In a tweet about Kenya’s third wave of Covid-19 infections, Machakos county governor Alfred Mutua said the country had “less than 300 ICU beds”.
The most recent data reveals there are 390 ICU beds in 32 county health facilities, and 206 beds in five of Nairobi’s largest hospitals. This gives a total of 596 – more than 300 – although we could not pin down the exact number.
And intensive care requires more than just beds with ICU equipment. Trained staff are also essential.
All beds in the intensive care (ICU) and high dependency (HDU) units in his county were “full”, he said on 23 March 2021.
“NIKUBAYA,” he tweeted – Kiswahili for “It’s bad.”
“People are waiting for others to die to get a bed. MASK, avoid BARS, be WISE. HAKUNA VITANDA. [There are no beds].”
On the same day, the Kenya Medical Practitioners Pharmacists and Dentists Union warned that a third wave of Covid-19 infections was limiting space in ICUs.
Responding to Twitter users’ questions about the county’s readiness, Mutua said the “challenge was ICU beds with ventilators”.
What is an ICU bed?
Mutinda Mwanzia, the governor’s spokesperson, told us the claim was accurate and that he’d send us evidence backing it up. We’ll update this report when we receive it.
But what qualifies as an ICU bed?
It must have a ventilator machine, cardiopulmonary monitors, an ICU doctor, an anaesthesiologist, three nurses and other key medical equipment, Dr Andrew Were Onyino told Africa Check.
He is president of the Kenya Medical Association of doctors and dentists.
Dr Idris Chikophe is the secretary of the Critical Care Society of Kenya, which has collected data on ICUs in the country.
He said a functional ICU bed would have a ventilator, monitors to track oxygen, blood pressure and breathing rate, drug delivery devices, critical care nurses, a resident doctor and a consultant.
The Kenya Medical Practitioners and Dentists Council regulates medicine and dentistry in the country. It says the following equipment – and “other medical consumables” – is necessary for intensive or critical care.
An ICU bed with a flexible mattress
Uninterrupted oxygen supply
Blood gas analyser
Patient monitor [for vital signs such as blood pressure]
Infusion pumps [to deliver fluids]
Defibrillator [restores normal heartbeat]
Trained clinical care staff
ICU beds at the start of the pandemic
Kenya has “capacity” for at least 1,000 ICU beds, the health minister Mutahi Kagwe said on 29 March 2020, a few weeks after the country’s first case of Covid-19 was confirmed. But it’s not clear what he meant by this.
Three days later, on 1 April 2020, Kenya’s Council of Governors tweeted that there were a total of 162 ICU beds across the country. But these were in just 25 of Kenya’s 47 counties, meaning that 22 counties had no ICU beds.
A peer-reviewed study submitted in April 2020 said Kenya had 537 ICU beds, with ventilators available at 256 of them. The researchers counted “hospital beds in hospitals that have oxygen supply because oxygen is an essential requirement for the management of Covid-19 patients”.
“Therefore, when ventilators are considered, 281 of existing ICU beds do not have the accompanying equipment to provide care for Covid-19 critically ill patients,” the researchers said.
The study’s data was gathered from both public and private health facilities in Kenya. We have tried to contact its authors.
As of 18 April 2020 Kenya had 518 ICU beds “spread across 79 public and private health facilities”, a senate report on the country’s handling of the pandemic said, citing the health ministry. Of these, 94% or 448 were already in use by non-Covid patients.
The senate report also revealed that there were 297 ventilators in the country, only 90 of them in public health facilities. An additional 30 ventilators had been bought but had not yet been delivered to the counties, it said.
Where are we now?
Hospitals had certainly increased their ICU capacity over the course of the pandemic, Chikophe said, adding that he did not have more data.
In December 2020, president Uhuru Kenyatta said that “infectious disease ICU beds” in the country had increased to 827, from “only eight countrywide” when the first Covid-19 case was confirmed 10 months earlier. The “eight” seems to refer to county health facilities.
But a letter dated 23 March 2021, which the regulator sent to minister Kagwe, showed that five of the largest hospitals in the capital Nairobi had a combined 206 ICU beds. The letter was in response to media reports that hospitals were levying hefty charges for these beds.
On 14 April 2021, county governors reported that there were 390 ICU beds, in 32 counties. But the number was only for county-run health facilities, and excluded private facilities.
Put together, the available data shows that Kenya has at least 596 ICU beds – 390 in the counties and 206 in major hospitals in Nairobi – far more than the 300 the governor claimed. We have not been able to establish a specific number.
Photo: Simon MAINA / AFP
Intensive care is more than just a bed
People who research critical care say there’s no standard definition of an ICU bed. The Organisation for Economic Co-operation and Development says that “a key point, especially for Covid-19 treatment, is that intensive care beds need to be equipped with respiratory equipment”.
There’s more to this, researchers and experts say. Kenyan medics told Africa Check it would be unhelpful, in dealing with the Covid-19 pandemic, to call a hospital bed an ICU bed if it didn’t have important equipment such as ventilators, and trained critical care professionals in attendance.
“If you have a bed without a ventilator, the monitors or trained ICU staff, we cannot say that it is a fully functional ICU bed for a [critically ill] Covid-19 patient,” said Dr Andrew Were Onyino, president of the Kenya Medical Association.
Dr Idris Chikophe, secretary of the Critical Care Society of Kenya, had a similar take. “ICUs have to be fully equipped for them to be considered functional.” He added that trained ICU staff were essential to functionality.
But what is an “intensive care unit”? The World Federation of Intensive and Critical Care, based in the UK, convened a task force to answer the question. The results, reported in a 2017 article in the Journal of Critical Care, produced this 200-word definition.
The report said: “This attempt to standardise definitions notwithstanding, intensive care is provided in different settings across the world today, from ICUs capable of extracorporeal [or life] support in resource-rich areas to makeshift facilities without mechanical ventilators in resource-limited rural areas.
“ICUs are not just a static collection of infrastructure and equipment, but a dynamic force driven by physicians, nurses, and allied health professionals.”
Conclusion: More than 300 ICU beds in Kenya, but unclear just how many
Raising the alarm over a surge in Covid-19 infections and the resulting shortage of intensive care beds, Machakos county governor Alfred Mutua claimed that Kenya had “less than 300 ICU beds”.
The most recent data from county governments shows that, as of April 2021, there are 390 ICU beds in 32 county health facilities. A March 2021 survey of five of Nairobi’s largest hospitals, which excluded the county data, found 206 ICU beds.
This means there are at least 596 ICU beds in Kenya. Although we could not pin down a specific number, the governor’s claim is incorrect.
And researchers say there’s more to intensive care for Covid-19 patients than just ICU beds. This includes adequately trained staff.