Making Kenya’s health care system fit for the future

By Joan Atim

Kenya has 8,250 confirmed Covid-19 cases and the figures show that the country may reach the 10,000 mark in a few weeks. Earlier, the government of Kenya seemed ahead of the curve and through an Executive Order issued on 28 February 2020, the President established the National Emergency and Response Committee (NERC) for Covid-19 chaired by the Cabinet Secretary (CS) for Health. The Ministry of Health also set up an Emergency Operations Centre comprising of four Rapid Response Teams (RRTs). Each team had five trained medical staff as well as designated telephone communication numbers for members of the public to report suspected cases, seek more information on the infection and ask questions. A treatment and isolation unit for managing Covid-19 positive cases was set up at the country’s largest teaching and referral hospital – Kenyatta National Hospital and over 1500 health workers have received training on managing Covid-19 patients. Further, monitoring the geographical spread and transmission intensity in different areas was started and intensified to curb community transmissions. There have also been infection prevention and control measures at all levels of the healthcare system even in counties within Kenya and the establishment of functional triage systems and isolation rooms, procurement of supplies based on the World Health Organization’s (WHO) Covid-19 Disease Commodity Package (DCP). Nationwide, there has been sensitization and public education through mainstream as well as social media; including advice on self-care for persons with mild symptoms.

Though the government enhanced public-private partnerships to increase the local capacity for production of PPE for the healthcare facilities, some loopholes were shown to exist especially regarding the management of the donations. Despite this, there has been increased local production and this has ensured a steady supply of PPEs to the healthcare facilities meeting the current demand. The Public Finance Management (Covid-19 Emergency Response Fund) Regulations, 2020 was also enacted and it established the Covid-19 Emergency Response Fund. It consists of monies appropriated by the National assembly, grants, donations, subscriptions, voluntary contributions from public officers and private persons and other gifts made. The fund shall be wound up when the President directs so after confirming that Covid-19 is no longer a threat to social-economic and political stability in Kenya. The fund should be utilized for the purposes given in an accountable and transparent manner. With all these measures in place, the virus has, however, proved to be stubborn and unrelenting, ravaging even the best healthcare systems in the world. This persistence led the WHO to declare it endemic on 13 th May 2020; as the world prepares to live with the virus.

In Kenya, data on the numbers reveal that the healthcare facilities are already overwhelmed. The government recently through the CS Health in his daily briefings announced that the hospitals and isolation centres are full and they were considering sending patients with mild symptoms to isolate at home. This is a recipe for disaster and the country should be prepared for worse. Take for instance places like Kibera and Kawangware (slum dwellings), maintaining physical distance is almost impossible. People live in tiny, overcrowded homes with few windows or other ventilation, thus, the usual health promotion messages just don’t apply. The ministry has also criticised the dangerous behaviour of issuing false contacts during targeted tracing and this is hurting the government efforts. There have also been challenges and gaps in coordination between the county and national levels of government in the procurement of critical equipment such as ventilators for respiratory support as well as recruitment of additional healthcare personnel. Patients have been witnessed escaping from these isolation centers; and this speaks to the status of the places. There is therefore, an urgent need for a better defined and coordinated mechanism to increase the capacity for intensive care, the supply of PPEs and recruitment of trained healthcare personnel in further anticipation of a high surge in the numbers of positive cases. The ministry could take advantage of its health workforce ranging from nurses, dentist, laboratory technicians, pharmacists, nutritionist, and virologists to public health officials and they could make use of this pool of workers to further intensify on the fight against the virus.

In summary, Kenya has taken most of the appropriate steps at implementing the WHO recommended Country Preparedness and Response measures for healthcare facilities. However, these require scaling-up. Kenya has also shown that it can deliver short term aid and try to develop innovative vaccines and treatments for infectious diseases, the real issue is the danger of a weak healthcare system. In the longer term, therefore, the government can focus on building better infrastructure; especially digital infrastructure (which means good electricity connectivity, internet fibres amongst others) and further leverage on digital technologies i.e., using mobile healthcare system, m-health systems in the wake of telemedicine. Kenya should also invest in training its next generation of medical experts especially on the right knowledge, skills and use of the available resources. This will add to the drugs, vaccines research and diagnostic tests. Further, research and innovation should be encouraged through funding. The government should be at the forefront in partnering with the private sector, civil society and donors. Public health schemes should be readily available and affordable. This calls for increased budget allocations and spending for the health sector and where possible exceed the recommended minimum of 15% of the total Government budget. As a result, the government should engage in reforming the financing mechanisms to improve flexibility, through programme based budgeting and modified regulations.

References
1. Institute for Health Metrics and Evaluation (IHME) (2014), Assessing Facility Capacity, Costs of Care, and Patient Perspectives. Available at http://publications.universalhealth2030.org/uploads/abce_kenya_full_report_2014.pdf
2. Kenyans warned against giving false contacts during targeted Covid19 testing. Available at https://www.standardmedia.co.ke/health/article/2001372826/kenyans-warned-against-giving- false-contacts-during-targeted-covid-19-testing
3. World Health Organisation, Investing in and building longer-term health emergency
preparedness during Covid-19 pandemic. Available at https://www.who.int/publications/i/item/investing-in-and-building-longer-term-health-
emergency-preparedness-during-the-covid-19-pandemic
4. Covid19, Ministry of Health Website. Accessible at https://www.health.go.ke/covid-19/
5. Kenya Health Workforce Report: The Status of Healthcare Professionals in Kenya, 2015. Available at https://taskforce.org/wp-
content/uploads/2019/09/KHWF_2017Report_Fullreport_042317-MR-comments.pdf