Huge gaps rock Kenya's healthcare system despite push to attain UHC

Health CS Susan Nakhumicha is joined by Director General for Health Patrick Amoth, WHO and UNICEF representatives during the launch of the health facility census assessment report on Dec 21, 2023. [Jonah Onyango, Standard]

As President William Ruto pushes for implementation of the Universal Health Coverage (UHC), just a handful of hospitals have what it takes to offer quality services in line with that ambitious agenda.

A new report by the Kenya Health Facility Census notes a paltry seven per cent of hospitals are ready to meet the aspirations of the crafters of UHC which came into being following the signing of four bills by President Ruto in October. These bills are the Primary Health Care Act, 2023, the Digital Health Act, 2023, the Facility Improvement Financing Act, 2023 and the Social Health Insurance Act, 2023.

The report also revealed that only six per cent of hospitals in the country have pharmaceutical services.

The data on the state of hospitals in Kenya was collected in 12,384 public and private hospitals.

The report released by Health CS Susan Nakhumicha yesterday says maternity is the most affected with less than half (40 per cent) of 902 hospitals offering comprehensive maternal services. "The report will help us in achieving UHC. Data shared will support health sector review and make evidence-based decisions," said Nakhumicha.

Lack of infrastructure and adequate human resources have been identified as major hindrances to access to maternal care in Kenya.

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Lack of access to comprehensive maternal care is the main cause of maternal deaths, which stands at 365 deaths per 10,000 live births, according to the Kenya Demographic Health Survey (KDHS).

Of the 902 hospitals offering maternal services assessed, almost all had oxygen (97 per cent), a delivery bed (98 per cent), delivery packs (98 per cent) and a nurse (99 per cent).

Emergency obstetric care was only offered by a third of facilities while half had emergency trays and vacuum extractors available.

Whereas the government encourages women to deliver in hospitals, it was found that only 10 per cent of the facilities had a clinical officer and a medical officer.

"At least 13 per cent of facilities had all the equipment required to offer basic maternity services while one per cent of the facilities had none of the equipment. Most facilities had delivery packs (92 per cent) and delivery beds (86 per cent)," reads the report.

The report noted that only five per cent of the facilities offering maternity services had all the equipment required to provide comprehensive maternity services.

Additionally, of the facilities that offer maternity services, at least 18 per cent reported conducting CS. However, only 42 per cent of these had blood transfusion services and very few (16 per cent) had Continuous Positive Airway Pressure (CAPAP) machines.

"The readiness to provide maternity services was only five per cent revealing the critical infrastructure, basic amenities and human resources gap that compromise the quality of maternal services being offered," said the report.

Only 21 per cent of the facilities offering comprehensive maternity services had a gynaecologist while only 63 per cent had a maternity theatre, according to the findings.

"Whereas reported basic maternity services available were found to be 40 per cent, basic maternity services readiness was noted to be very low with significant gaps in the availability of equipment," the report found.

"Readiness to provide comprehensive maternity services was also very low with notably inadequate maternity beds and specialist health workforce."

The country is also grappling with a shortage of Critical Care Services. According to the report, out of 12,375 health facilities assessed, less than half of them (22 per cent) offer critical services.

Kenya has a total of 2,304 critical care beds. Out of these, 779 are available in public hospitals, representing 34 per cent.

Counties in Northern Kenya lack ICU services, the report said noting the services are concentrated in towns.

Only 25 government facilities offer ICU services whereas 28 offer High Dependency Unit (HDU).

Critical care is the medical care provided to patients who are critically ill with life-threatening injuries or illnesses.

The report noted that eight per cent of facilities provided theatre services with a majority having general theatres. Maternity theatres were available in half of the facilities providing theatre services.

The last available theatres were paediatric, ENT and ophthalmic.

"Overall, few facilities were offering critical care services with a lower availability of paediatric beds when compared to adult beds, and less than optimal availability of all required equipment in both HDU and ICU," says the report.

Even with the changes within the medical insurance scheme, the report has revealed that few public hospitals are National Health Insurance Fund (NHIF) accredited, compared to private and faith-based facilities.

Overall, only 40 per cent of facilities assessed were NHIF accredited, out of which, 45 per cent are public hospitals, with a third being private.

Across levels of care, NHIF accreditation was highest in government Level 2 facilities (57 per cent) while a third of public Level 3 facilities were accredited.

"Accreditation was generally higher in non-governmental and faith-based facilities," adds the report.

The report also highlighted the shortage of essential drugs in hospitals, coming amid an uproar over the current shortage of TB drugs.

More than half of the facilities (57 per cent) had pharmacy services and only 6 per cent and 15 per cent had all tracer drugs and non-pharmaceuticals respectively.

Mental health drugs were the least available with only 23 per cent of facilities having them in stock. Notably, three of every 1,000 facilities that reported having a pharmacy did not have any of the tracer drugs.

"Nearly half of facilities do not offer pharmacy services and most of those that do lack the whole basket of tracer drugs," the report says.