Audit exposes rot in Kenya's emergency care

An audit has laid bare the fragile state of Kenya’s emergency medical care system, revealing widespread failures that are costing lives during the most critical window for survival.

In emergencies, minutes matter. Yet for many Kenyans, help arrives too late, or not at all.

Auditor General in a 2025 report on the Provision of Emergency Medical Care Services in Kenya, paints a troubling picture of delayed ambulance responses, under-equipped hospitals, and a severe shortage of trained personnel across the country. 

The report was commissioned following a 2022 recommendation by the Senate Committee on Health.

At the heart of the crisis is the time after injury or sudden illness, when prompt medical intervention is required to significantly increase the chances of survival.

According to the audit, ambulance response times in sampled counties range from 20 to 60 minutes, far exceeding required standards.

The Kenya Emergency Medical Care Strategy, 2020 to 2025, provides that 15-20 minutes is the ideal response time for an ambulance after a distress call, and that the ambulance should transport the patient to a health facility within 20 minutes.

The delays are attributed to a combination of systemic failures, including a shortage of ambulances, poor maintenance, inadequate fuel supplies, and a lack of trained personnel. Even more concerning, 34 per cent of ambulances inspected were found to be non-functional, grounded due to mechanical issues.

Of the counties reviewed, only Machakos County consistently met the recommended response times.

The report revealed a lack of a centralised national ambulance dispatch system. While some counties operate dispatch centres, most are plagued by inefficiencies, including poor communication systems, a lack of real-time tracking technology, and the absence of toll-free emergency numbers.

The audit established that 11 out of the 16 sampled counties had ambulances that were not staffed with Emergency Medical Technicians. This was attributed to a lack of a scheme of service for Emergency Medical Technicians in the public service, as well as inadequate planning for ambulance staffing.

Patients, as per the audit, were accompanied by nurses and clinical officers who were designated in health facilities, and therefore, had other duties to execute. This aggravated staff shortages in already staff-constrained facilities, thereby causing delays and negatively affecting the quality of patient care.

Section 7 of the KEBS Minimum Ground Ambulance Requirements, 2013 requires that ambulances should have emergency vehicle operators and Emergency Medical Technicians.

“The audit established that all counties operating county-owned ambulances were staffed with drivers who were not certified emergency vehicle operators. This was due to a lack of a scheme of service to facilitate onboarding these staff in the public service. The uncertified drivers may not have the skills to adequately respond to an emergency medical situation, therefore, endangering the lives of both the patient and staff on board,” read the report in part.

The crisis does not end at the roadside. Inside hospitals, the situation is equally dire.

The audit found that while all Level 6 hospitals have established accident and emergency units, the majority of lower-level facilities—the backbone of county healthcare—are ill-equipped to handle urgent cases.

Only 9 per cent of Level 4 hospitals have functional emergency departments. Among Level 5 hospitals, nearly three-quarters operate emergency units, but most lack specialised sections for children.

Even where emergency departments exist, they are often critically understaffed. Some facilities have as few as one trained emergency nurse, forcing general nurses without specialised training to manage life-threatening conditions.

Nurse-to-patient ratios in these units range from 1:5 to as high as 1:122, far exceeding the World Health Organisation’s recommended ratio of 1:4. The result is overworked staff, delayed care, and increased risk of medical errors.

“As a result of the shortage of accident and emergency nurses, emergency patients were attended to by general nurses who did not have the Kenya Registered Accident and Emergency Nursing qualification, which equips nurses with training to handle critical situations and deliver advanced emergency medical treatment,” read the report in part.

Compounding the crisis is a severe shortage of essential medical equipment.

The audit revealed that 90 per cent of Level 4 hospitals lack piped oxygen, a basic requirement for treating critically ill patients. Ventilators—vital for patients in respiratory distress—are also largely unavailable.

Lower-level facilities are even worse off, with many lacking any form of oxygen supply.

Without these critical tools, healthcare workers are often unable to stabilise patients or make timely diagnoses. This forces unnecessary referrals to higher-level hospitals, further delaying treatment and increasing the burden on already strained facilities.

The audit found that 90 per cent of Level 4 hospitals and one-third of Level 5 hospitals do not have intensive care or high dependency units. Among those that do, most fall short of the required bed capacity.

Only one Level 5 hospital met the minimum standard for ICU beds.

As a result, critically ill patients are routinely referred to Level 6 hospitals, leading to overcrowding and stretched resources. In some cases, patients are discharged prematurely from ICUs or retained longer than necessary due to a lack of step-down facilities.

“The audit established that the sampled health facilities did not have adequate equipment for the provision of emergency medical services. For instance, 90 per cent of the sampled Level 4 and 46 per cent of the sampled Level 5 hospitals lacked piped oxygen, while 84 per cent and 80 per cent lacked ventilators, respectively. All sampled Level 2 and Level 3 facilities lacked piped oxygen. Further, out of the sampled facilities, 83 per cent of Level 2 and 62 per cent of Level 3 facilities lacked oxygen cylinders,” read the report further.

The audit revealed that no county has a dedicated budget for emergency medical services. Instead, funding for emergency care is spread across broader health budgets, forcing it to compete with other priorities.

Beyond hospitals and ambulances, the audit highlights weak community-level preparedness as the majority of Kenyans lack basic knowledge of how to respond to emergencies, and community health services remain underdeveloped.

This means that even before an ambulance is called, precious minutes are lost due to a lack of first aid or coordination.

Taken together, these failures point to a system that is struggling at every level—from the community to the highest referral hospitals.

The report calls for sweeping reforms to address the crisis. Key recommendations include the establishment of a national ambulance dispatch centre, introduction of a single toll-free emergency number, and increased investment in ambulances, equipment, and trained personnel.

It also urges county governments to expand emergency departments in lower-level hospitals and allocate dedicated funding for emergency medical services.