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Learn from coronavirus and improve health system

By Pauline Aluoch, Jacinta Waruguru and Josea Rono | April 9th 2020 at 05:00:00 GMT +0300

Health workers wear protective gear at Mbagathi Hospital, Nairobi. Kenya needs to strengthen its healthcare system to deal with pandemics such as Covid-19. [Elvis Ogina, Standard]

Inadequacy of healthcare infrastructure limits any progress towards attaining the third sustainable development goal (SDG) on good health and well-being.

More specifically, the national goal of provision of universal health coverage (UHC) is precluded by inefficiencies in the health system, including the lack of a strong infrastructure.

UHC, an essential part of the Kenyan government's big four development agenda, seeks to provide quality health services for all, where and when they need them without suffering financial hardships.

Most recently, the Global Burden of Disease ranked Kenya’s progress towards UHC at 50 per cent and predicted a 60 per cent coverage index by 2030, a far cry from the ideal target of 100 per cent.

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What should Kenya do to close the 40 per cent gap?


Infrastructure is the less talked about but necessary pre-requisite in securing the third SDG goal. By lose definition, infrastructure in a health system ranges from the inpatient beds to support amenities such as water, electricity and telecommunications.

Limitations and vulnerabilities of the system have often been exposed through isolated cases, but never in a great magnitude as with the outbreak of the most recent pandemic, the Covid-19 disease.

The Global Health Security (GHS) Index, which ranks countries based on their capacity to deal with epidemics or pandemics, yielded a global average of 40.2 (out of a possible 100) – evidence that a big part of the world needs to do more to reinforce their health systems.

Thailand has been an admirable pioneer on this front. Ranking sixth best country by the GHS index, Thailand leveraged its strong health systems to control the spread of the deadly Middle East Respiratory System outbreak in 2015.

In the present pandemic, the proportion of deaths to reported active cases in Thailand stands at 0.5 per cent - much lower than in neighbouring countries such as Indonesia (9 per cent) and Philippines (7per cent).

Low and middle income countries could borrow a leaf from Thailand. South Africa, which ranked first in Africa and 34th in the world, reported an average of 54.8 on the GHS Index and Kenya, a close contender, ranked second in Africa and 55th in the world, with an average score of 47.8.

Ensuring the resilience of this core infrastructure resources acts as a buffer during these occurrences and boosts outcomes of treatment of sick populations.

Snail’s pace

Taking second position in a continent of 55 countries appears close to ideal. However, a microscopic look into this particular status may raise an eyebrow or two.

While the minimum acceptable ratio of hospital beds-to-population is 50 per 10,000 people, Kenya’s national average stands at 14 beds with outlier counties such as Turkana averaging at five beds per 10,000 people, a status that has been maintained from as far back as 2013.

And while at the hospital, patients are required to endure long waiting periods before being attended to, an indication of limited human resource for health capacity.

The advent of the Covid-19 pandemic also brought to light the limitations of our epidemiology training programmes and our snail’s pace in ramping up medical equipment and systems to deliver the global goal of quality healthcare for all.

Low hanging fruits

Strengthening our health systems to Thailand’s level can at best be a long term goal. In the presence of a looming crisis, Kenya should focus on working on its other limitations to control the spread of the Covid19.

At present, several calls to action have been made by the government to control the spread of the disease. From closure of learning institutions, to advocating for self-isolation and self-quarantines, the government has inferred learnings from what it has witnessed from the East.

While the government is advocating for better hygiene including frequent washing of hands, the fact that more than 30 per cent of its population lacks access to clean water and more than 70 per cent lack access to sanitary conditions including sewerage services, the universal applicability of this directive is precluded.

Healthcare facilities are part of these adverse statistics and are unable to universally offer water and sanitation services to their patients, in addition to deficiencies in beds, medicines, vaccines, technologies, and systems.

A pragmatic quick-win intervention would be to fix the basic infrastructural mishaps such as water and sanitation connectivity in the immediate term and pursue the attainment of health security of a standard higher than that of Thailand in the longer term.

The Covid-19 pandemic is an ongoing class and our health system is the student – this distressing class portends critical lessons for the student. Will she learn?

Dr Rono, Waruguru and Aluoch work for E&K Consulting Firm

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