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System error: Why Kenya should have done better pre- corona

The coronavirus pandemic continues to expose systematic failures in the country.

From healthcare to transport to an economy hanging on to hope, the virus that has so far claimed four lives and infected scores more has also exposed inefficiencies within government that could turn fatal.

Key among these inefficiencies is unwillingness of those in government to act on recommendations made by different specialists on an array of matters, including preparing the country for eventualities.

Since the announcement of Kenya’s first coronavirus case, Sunday Standard has accessed key documents done and presented to top officials in President Uhuru Kenyatta’s government between 2017 and January this year that addressed possible solutions that, if implemented, could have cushioned the nation from the Covid-19 blow.

The first is a 2017 mission report by a team of government technocrats and academics presented to the World Health Organisation in a meeting held between February 27 and March 3. This document outlined in detail the needs of the country with regards to prevention, detection and treatment of zoonotic disease outbreaks.

International hub

While prevention of a global virus outbreak might have been almost impossible given Kenya’s status as an international travel and business hub, the detection, management and treatment of cases could have been handled much better had recommendations to the State been taken seriously.

A key proposal with regard to detection of outbreaks was to subject then existing laboratories around the country to global standardisation tests that would have pointed out weaknesses in our own internal systems in case of global outbreaks.

“There is a need to establish a database of laboratory testing capacities to determine proportion of population with access to laboratory services,” the report reads. “It would be in the country’s best interests to clearly define all national and partner reference laboratory capabilities to provide clear lines of specimen referral and testing at the national level.”

The current crisis has shown that laboratories at county referral hospitals and many other accredited ones around the country have neither the capacity nor capability of not only testing for the coronavirus, but are incapable of handling the specimens too.

As a result, suspected cases have all been sent to Nairobi where testing has happened at one of two facilities; the National Influenza Centre and Kenya Medical Research Institute (Kemri) headquarters.

Although these two facilities are at the forefront of testing, they are heavily dependent on donor funding, something the report points out could in future pose “sustainability challenges”.

It has also emerged from the presentation that the country was lagging behind in terms of disease surveillance and that it was behind in terms of early warning and awareness of global biological events.

“There is a need to strengthen the use of surveillance data as evidence for planning, advocacy and early response at all levels,” the report says. “Allocation of budget from the government is required to ensure sustainability.”

The other key concerns raised was the obvious shortages in medical personnel.

“The number of registered medical personnel per 100,000 population is below the WHO standard in all or most of the different cadres.  There is no tracking or mapping of non-clinical care personnel like epidemiologists and biostatisticians,” the report states.

“At the national level, in both sectors, there is perceived adequate staffing and mix of staff; but at the county and sub-county levels, this is inconsistent due to devolution, redistribution and attrition of staff.”

Playing catch up

On March 25, President Kenyatta, apparently playing catch up to this recommendation, announced release of Sh1 billion from the Universal Health Care kitty “towards the recruitment of additional health workers to support in the management of the spread of Covid-19”.

It is not clear whether the hired staff would remain in employment when eventually the pandemic runs its course.

Apart from staffing, the multi-sectoral member team that drafted the Joint External Evaluation of IHR Core Capacities of the Republic of Kenya also recommended that the country heightens its levels of preparedness.

“The country needs to develop and maintain national, intermediate and local level public health emergency response plans for relevant biological, chemical, radiological and nuclear hazards.

“This covers mapping of potential hazards, identification and maintenance of available resources, including national stockpiles and the capacity to support operations at the intermediate and local/primary levels during a public health emergency,” the report reads.

This, like many other recommendations remained on paper. Between 2017 to date, there has been no stockpiling of key items.

“We need to consolidate risk assessment for all emergencies, establish contingency funds and plans, develop multisectoral database for surge staff and experts as well as procure and pre-position stockpiles,” it said.

At the time of the outbreak, the country had only 12,000 test kits, 35,000 face masks and some 25,000 body suits.

To date, there are counties that are still without adequate personal protective equipment and the country’s stockpiles of personal protective equipment (PPEs) remain dangerously low.

“There is a lack of planning and sourcing for stockpiles due to inadequate funding and bureaucratic delays in accessing emergency funds,” the team noted, advising that money needed to be available at all times in an Emergency Fund ready for access at the presentation of a calamity.

On March 30, President Kenyatta directed the National Treasury to set up an emergency response fund overseen by a 10-member board committee to bolster the country’s countermeasures against Covid-19. This was 18 days after the first case was recorded.

“The principal object of the fund shall be to mobilise resources for emergency response towards containing the spread, effects, and impact of the Covid-19 pandemic,” the Head of State said.

The source of the funds? Monies received from government officials who committed to voluntary pay cuts to help in ongoing efforts to fight the virus.

“The seed capital of the fund shall be drawn from the exchequer including the voluntary salary cuts undertaken by the senior ranks of the Executive, Judiciary, Legislature, and county governments,” he added.

This was however not all. In 2015, the government created the Public Health Emergency Operation Centre (EOC) with support from WHO and other donors. On paper, the EOC was a noble idea meant to, among other duties, gather real-time information from public rumours and other sources using hotlines and media monitoring.

Situation reports

The information collected is analysed daily and submitted to relevant authorities for evidence-based decision-making. In addition, it prepares situation reports during emergencies to share them with partners. Ideally, the EOC is also meant to serve as the interface with the media and provide reliable information to the public during emergencies.

There are some hitches to this plan though.

The EOC has no dedicated budget from the central government and heavily relies on donor support that has, over the years been inconsistent. The staff seconded to the EOC have other unrelated duties and responsibilities and work with no data or power back up, items critical to an institution such as EOC.

During the fourth day of the week-long meeting that sought to analyse the country’s healthcare system, participants made one of their last presentations to WHO representatives.

A key threat to Kenyans’ healthcare with regards to disease outbreaks was the manning of the country’s entry points, questioning whether they were well equipped to deal with emerging threats to public health.

Kenya has 38 points of entry, including eight airports, four sea or lake ports, and 26 ground crossings. In addition, there are numerous informal crossing points at all land borders. Sixteen of these have no port health capacity.

“Facilities for isolation/quarantine of ill travellers are very limited at most points of entry,” the report reads.

“Points-of-entry port health functions are a national responsibility, but many of the support services such as clinical referral facilities, diagnostics and treatment do not get sufficient national funding support.”

This article was posted on Standard Media.


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