ICU debacle exposes KNH resource gap at Kenyatta National Hospital

For some time, Kenyatta National Hospital (KNH) administrators have been pitching for some Sh1.5 billion for doubling the referral facility’s bed capacity.

The administrators say the hospital, which has 1,800 beds, needs the cash to expand this capacity to 3,800. That cash is part of the Sh18bn that the officials have been pitching for to finance the hospital’s operations and projects.

This wish list, buried somewhere on the shelves, has ranked low in the minds of most Kenyans until KNH admitted this week that a patient died on August 28 while waiting for a bed at its packed intensive care unit (ICU).

Acting Clinical Services Director, Dr Peter Masinde, said the patient, Hana Njoki, 68, who required ICU services died at the general ward because all the hospital’s 31 ICU beds were occupied at the time of her admission.

A referral hospital of KNH’s status ought to have 61 critical care beds to cover part of the 2,500 inpatients that it receives, admits its administrators.

“Even if we have that number, we would still be full most of the time given the occupancy threshold set by the World Health Organisation (WHO),” said Dr Masinde.

The hospital’s bed capacity has remained flat at 1,800 beds over the years yet the number of patients who stream in has ballooned to an annual average of 700,000 for inpatients and 600,000 outpatients.

The World Health Organisation (WHO) recommends that general ICU’s in any hospital should not exceed 70 per cent occupancy at any given time.

Speaking to the Business Daily in a previous interview, Dr Masinde said the lack of beds was the biggest impediment to offering “the best” services.

“KNH is operating at more than full capacity at any given time with a bed capacity of 1,800. Our records show that the average number of patients hosted in the hospital wards each day ranges between 2,500 and 3,000 patients,” he said.

And so would the problems at the national referral hospital disappear overnight once the State make available the billions of shillings its administrators are pushing for? The short answer is no.

The 2018-2023 strategic plan also identifies the old and dilapidated infrastructure, staff absenteeism and inadequate security system as some of the weaknesses hindering delivery of quality services to Kenyans.

In the five-year plan, however, the national referral facility says it hopes to relieve the agony of cancer, heart and kidney patients who wait for treatment for months due to lack of specialists and equipment by channeling Sh2.9 billion towards the upgrade of the existing services.

But there is a long way before this can happen. Its human resource base – made up of 4,700 clinical and non-clinical staff, is falling short of the 6,200 it requires to operate optimally, says the administrators.

Of its current staff, there are 800 nurses and 227 doctors, meaning the hospital heavily relies on the University of Nairobi personnel, among them the over 700 postgraduate students and their lecturers. The strategic plan cites staff absenteeism as a major weakness which leads to low productivity, poor service delivery and increased payroll costs.

Self-directed referral amongst patients seeking health services is also cited as another challenge experienced at KNH “because 75 per cent of the people you see here do not come through the referral system.”

Hospital records reveal that 250 patients report at the accidents and emergency unit daily from Kiambu, Machakos, Murang’a and Kajiado counties.

The referrals report at the accidents and emergency unit shows that patients from Nairobi County are the majority, accounting for 46 per cent of all referrals followed by Kiambu at 13 per cent and Machakos 6.3 per cent. Others are patients from Kajiado (5.6 per cent) and Murang’a 4.6 per cent.

In the absence of exchequer cash, the hospital has lined up changes that will cost patients some money as it aims to raise Sh31.4 billion from patient fees starting this year.

“Cost-sharing fees will be reviewed annually during the implementation of this strategic plan resulting in five per cent increase in revenue per annum,” states the plan

KNH intends to spend Sh95 billion, including Sh10.7 billion on upgrades during the period. The hospital which expects a grant of just Sh10 billion from the government is supposed to generate the deficit from user fees.

That however is nearly impossible given that the number of patients who cannot pay their bills is equally rising.

“We lose nearly Sh600 million annually to patients who cannot pay. We are also owed Sh400 million every year,” said Dr Masinde.

Still, this week’s death at KNH is not an isolated case. In April this year, a 16-year-old from Wajir County who had travelled in an ambulance for 14 hours was turned away because there were no available ICU beds.

The girls' father had to seek an alternative private hospital since there was a fire in Nairobi and because the burn victims were transferred there the unit was filled to capacity.