Explainer: So, what is a Level 4 hospital?

If you walk into any medical facility in Kenya, would you be in a position to tell what grade it is and what kind of services it should offer?

Most Kenyans, when asked these questions, do not have ready answers.

The Nation took to the streets to find out from citizens if they knew what services they should expect from various hospitals and how these facilities are classified.

All Ms Mercy Wambui knows is that health centres are the lowest class in the health facilities ratings with level six hospitals at the top.

“I know that those at the community level are health centres and the type of Kenyatta National Hospital are level six hospitals which handle complicated cases,” she says.

Others like Mr Njoroge Peter were not even aware that there are other levels of hospitals save for health centres and the national referral hospital.

“I know when I am feeling a headache, I go to health centres and get drugs for my headache. I have never known the difference between a level two, three or four in this country. I only know of one referral hospital in the country which is Kenyatta National Hospital,” he said.

HOSPITALS CLASSIFICATION

The Kenya Medical and Practitioners and Dentists Board is in charge of the classification of medical facilities in the country.

The health stations range from Level 2 to Level 6, according to the KMPD chief executive Mr Daniel Yumbya.

This classification is based on the services, infrastructure, and human resource attending to patients.

LEVEL 2

• The hospitals in this category are health centres, dispensaries, medical and dental clinics, eye and Ear, Nose and Throat (ENT) clinics.

• Dispensaries serve up to 10,000 patients and are managed by two general clinical officers assisted by six registered community health nurses and a pharmaceutical technologist.

• For recordkeeping, the facility must employ at least two clerks and a health records information management officer.

• Other workers are two medical laboratory technologists, a nutritionist and a dietician.

• Services offered are outpatient, emergency maternity, basic laboratory, and minor surgical procedures.

• It is also at the dispensary that food quality, safety and fortification advocacy, school health programmes or outreach and population management services are done.

LEVEL 3

• The facility serves up to 30,000 patients and general and specialised clinical officers and nurses.

• It is managed by either the government, or A humanitarian organisation, and licenced to a faith-based organisation or community or registered organisation such as a school or company.

• The hospital offers all services available at a level 2 station as well as radiological and imaging, maternity for normal deliveries, antenatal care, immunisation and family planning.

• It must also have an inpatient bed capacity of not more than 16 beds with four beds each for the male, female, paediatric and maternity wards.
• According to Mr Yumbya, to be licenced, a level 3 hospital must have a functional incinerator or burning chamber, and a protected placenta pit or macerator.
• It must also have a working transport system with a utility vehicle or motorcycle and ambulance services.
• For its staff, the hospital should have at least two doctors, two public health officers and two public health technicians.
• Other workers are six general clinical officers, a graduate clinical officer, a lung and skin specialised clinical officer, a paediatric clinical officer, a reproductive health clinical officer, two specialised nurses, 23 registered community health nurses, eight Kenya Registered community health nurses and four registered midwives.
• There should also be a pharmacist and three pharmaceutical technologists, a sign language interpreter, a dental officer, four clerks, a health administrative officer and five medical laboratory technologists.
• Subordinate staff should include two cooks, four drivers, ten support staff, two mortuary attendants and four security officers.

LEVEL 4

• Has more comprehensive services and specialised staff than a level 3 hospital.

• Emergency, general and specialised operations are handled at the facility.

• Provides a highly active anti-retroviral therapy (HAART), antiretroviral (ARV) prophylaxis for children born of HIV-positive mothers, male circumcision, pelvic inflammatory disease (PID) management, and screening for animal transmitted conditions.

• The facility also screen for and examines cervical, breast and prostate cancers, vaccination for yellow fever, tetanus, hepatitis B and rabies, management of surgical and medical and advanced life support, management of high-risk pregnancies and obstetric complications, pre-term labour and caesarean sections.

• Has the capacity to manage medical, surgical, paediatric and gynaecological in-patients, radiology services, renal dialysis, tuberculosis management and mortuary and autopsy services.
• The facility should be built on five-acre piece of land or an office space of approximately 2,500 square metres.
• Should have a 150- bed capacity for inpatient with 30 beds each for male, female, paediatric, antenatal and postnatal wards.
• The labour ward should have at least three delivery beds and two resuscitating beds while the new-born unit should have at least five incubators and five cots.
• There should be at least six beds at the Intensive Care Unit (ICU) with an equivalent bed capacity for the High Dependence Unit (HDU) and radiology.
• In terms of equipment, the renal unit should have at least five dialysis machines, there should also be an MRI machine, CT scan and mammography machine.
• It should also have an endoscopy, laparoscopy and colonoscopy.
• Level 4 requires a more specialised personnel with at least 16 resident medical officers, two anaesthesiologists, two general surgeons, two gynaecologists, two paediatrics and two radiologists.
• The least number of clinical officers that such a hospital should employ is 195 specialists with 76 special nurses, 4 pharmacists, 2 clinical Pharmacists and 8 pharmaceutical technologists.

LEVEL 5

• The services offered are similar to level 4 except for the number of patients, which is higher. A level 5 hospital can handle more than 250 patients per day as well as specialised clinics.

• The facility also offers specialised therapy services including radiotherapy, chemotherapy and renal dialysis, sterile production unit services, internship training, forensic pathology services, and 24-hour pharmacy services.

• The hospital should be built on at least ten acres of land or 5,000 square metres.

• It should have a 500-bed capacity with ICU and HDU having 12 beds each.

• There should be an inpatient and outpatient pharmacy, burns unit and a staff quarters for at least eight persons on duty.

• A medical superintendent should lead a team of at least 15 medical officers, seven anaesthesiologists, two cardiologists, four general surgeons and two orthopaedic surgeons.

• The team should also include a critical care physician, two ENT surgeons, three gynaecologists, four oncologists, and two palliative care specialists.

• The hospital should employ at least 90 clinical officers, 1,118 nurses with specialists spread across different departments, 11 pharmacists (general, clinical, oncology pharmacists) and 10 pharmaceutical technologists.

• One mammographer, three CT scan or MRI radiographer, two human resource management officers, 50 medical laboratory technologists, four cateresses, 20 cooks, 15 drivers, 60 support staff, 10 mortuary attendants, and 16 security officers should also form part of the staff.

LEVEL 6

• A Level 6 hospital offers all specialised services exclusively or a group of specialised services, among others, radiology, oncology, ophthalmology, dental and renal.

• Organ transplant, bypass and reconstructive surgeries, and assisted reproductive in vitro-fertilisation and training of medical specialists and subspecialists are only offered at level 6 hospitals.
• The hospital should be built on ten acres of land or office space of approximately 10,000 square metres.
• It should have a 1,500-bed capacity.
• The accident and emergency department should have at least four operating theatres and one plaster room.

• Outpatient department with specialised clinics should include ten triage rooms, twenty consultation rooms, one nursing station, two injection rooms, one minor theatre per specialised surgical department and a laboratory.

• There should be a delivery room with six delivery couches, antenatal department and a new-born unit with 20 incubators and 10 HDU cots.

• It should have an operating theatre bed each for general, maternity, orthopaedic, paediatric, ENT, ophthalmology, dental, neurosurgery, cardiothoracic, and plastic surgery.

• The hospital should be manned by a chief executive officer (CEO) assisted by at least 100 medical officers, 30 anaesthesiologists, at least 64 surgeons in different departments, 20 oncologists, 10 cardiologists, and 20 gynaecologists.

• Other employees are 1,822 specialised nurses, 120 pharmacy specialists (pharmacists, pharmaceutical technologists and plaster technologists), 25 general radiographers, three mammographers, three CT scan or MRI radiographer, four human resource management officers, 50 scientific medical laboratory specialists, five cateresses, 20 cooks, 15 drivers, 100 support staff, 10 mortuary attendants and 16 security officers.