Health ministry diverts Sh1.2bn to oxygen kitty

The Ministry of Health (MoH) has been forced to redirect Sh1.2 billion allocated for the renovation of isolation centres to the purchase of piped oxygen to save critically ill Covid-19 patients.

The oxygen pipes are expected in 10 high-risk counties and will take a huge chunk of the remaining Sh4 billion from the Sh5 billion the MoH received from the World Bank to fight the pandemic.

Health Principal Secretary Susan Mochache said the reallocation of the funds was done in consultation with the World Bank. Priority has therefore shifted to oxygen which she said will take in the largest share of the money.

“We are now focusing on saving lives. Kenyans have started experiencing a more severe form of Covid-19 and more people are being admitted to intensive care units across the country,” she said.

The purchase will be in phases, with the initial one focusing on 10 counties: Nairobi, Kajiado, Machakos, Kiambu, Mombasa, Nakuru, Migori, Uasin Gishu, Kilifi and Busia.

Over Sh1 billion has been used, with Sh833 million spent on medical supplies and equipment, Sh103 million on response and capacity building and Sh70 million on community engagement and grassroots outreach.

Medical supplies

The ministry will spend a further Sh1.8 billion on medical supplies and equipment; test kits and sample collection supplies is allocated Sh420 million while equipping and renovation of labs in counties have been given Sh162 million. Another Sh50 million will go to personal protective equipment.

Eleven PCR machines worth Sh262million will be distributed to the counties to decentralise testing to at least 20 counties.

The ministry’s budget has six components: response, capacity building and staff training on various capacities.

Leasing ambulances for Covid response will cost Sh153million while Sh20 million will be spent on fuelling the vehicles and printing and disseminating the guidelines.

Equipping and assessment

Quarantine, isolation and treatment are divided into two categories that will take in Sh370 million. The first Sh260 million is for renovation, equipping and assessment of facilities such as Mama Lucy Hospital (Sh150 million), Kenyatta University Teaching and Referral Hospital, KUTRH, (Sh100 million)  and renovation of Lady Northy Clinic in Nairobi as a testing centre (Sh10 million).

In the second tranche of Sh170 million, Sh90 million will be spent on a shredder and microwave for the KUTRH, Sh64 million to buy incinerators for 16 facilities in high-risk counties, Sh6 million for incinerators in six specialised labs and Sh10 million will be spent on environmental impact assessment.

Communication and information outreach will consume Sh170 million, with the Ministry spending Sh20 million on airtime for contact tracing and surveillance while for continuous behaviour assessment and sensitisation of communities, Sh150 million has been allocated.

Covid-19 has forced the ministry to clean up the mess at the blood bank, allocating Sh1 billion for the blood and blood components. Months before the coronavirus struck, there were allegations that Kenya was selling blood to Somalia, with the agency accused of siphoning the life-saving product for sale to private health facilities.

Now, the blood bank is running on empty, a situation blamed on corruption and mismanagement. 

Kenya National Blood Transfusion Service director Charles Rombo says that blood is very necessary in the management of Covid-19 cases .

In the Covid-19 Emergency Response Project Phase 2 work plan, reagents and consumables take  Sh252 million, improvement of ICT Sh250 million, while Sh125 million goes to the procurement of blood and manufacturing equipment. Blood cold chain, courier services, temperature and maintenance and procurement of air condition will cost Sh101 million.

In most of the health facilities, liquid oxygen tanks with piping in all the units  will be installed with cylinder manifolds  to monitor the oxygen demand and supply.  Some facilities will require oxygen plants.

Oxygen gas manifolds are designed to supply the correct pressure and volume of oxygen from gas cylinders located outside the building through a pipeline.

“Oxygen is one of the essential commodities in the management of Covid-19, specifically for severe cases requiring breathing support.

“However, availability remains low in public health facilities (16 per cent), and where available the supply is not optimal and lacks the necessary distribution and delivery infrastructure,” said Dr Benjamin Wachira, assistant professor of emergency medicine at the Aga Khan University, Nairobi and president of the African Federation for Emergency Medicine.

He said that, with the growing number of Covid-19 cases, the demand for oxygen will grow 10 times yet supply has not changed significantly.

“There is therefore an urgent need to address the oxygen supply gaps that have been identified,” he said.

A survey on emergency care centres across the country showed that nine out of 10 facilities do not have piped oxygen in the emergency department and delivered oxygen directly from the tanks to the patient.

This means that a good number of facilities are rationing oxygen while deciding who gets it. But piped oxygen boosts the capacity to deliver therapy to up to 10 patients simultaneously.

“There is a need for hospitals to install oxygen gas manifolds in the emergency departments at the county referral hospitals,” said Dr Wachira.

Five days

It costs Sh500, 000and installation takes five days.

The survey also showed that three out of every 10 hospitals in the country do not have a regular supply of oxygen and many also lack pulse oximeters to monitor patients' oxygen levels. They helps healthcare workers to determine if a patient needs supplemental oxygen.

The Covid-19 Oxygen Gas Manifold Report done last month by the Emergency Medicine Kenya Foundation mapped oxygen gas manifolds in Machakos, Kiambu  Kajiado and Busia counties.

Dr Bernard Olayo, a public health specialist at the World Bank Group, said there is already a global shortage of medical oxygen to treat pneumonia, malaria, and other diseases.

A lot of attention has been focused on ventilators, coveted mechanical devices that pushes oxygen into damaged lungs to help patients breathe. The lack of oxygen is equally worrying.

 “If patients have access to oxygen as an initial treatment, it may prevent many of them from becoming critically ill t,” said Dr Olayo.

In patients who develop severe symptoms of Covid, oxygen is the key treatment because it cuts down hospitalisation time as well as severity of the disease. Depending on the age of the patient and severity of their condition, one oxygen cylinder used in the ICU will last 28 hours when an adult patient is plugged on.

The World Health Organisation estimates that with about one million new coronavirus cases globally every week, the world will need 620,000 cubic metres of oxygen per day, or 88,000 large cylinders.

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