The ICU Sector in Kenya’s Public Health Sector

There have been numerous reports about the health sector in Kenya especially the public health sector. Many people are of the opinion that the health sector is itself sick and in dire need of medication in order to revive it and, in the process, restore the confidence of the general public in the sector.

The fact is that the public hospitals in this country face numerous challenges including but not limited to general hospital negligence, lack of sufficient human resources as well as deficient budgetary allocation of funds to government hospitals leading to inadequate facilities, drugs and equipment.

What is the state of the Intensive Care Unit in the Country? What does the Critical Care encompass? The Critical Care encompasses not just ICU per se, but also High Dependency Units; Kidney Dialysis Units; Operating Theatres; Burn Units; Cardiology Units and Stroke Units but according to a report published of the Daily Nation newspaper on 26^th Monday of August 2013, Kenya’s public health sector had less than 50 Intensive Care Unit beds in public hospitals for the over 40 million Kenyans with another major problem being the lack of staff trained in critical care, especially in the public health facilities because most of the nurses and doctors trained in Critical Care end up working in private institutions, simply because they have the skills but no equipment to work with.

Kenyatta National Hospital is the largest referral and teaching hospital in the country. According to the statistics, Kenyatta National Hospital receives a total of 2500 patients daily and, therefore, should have at least 125 Intensive Care Unit beds but unfortunately, the hospital currently 21 Intensive Care Unit beds making it hard for many patients who are in critical conditions and cannot afford the escalated charges at private institutions to get medical attention.

With the number of patients received daily, this implies that the 21 ICU beds are always occupied and a bed is only available when a patient who shows any slight improvement is moved and his place taken over by another patient. The percentage of ICU beds at the facility is less than two percent.

Moi Teaching and Referral Hospital (MTRH) has a bed capacity of more than 800 and receives patients from Western Kenya, Rift Valley, parts of Eastern Uganda as well as the Southern Sudan but has an ICU bed capacity of less than 15 though plans were underway to increase the bed capacity to more than 28.

According to a survey carried out in 2014 on 21 hospitals in Kenya that had ICU facilities; that is two referral hospitals, three Mission Hospitals, eight Provincial Hospitals/level 5 hospitals and eight Private Hospitals gave a real picture of the ICU sector in the country.

According to the survey, the total bed capacity of the 21 hospitals that were surveyed was 6,551 in 2014 with Kenyatta hospital having 1,445, Moi Teaching and Referral Hospital having 734, all Provincial hospitals combined had 2316, and the eight Private hospitals under survey had 1203 while the eight Mission hospitals had 853 beds.

The table below shows the number of beds in terms of percentages for the sampled 21 hospitals.

The total number of ICU beds in the 21 hospitals were 130 in total and distributed as shown in the table below;

The percentage of ICU beds to hospital beds was low in most categories of hospitals according to the survey falling short of the required 10-20% of hospital beds as per World Health Organization standards. See the table below;

What about the staffing in terms of the nurses? According to the survey, there were 414 nurses working in the ICU from the sampled 21 hospitals. Nurses working in ICU per shift were 81 in all hospitals. The nurse to patient ratio was variable in different categories of hospitals. The two referral hospitals had a ratio of 1:2.In the private hospitals 6 had a ratio of 1:1, 3 had a 1:2 ratio and 2 had 1:3 ratio. The 3 mission hospitals surveyed had a ratio of 1:2. Among the 5 provincial hospitals 3 had 1:2 ratios while two others had a ratio of 1:3

The table below shows the number of nurses working in the ICU at the time of the survey and the number per shift.

From the above demonstrations, this clearly indicates the status of critical care services in Kenya. This shows that only 11% of hospitals in Kenya provide Intensive Care Unit services. The World Health Organization states that every hospital performing surgery and anesthesia must have an ICU but this is not the case with Kenya. The bed capacity comparing between ICU beds and hospital beds in the hospitals surveyed fell short of the required 20-40% of total hospital beds recommended by Society of Critical Care Medicine.

From the hospitals surveyed known to have ICUs gives an indication that there is a total of 130 beds in the whole country for a population of more than 44,000,000 million people. If this is broken down to ICU beds per 100000 populations it would be 0.29. This means there is a shortage of ICU beds to serve the Kenyan population.