Healthcare headache as Covid-19 cases rise

A bed structure and personnel protective suits in boxes outside the five-bed isolation facility at Kisumu County Hospital on March 15,2020. PHOTO | ONDARI OGEGA 

By KEZIAH KINUTHIA
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Summary

• Taking the cue from large economies such as China, where the virus started from, Kenya has rushed to effect a raft of measures to contain and cushion its citizens from coronavirus shocks.
• The country has set up isolation and test units across the country even though the bigger concern is whether its healthcare system would handle a full blown coronavirus pandemic.

The past three weeks have been adrenalin-packed for State officials as the government rushed to reinforce measures to contain the spread of coronavirus, amid fears that the country’s fragile health systems could be overrun if the disease spread in the rural and informal settlements.

By Monday, Kenya had confirmed 50 cases of Covid-19 — a rapid rise from March 13 when the Health ministry confirmed the first case of the disease, triggering a sense of panic, especially because the country is still struggling to control other communicable diseases such as tuberculosis (TB).

Taking the cue from large economies such as China, where the virus started from, the government has notably rushed to effect a raft of measures to contain and cushion its citizens from coronavirus shocks.

Kenya has, for instance, set up isolation and test units across the country even though the bigger concern is whether its healthcare system would handle a full blown coronavirus pandemic.

Kenya’s public healthcare system has long been burdened and underfunded. The government expenditure on health as a share of the total spend remains low at 7.2 percent against the target of 15 percent, as declared by the African Union countries.

The Health Ministry’s Sh85.1 billion allocation in the 2018/19 financial year with a recurrent budget of Sh48.8 billion gives little room for improvement of services in public hospitals.

This has resulted in lack of essential equipment such as Intensive Care Unit (ICU) beds which are critical to saving lives, especially in the outbreaks such as coronavirus.

Sources in the medical sector say Kenya has an estimated 200 fully equipped ICU beds, which means 0.4 beds per 100,000 or one bed in 250,000 people. The government, however, maintains it has about 1,000 such beds.

An ICU is critical to the current circumstances because severe Covid -19 leads mostly to lung failure but also causes kidney and cardiovascular (heart and blood vessel) failure. All these are rapidly fatal without an ICU treatment facility.

Even hospitals in developed countries with the world’s best healthcare risk becoming triage wards, forcing ordinary doctors and nurses to make extraordinary decisions about who may live or die.

For instance, Italy’s healthcare system ranks eighth country with the highest number of ICU beds. The country has 12.5 ICU beds per 1000,000 population.

Despite having a world-class health system, Italy has registered the highest number of fatalities at 10,779, pushing the country to the breaking point. The country is battling to at least “flatten the curve’’ of new cases — allowing the sick to be treated without swamping the capacity of hospitals.

Things are no different in the UK, Australia and the Netherlands, whose healthcare system are top-ranked in a 2017 study by common wealth.

HOSPITALS OVERLOAD

The UK with 6.6 ICU beds in 100,000 population, has confirmed 19,784 coronavirus cases and 1,231 deaths while Australia, with 21.8 ICU beds in 1000,000, has confirmed 8,788 cases and 86 deaths.

The Netherlands recorded 10,930 cases and 772 deaths, despite having 6.4 ICU beds in 100,000 population.

In general, Europe has an average of 11.5 ICU beds in 100,000 population.

This paints a picture of how overloaded hospitals in high income countries are, offering a grim glimpse of what awaits low income countries like Kenya, if the spread of the virus is not contained.

According to the World Health Organisation (WHO), a well-functioning healthcare system requires a steady financing mechanism, a properly-trained and adequately-paid workforce, well-maintained facilities, and access to reliable information to base decisions on.

Besides the ICU facilities, the size of medical personnel in Kenya is also set to come under focus amid long running shortage of specialists.

Ouma Oluga, the former secretary-general of the Kenya Medical Practitioners and Dentists Union (KMPDU) said on Thursday that the country requires an additional 3,000 to 5,000 medical personnel to effectively deal with the coronavirus pandemic.

According the WHO, a well-functioning healthcare system for a country like Kenya should have a minimum of 16,278 clinical officers, 13,141 doctors and 38,315 nurses in public health sector.

Despite Kenya having 175,681 registered health personnel, including 11,667 medical personnel, 22,626 clinical officers and 52,587 nurses, the Ministry of Health points out that staff attrition without a replacement has led to low doctor-to-population ratio, hindering service delivery.

President Uhuru Kenyatta on Wednesday last week announced that Sh1 billion from Universal Health Care kitty will be spent on recruitment of temporary additional health workers, intervening on staff shortages facing the health sector.

Besides, the existence of regional disparities in the distribution of existing health workers, where arid and semi-arid areas are disadvantaged with less staff hindering the delivery of universal healthcare.

The State would also have to juggle payouts to medical personnel amid statistics showing that compensation for employees formed the highest component of the expenditure with an allocation of 80 percent of the entire budget.

“In two years, compensation to employees have increased by 41 percent to Sh981 million in the financial year 2018/19,” says the Ministry of Health.

“The increase is attributed to annual salary adjustment, approved doctors non-practicing allowance as approved by the Salaries and Remuneration Commission new minimum wage guidelines. However, there has been no significant increase in transfers which relates to grants in support of personal emoluments.”

Besides financial constraints, staff shortages, performance management and governance has been a big challenge in the health ministry.