By Dr. Steve Adudans
President Uhuru Kenyatta recently highlighted the sorry state of the country’s isolation capacity as numbers of those infected by COVID-19 continues to rise. Consequently, he ordered all the county governments to create at least 300-bed capacities for those who may need special attention.
The virus has exposed us as a nation with insufficient capacity to manage population-level threats like COVID-19. Over the years, our approach to healthcare has been focused on individual diseases in silos. Improvement of health facilities remained on the back-burner of government priorities, often regarded by policymakers as a cost, rather than an investment to improve the sustainability and transformation of the economy.
As it is, we are rushing to stock equipment and supplies, including ventilators and oxygen tanks. According to data from the Ministry of Health, there are a total of 518 ICU hospital beds spread across 25 counties. More than 200 of the ICU beds are in Nairobi. Uasin Gushu County as the second-largest number at 55 beds, with 20 of them being at the Moi Teaching and Referral Hospital. Mombasa is third with a 36-bed capacity, and Kisumu has 21.
There are 256 ventilators in the country. Recommendations by the Kenya Medical Research Institute in their assessment report released in April said the country needed to urgently invest in 1,511 ICU beds and 1,609 ventilators.
And increasing ICU beds is only part of the puzzle. Beds are of no help when there is no skilled workforce to manage patients requiring them. Critical care medicine is unique, challenging, and dynamic. It requires attentive, skilled nurses, respiratory therapists, and intensivists to adequately treat patients in the ICU. These human resources are more often a luxury than not. Many have only a handful of health workers who are trained in critical care if any at all. Ventilators are critical equipment to keep patients alive and maintain hope for survival; however, they are as rare as ICU beds.
Responding to COVID-19 entails more than immediate containment, patient management, and temporary expansions. Critical care capacity is lacking and requires systematic changes to health strengthening to save the lives of hundreds of thousands more in the years to come.
One aspect that should be explored is public-private partnerships in health, which has proved a game-changer in most instances. Because of these, there have been incremental improvements in some areas, including increased life expectancy, reduced maternal and neonatal deaths.
A good example of public-private partnership is Kenya’s Hewa Tele which delivers life-saving medical oxygen to health facilities in the country that have little or no access to it otherwise, operating production plants in partnership with governments and hospitals. The plants have cut hospital purchase costs by around one-third. The social enterprise provides medical-grade oxygen to several Covid-19 isolation facilities across the country, with a set of cylinders dedicated solely to the pandemic, and has increased production to meet the oxygen needs of a growing number of patients.
The current pandemic provides a golden opportunity for more critical thinking about the quality and effectiveness of interventions in the health sector now that policymakers are forced to pay attention. It also presents an opportunity to focus on adopting a comprehensive and integrated approach based on each county’s individual needs. Let us not go back to business as usual after this pandemic.
Dr. Adudans is the executive director Centrer for Public Health and Development
