offers inpatient services, the majority of which are medical and paediatric at 85 and 69 per cent respectively. Less than a third (27 per cent) offer inpatient surgical services,” the report observes.

Only four per cent of hospitals offer inpatient services for oncology and psychiatry.

Just 40 per cent of hospitals are accredited by the National Health Insurance Fund (NHIF). Across all levels of care, NHIF accreditation is highest at government Level Two hospitals at 57 per cent.

“NHIF accreditation varies across counties, with only 10 having more than half of their hospitals accredited. Twelve counties have less than 25 per cent of their hospitals accredited. Half of the hospitals across the country (51 per cent) lack access to functional ambulances,” the report says.

Eighty-four per cent of hospitals are accessible by road all year round.

Sixty-nine per cent do not use any electronic healthcare information system (EHIS) while 62 per cent among those that have it use integrated/end-to-end systems.

More than 80 per cent of hospitals have a reliable power and water source. Of these, 87 per cent report the national grid as their main source of power while 45 per cent use piped/municipal council water supply.

“Hospitals should have power back-up systems,” the report says.

The census concludes that 90 per cent or 11,147 of the 12,384 hospitals provide at least one of the 16 basic outpatient services while only two per cent offer all.

“Availability of basic outpatient services is varied as outlined; referral mechanism (100 per cent); management of communicable diseases (84 per cent); maternal child health services (83 per cent); management of non-communicable diseases (81 per cent); minor surgical services (73 per cent); immunisation (69 per cent); basic laboratory (68 per cent); outreach (64 per cent); general emergency (60 per cent); emergency obstetric (60 per cent); maternity (47 per cent); emergency obstetric care (33 per cent); obstetric and gynaecology (31 per cent); mental health (17 per cent); dental – extraction (12 per cent); physiotherapy (10 per cent); and rehabilitative services (six per cent),” the report adds.

Health CS, Susan Nakhumicha, said determining the level of services and readiness is important.

“The findings will be instrumental in informing planning, guiding investments and consequent management of available resources to maximise on outputs at national and county level,” the minister said.

The report targeted 14,366 hospitals but assessed 12,384.

“Public, private, faith-based/NGO hospitals accounted for 47 per cent, 46 per cent and eight per cent of those assessed respectively.

Level Six hospitals are state-owned. Only 47 per cent of hospitals have disability-friendly infrastructure.

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