Introduction
Access to emergency medical care by every Kenyan is a right enshrined in the Constitution of Kenya. It is a critical component in medical care given its potential to avert loss of life or severity in injury. This makes emergency medical treatment an integral component of the healthcare system. Emergency medical care comprises of emergency medical services and infrastructure, and it focuses on immediate decision to prevent death, worsening of an injury or disability. There are daily emergencies from various causes, including collapsing buildings, floods, road accidents and terrorism-related incidents, among others.
Emergency and disaster management is a co-shared function between the national and county governments, which requires adequate coordination and collaboration. County governments are charged with offering emergency medical services, including ambulance services, while the Ministry of Health is the overall body that regulates the emergency medical care. These efforts are complemented by other non-governmental entities to strengthen both pre-hospital and facility-based care across Kenya.
This blog focusses on interventions towards strengthening access to emergency medical care. This is founded on the constitutional commitments and policy framework that promotes access to emergency medical care. The increasing population and cases which require emergency medical care call for the need to re-examine the strategies for the purpose of improving the readiness.
Status of Emergency Healthcare in Kenya
The Kenyan Constitution (2010) guarantees every Kenyan a right to the highest standard of medical care. Particularly, Article 43(2) states that no Kenyan shall be denied emergency medical care. This guarantees access to emergency care whenever a need arises. Access to emergency health care is, however, hampered by weak policy implementation, technological and infrastructural limitations. The World Health Organization (WHO) emergency programme advocates for quality and timely emergency care accessible to all. It reiterates the need for well-established infrastructure and staffing capacity for emergency service units at all levels.
The Kenya Emergency Medical Care Policy 2020-2030 and Kenya Emergency Medical Care Strategy 2020-2025 provide solid guidelines on addressing emergency medical care including governance systems, financing instruments, professional development, and establishment of integrated national and county infrastructure. This ensures seamless coordination, response, and treatment. In addition, the Kenya Health Policy 2014-2030 identifies the provision of ambulance services as a primary care service that should be available from level 2 (dispensary levels). It also defines emergency health services as part of the referral services to be provided by the nearest health facility. The national referral hospitals (tertiary-level providing highly specialized services) under the national government are well equipped with defined areas for emergency services and preparedness team, thus can provide learning lessons to counties on addressing emergency cases.
The ease of access to emergency medical care can be demonstrated by the availability of medical facilities, whereby as of 2022, Kenya had 16,517 health facilities comprising of 12,821 level 2 (dispensaries and private clinics), 2,712 level 3 (health centres), 958 level 4 (sub-county hospitals), 20 level 5 (county referral hospitals, teaching and referral, and private hospitals) and 6 level 6 (National referral hospitals). Most emergency cases occur at the community level, and therefore level 2 hospitals are the first line in responding to these cases. All these levels of hospitals provide emergency response services, with level 6 offering specialized treatment.
There are various causes contributing to medical emergencies (Table 1). Assault is the leading cause of medical emergency as per the Kenya Emergency Medical Care Policy 2020-2030, comprising of 42 per cent of all reported cases. The number of road-related injuries has been rising from 0.6 per cent to 1.9 per cent of all disease-related cases reported between 2018 and 2022 as shown in Table 2. Also, road injuries is the 7th cause of death in Kenya, with estimates showing that a half of deaths and a third of disabilities could be addressed with effective emergency care. Further, accidents and injuries are leading in the Average Length of Stay (ALOS) in hospital, with affected patients spending an average of 22.2 days. The Ministry of Health classifies road accidents and injuries as disease burdens. Road accidents result in injuries and trauma. Injuries cause mortality, disability and even impairment, which have an implication on treatment cost, quality of life and productivity of an individual. These statistics imply a need for agility in response and adequate preparedness. Post-accident crash response (immediate care after an accident up to hospitalization) is an emergency need. This requires an effective emergency medical care system, including handling at the accident scene, ferrying of the victims to hospital and in-hospital care.
Table 1: Medical emergency cases (2018-2022)
| Emergency cases | 2018 | 2019 | 2020 | 2021 | 2022 |
| Rape | 921 | 950 | 973 | 1,013 | 827 |
| Defilement | 4,767 | 5,397 | 6,801 | 6,492 | 5,530 |
| Incest | 308 | 261 | 323 | 367 | 279 |
| Unnatural/sodomy | 71 | 91 | 54 | 88 | 86 |
| Bestiality | 5 | 20 | 19 | 14 | 22 |
| Indecent assault | 141 | 248 | 267 | 315 | 375 |
| Abduction | 52 | 71 | 70 | 61 | 59 |
| Bigamy | 12 | 26 | 58 | 99 | 21 |
| Assault | 16,088 | 16,304 | 13,139 | 16,259 | 16,497 |
| Total cases | 22,365 | 23,368 | 21,704 | 24,708 | 23,696 |
Data source: National Police Service (2023)
Table 2: Medical emergencies related to road traffic accidents (2018-2022)
| Disease | 2018 | 2019 | 2020 | 2021 | 2022 |
| No. of injuries (Road Traffic Accident) | 411,704 | 480,993 | 247,252 | 243,391 | 1,687,525 |
| Injuries (Road Traffic Accident in percentage) | 0.6 | 0.5 | 0.4 | 0.3 | 1.9 |
Data source: Ministry of Health (2023), Kenya Health information System (KHIS/DHIS2)
Gaps and Emerging Issues in Emergency Medical Care
Emerging issues on emergency health care include technology, low health insurance coverage, climate-related emergencies and inadequate ambulances response capacity.
Emerging technology in emergency management
The role of technology in emergency management cannot be overlooked. Notable progress has been made on use of mobile devices and toll-free lines to access emergency services and mapping of emergency care centres[i]. Also, technology can aid in real time emergency data collection and documentation, enhancing planned response and decision making especially in mass casualty and natural disasters. The Kenya Medical Research Institute (KEMRI) with technology use was able to increase real time patient data sharing on medical tests from 651,381 to 4 million annually. Manual patient information sharing is time consuming, resulting in delays in treatment. However, there is limited information on technology adoption and use in relation to emergency medical care.
Health insurance coverage
Both the National Health and Insurance Fund (NHIF) and private insurance providers cover emergency care. In 2022, 19.2 per cent of the population had health insurance. The National Health Insurance Fund with 89.4 per cent share coverage of all insurers has established an emergency care benefit package. This package is accessible through a toll-free number that connects a user to a road ambulance service that links to the nearest health facility. This means that the beneficiaries are not required to pay any out-of-pocket fee to access the services. The transition of NHIF to Social Health Insurance Fund (SHIF) 2023 provides for seamless coverage of emergency medical care. There is also emergency, chronic, and critical illness fund under the social health regulations that covers for emergency once the social health insurance fund cover is depleted. However, emergency care package is limited to only 19.2 per cent of Kenya’s population who are active members of private and public health insurance cover, locking out the rest of the population.
Inter-governmental synergies
While several interventions have been put in place to strengthen emergency response at national and county levels, there are gaps in community handling of emergency situations[ii]. Community members being the first responders have limited education in handling emergency cases, for instance, offering First Aid. There are limited emergency community programmes to capacitate communities on emergency response. While the community may be endowed with local resources to assist emergency victims, training on how they can effectively use them to respond is still unexplored.
Climate-related emergencies
Climate change has potential to increase the demand for emergency medical care since the changes result in natural calamities that threaten lives, for instance floods that affect an average of 150,000 Kenyans annually. This results in injuries and disease outbreaks, necessitating a need for emergency response. Destruction of infrastructure by floods inhibits medical supplies and access to emergency treatment. Disease outbreaks and injuries result in influx of people seeking medical attention overwhelming the healthcare system.
Ambulances response capacity
Ambulances are critical in ensuring victims access timely and quality emergency care. The World Health Organization recommends one (1) ambulance for every 50,000 people. However, there is limited information on the number of ambulances and their distribution across the country, making it difficult to estimate the ambulance population ratio. This affects budgetary allocation and plans towards emergency response.
Conclusion and Recommendations
Kenya has made significant progress in ensuring access to emergency medical care, with two policies in place, that is: Kenya Emergency Medical Care Policy 2020-2030 and Kenya Emergency Medical Care Strategy 2020-2025. Improvement in adoption of technology, standardization of emergency medical services, and preparedness across the country has potential to strengthen emergency medical care. Technology can be utilized to ensure seamless patient health data exchange between and within hospitals by developing an integrated electronic emergency system, thus enhancing timely delivery of emergency services. It will be important to establish an active free toll number that meets the prescribed standards for hospitals, especially at the county level. The hotlines can be shared on social media pages and as adds on mainstream media. There is need to increase the membership for insurance cover by sensitizing the public on the new SHIF registration to ensure all Kenyans benefit.
While standardization and coordination of emergency care across the 47 counties is key, there is need to build county emergency departments to respond to unique local emergency service needs up to sub-county and ward levels. Further, collaboration between communities and emergency care centres to build capacities of the public in handling emergencies through campaigns and targeted trainings are important. By-stander trainings on emergency handling can be targeted on boda-boda operators and public service vehicle drivers. An emergency response framework is needed to respond to flood-related medical emergencies. Water harvesting, building of dykes and opening drainage systems can help reduce the effects of floods. Also, there is need to set up an ambulance database to inform on their numbers and increase the number to meet the ambulance population ratio in line with international standards. More effort could be placed on implementing the policy commitments and expanding coverage of pre-hospital emergency handling structures while strengthening in-hospital systems to be affordable to the less privileged.
[i]Ministry of Health in Collaboration with Emergency Medicine Kenya Foundation.
[ii]Community Based Perception of Emergency Care in Kenya.
Authors: Delphina Dali–KIPPRA Young Professional
Yegon Wilbon – KIPPRA Young Professional
