Critical shortages of essential drugs and medical equipment are harming the ability of the health system to deliver quality health services to patients.
On average, about half (54 per cent) of essential drugs and minimum basic equipment (51 per cent) were available in health facilities, according to The Kenya Health Service Delivery Indicator Survey (SDI) 2018. These are drugs on the Kenya Essential Medicines List.
While over half (58 percent) of drugs for treating pneumonia and severe dehydration due to diarrhoea in children, and tuberculosis of the lungs and type 2 diabetes in adults were available, only five percent of facilities had all the drugs needed to manage the conditions.
Share of essential drugs and basic equipment available dropped last year compared to 2012. The availability of drugs dropped 13 percentage points while the proportion of health facilities that meet basic equipment requirements declined by about a quarter during the period. Rural facilities had a higher share of priority drugs (55 per cent) compared to urban ones (52 per cent). Public facilities had a marginally higher proportion of essential drugs.
While over half (58 percent) of drugs for treating pneumonia and severe dehydration due to diarrhoea in children, and tuberculosis of the lungs and type 2 diabetes in adults were available, only five percent of facilities had all the drugs needed to manage the conditions. The four were the tracer conditions in the study that aims to determine the quality of services in basic healthcare.
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Availability of priority drugs for mothers (a third) is quite poor while less than two-thirds of the necessary vaccines are available.
Among the various levels, hospitals had a higher proportion of essential drugs available (more than three-quarters) while dispensaries had the least (about half). This is alarming given the fact that most of the population accesses care at a public primary health facility.
Across the counties, Marsabit had the highest share (71 per cent) of essential drugs available and Kirinyaga the lowest (41 percent). Eleven other counties had less than half of the priority drugs. They include Tharaka-Nithi and Bomet (43 percent each), Kericho and Trans Nzoia (44 percent each), Nyeri and Murang’a (45 percent each), West Pokot (47 percent), Uasin Gishu (48 percent) as well as Meru, Nyandarua and Mombasa (49 percent each).
According to the study by the World Bank and Ministry of Health, there was a drop in the share of health facilities that met the minimum medical equipment requirements, from 77 percent in 2012 to 51 percent last year.
The equipment expected in all facilities are: a weighing scale (adult, child or infant), stethoscope, sphygmomanometer and thermometer; and additionally, refrigerator and sterilisation equipment at health centre and hospital levels. Most facilities have a scale, a stethoscope, sphygmomanometer and thermometer. Over two-thirds of facilities had sterilisation equipment but only 57 percent had a refrigerator.
Private facilities were better equipped (61 percent) compared to public facilities (42 percent), and urban facilities (62 percent) than their rural counterparts (46 percent). Dispensaries and clinics had the lowest level of basic equipment available (46 percent). First-level hospitals are typically better endowed with equipment (79 percent) followed by health centres (67 percent).
Meru County had the best score in availability of minimum medical equipment (73 per cent) and Marsabit scored the worst, at eight percent.
An effective referral system requires available ambulance services. This need not be ownership of a dedicated emergency vehicle, but rather the facility having access to the vehicle. According to the SDI report, ownership of an ambulance is very low (10 percent). However, 82 percent of health facilities had access to a vehicle to transport their patients. Rural facilities were more likely to have access (83 percent) than urban ones (79 percent), whereas public facilities (87 percent) were more likely than their private counterparts (76 percent).
Overall, Kenya seems to be doing worse in diagnostic accuracy, health provider absenteeism, caseload, availability of drugs and equipment and management of pregnancy and newborn-related complications in the 2018 SDI compared to the 2012 survey. The country only improved in the infrastructure indicator by 16 percentage points to 73 percent from 57 percent, while adherence to clinical guidelines remained the same, at 44 percent.
However, while the differences may be statistically significant, it is not possible to rule out that some of these differences are driven by improvements in the sampling methodologies used, according to the study.