Threat of El Nino puts Kenya's healthcare system on alert

The Ministry of Health is stepping up preparations for a possible El Nino linked health crisis, with expected heavy rains threatening to increase demand for services and overwhelm facilities.

The rains could trigger disease outbreaks, displace communities, damage health infrastructure and cut off access to healthcare, particularly in flood-prone counties.

The preparations come against the backdrop of the 2023/24 El nino floods, which left 175 people dead, 40 missing and 242 injured, while more than 384,000 people were displaced into 170 camps.

The floods also disrupted healthcare, with 64 of 1,434 assessed health facilities across 11 counties becoming inaccessible.

The period was associated with 409 cholera cases and four deaths, seven human Rift Valley fever cases and malaria upsurges in Wajir, Marsabit and Kitui.

With regional climate assessments indicating an increasing likelihood of El nino conditions this year, authorities are preparing for possible above-normal rainfall, flash floods and landslides, although the impact is expected to vary from county to county.

In an exclusive interview with The Standard, Director of Public Health Stephen Muleshe said flooding could cut off roads, interrupt normal deliveries and accelerate depletion of medicines in hospitals receiving additional patients.

The Ministry, Kenya Medical Supplies Authority (KEMSA) and county governments are therefore quantifying, procuring and pre-positioning essential medicines, vaccines, laboratory reagents, nutrition commodities, infection-prevention materials and water, sanitation and hygiene (WASH) supplies.

Dr Muleshe said supplies were being repositioned at regional, county and health-facility levels before roads become impassable.

The Ministry is also reviewing safety stocks, storage capacity, cold-chain systems and backup arrangements, while preparing for redistribution of commodities between counties where shortages arise.

Alternative last-mile delivery arrangements, including boats, drones, helicopters and other suitable transport, are also being considered for isolated communities.

“Commodity availability will be monitored continuously so that shortages can be identified early and replenished,” said the official. “However, the Ministry acknowledges that prolonged road closures may still present logistical challenges, particularly in remote and flood-prone areas.”

According to the Ministry, counties likely to experience flooding include Mandera, Wajir, Marsabit, Garissa, Kitui, Makueni, Machakos, Lamu, Kilifi, Kwale, Tana River, Taita Taveta and Mombasa.

Traditional flood plains include Kano Plains in Kisumu, Budalang’i in Busia and the Tana Delta in Tana River County, while urban flooding remains a concern in Nairobi and Mombasa, particularly in densely populated informal settlements with inadequate drainage and vulnerable water and sanitation systems.

Beyond disruption of healthcare services, flooding is expected to increase the risk of infectious diseases.

Stagnant water provides breeding sites for mosquitoes and could increase transmission of malaria, dengue fever, chikungunya and Rift Valley fever.

Preparedness measures include distribution and proper use of insecticide-treated mosquito nets, indoor residual spraying and targeted space spraying where epidemiologically indicated.

The Ministry is also strengthening larviciding, environmental management of stagnant water, surveillance and the availability of rapid diagnostic tests and other vector-control supplies.

Counties of Wajir, Marsabit and Kitui recorded notable malaria upsurges during the 2023-24 floods.

Waterborne diseases are another major concern as flooding can contaminate water and food supplies, increasing the risk of cholera, typhoid, dysentery, hepatitis A and other acute diarrhoeal illnesses.

The public health official said county rapid response teams and health facilities were being prepared to detect and manage cases early.

Laboratory reagents, sample-collection materials, treatment commodities and infection-prevention supplies are being pre-positioned, while community health promoters will support household-level surveillance.

Community Health promoters (CHPs) will also reinforce messages on handwashing, safe food preparation, household water treatment and early care-seeking.

“Members of the public should seek immediate medical attention for profuse watery diarrhoea, persistent vomiting, fever, severe abdominal pain, blood in stool or signs of dehydration,” added Muleshe.

The Ministry has mapped counties at risk of waterborne disease outbreaks based on recent cholera occurrence, including Garissa, Mandera, Nairobi, Wajir, Tana River, Kiambu, Machakos, Kajiado, Homa Bay, Mombasa, Siaya, Meru, Uasin Gishu, Marsabit, Samburu, Kisumu, Nyeri, Murang’a, Isiolo, Kitui, Kirinyaga, West Pokot, Nakuru, Bomet and Kwale.

But the concern goes beyond disease outbreaks.

For instance, Muleshe noted that some health facilities serving flood-prone communities are themselves located in areas at risk of flooding.

Such facilities could become inaccessible, sustain damage to equipment and medicines, lose electricity or water supplies, or be forced to temporarily relocate services.

As a mitigation, national and county governments were identifying and mapping vulnerable facilities, including those previously affected by floods.

Additionally, facilities are being supported to develop business continuity plans, protect medicines and equipment, maintain backup power and water supplies, identify alternative access routes and establish temporary or mobile service points where necessary.

Counties are also reviewing facility contingency plans, available beds, emergency treatment areas, referral pathways and ambulance arrangements.

Planned surge measures include temporary field hospitals and clinics where existing facilities become inaccessible or overwhelmed, as well as deployment of mobile medical teams and integrated outreach services.

The Ministry is also procuring field medical units, tents, portable equipment and alternative cold-chain systems.

Dr Muleshe said additional ambulance services, including air evacuation where necessary, were being considered, while alternative referral routes and facilities were being identified before roads become inaccessible.

“The contingency plan acknowledges that some counties have inadequate numbers of four-wheel-drive ambulances and limited air, land and water evacuation capacity,” he said.

“The Ministry is working with counties, Kenya Red Cross Society and other emergency partners to mobilise additional transport and evacuation support.”

The rains could also worsen malnutrition and disrupt nutrition services, particularly among flood-affected, displaced and food-insecure populations in arid and semi-arid areas.

To tackle malnutrition, preparedness measures put by the ministry include nutrition screening, community management of acute malnutrition, supplementary feeding, treatment of severe acute malnutrition and continuity of maternal and child nutrition services.

“Children under five, pregnant and breastfeeding women, older persons and people with chronic illnesses are at greatest risk,” warned Muleshe.

Landslides, mudslides and injuries are also expected in parts of Murang’a, Nyeri, Meru, Kisii, Nyamira, Taita Taveta, West Pokot, Elgeyo-Marakwet and Baringo.

Flash floods, drowning and trauma remain a concern across flood-prone counties, particularly Tana River, Garissa, Wajir, Mandera, Marsabit, Turkana, Busia, Kisumu and the Coast.

On his part, Architect and sustainability expert at at Niko Green Nickson Otieno said preparedness should, however, go beyond government contingency plans to include communities and households.

“As we are expecting more and more rains, there is need to strengthen science, be able to predict and also to provide early warning for communities for the people to be well prepared,” said Otieno.

He said Kenya’s network of community health promoters provided an important channel for delivering climate and health information to households.

“We need to build capacity of communities and families to have systems for them to survive during the rains,” added the expert.

Otieno said climate change could bring more intense flooding, including in urban areas, as well as extreme temperatures and heatwaves with direct health consequences.

People working outdoors would be particularly exposed to heat stress and dehydration, while other potential hazards included wildfires and strong waves along the Coast.

He said the health burden could also rise as flooding increases the risk of cholera and other waterborne diseases, while changing climatic conditions could alter the distribution of disease-carrying vectors responsible for malaria, dengue fever and chikungunya.

“Climate change is not a fictitious issue but affects daily livelihoods. For instance, we either have water to drink, or have water that is not clean to drink,” he said.

According to Otieno Kenya had already mapped climate and health hotspots, with information from the Kenya Meteorological Department helping the Ministry of Health and other agencies identify areas requiring targeted interventions.

However, he said preparedness should extend to local administrations, communities and health workers.

“This is continuous work in progress. Local administration, chiefs and CHPs should be sensitised more,” he said.

He noted that even where communities and health facilities were prepared, inaccessible roads during flooding could prevent people from reaching essential services.

More public sensitisation, he said, would help communities understand the risks and take preventive measures before disasters occur.

“We cannot control El Nino, but we can actually control how El Nino affects us,” said Otieno.

Meanwhile, Deputy President Kithure Kindiki has urged national and county governments to activate disaster preparedness and response plans before the rains begin.

Speaking during the 30th Ordinary Session of the Intergovernmental Budget and Economic Council on August 24, Kindiki said at least 18 counties and major urban centres including Nairobi, Mombasa and Kisumu had been identified as particularly vulnerable.

He said the Government was pre-positioning food and non-food relief supplies and had mapped areas vulnerable to flooding, landslides, disease outbreaks, displacement and infrastructure damage.

Kindiki urged counties to clear and maintain drainage systems, identify and protect vulnerable communities, pre-position essential supplies, strengthen emergency response teams and coordinate with national agencies.