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. 2023 Jul 3;3(7):e0000483.
doi: 10.1371/journal.pgph.0000483. eCollection 2023.

Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya

Jacquie Narotso Oliwa  1   2 , Rosanna Jeffries Mazhar  3 , George Serem  1 , Karima Khalid  4   5 , Patrick Amoth  6 , Helen Kiarie  7 , Osman Warfa  6 , Carl Otto Schell  8   9   10 , Tim Baker  4   5   8   11 , Mike English  1   3 , Jacob Mcknight  3
Affiliations

Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya

Jacquie Narotso Oliwa et al. PLOS Glob Public Health. .

Abstract

Critical illnesses cause several million deaths annually, with many of these occurring in low-resource settings like Kenya. Great efforts have been made worldwide to scale up critical care to reduce deaths from COVID-19. Lower income countries with fragile health systems may not have had sufficient resources to upscale their critical care. We aimed to review how efforts to strengthen emergency and critical care were operationalised during the pandemic in Kenya to point towards how future emergencies should be approached. This was an exploratory study that involved document reviews, and discussions with key stakeholders (donors, international agencies, professional associations, government actors), during the first year of the pandemic in Kenya. Our findings suggest that pre-pandemic health services for the critically ill in Kenya were sparse and unable to meet rising demand, with major limitations noted in human resources and infrastructure. The pandemic response saw galvanised action by the Government of Kenya and other agencies to mobilise resources (approximately USD 218 million). Earlier efforts were largely directed towards advanced critical care but since the human resource gap could not be reduced immediately, a lot of equipment remained unused. We also note that despite strong policies on what resources should be available, the reality on the ground was that there were often critical shortages. While emergency response mechanisms are not conducive to addressing long-term health system issues, the pandemic increased global recognition of the need to fund care for the critically ill. Limited resources may be best prioritised towards a public health approach with focus on provision of relatively basic, lower cost essential emergency and critical care (EECC) that can potentially save the most lives amongst critically ill patients.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: TB: Technical consultancies with UNICEF, the World Bank, USAID and the Wellcome Trust, all outside the submitted work. ME: Financial competing interests – Grants from Wellcome and NIHR UK for research on hospital care in Kenya. Non-financial interest – Advisory roles for: WHO, Academy of Medical Sciences (UK), UKRI The other authors have no competing interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Structure of Kenya Health care delivery.
Fig 2
Fig 2
(a) Kenya’s Covid 19 situation overview, with the first graph showing confirmed cases over time and the second graph showing COVID 19 related deaths. Source: WHO Covid 19 regional data https://covid19.who.int/region/afro/country/ke [18]. (b) Kenya’s Covid situation showing proportion of admitted patients on oxygen and ventilatory support over the waves.
Fig 3
Fig 3. Timeline of Key policy events during the study period.
Fig 4
Fig 4. Scale of funding to the MoH vs implementing partners for the COVID-19 response in Kenya.
See this image and copyright information in PMC

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