Maternal, Surgical Safety Lapses Persist in Kenya’s Hospitals, Report Shows

Only 61 per cent of Kenya’s health facilities are adequately prepared to deliver safe and effective care, according to a new government report assessing the country’s healthcare standards.

The 2024 Kenya Health Facility Assessment, released by Health Cabinet Secretary Aden Duale, exposes widespread gaps in service quality, infrastructure, and resource allocation across 3,605 facilities nationwide. While Kenya has expanded access to key services such as maternal health and immunisation, the report warns that the quality of care remains inconsistent and, in many cases, insufficient.

A major concern is the shortage of essential medical equipment. Forty-one of the country’s 47 counties have requested laboratory support through the National Equipment Service Programme (Nesp), launched in late 2023 to replace the previous Medical Equipment Service initiative. Nesp allows counties to access diagnostic equipment on a fee-for-service basis, but the level of demand highlights the depth of existing infrastructural deficiencies.

The assessment introduces two key measures of performance: the Structures Index, which evaluates physical and operational readiness, and the Process Index, which tracks compliance with clinical procedures. Both average 61 per cent nationally. 

Hospitals and faith-based or NGO-run facilities perform better than public and lower-tier centres, and urban facilities generally score higher than rural ones, underscoring persistent regional inequalities. Dr Patrick Amoth, Director General at the Ministry of Health, noted that quality improvement teams are present in 92 per cent of Level 5 hospitals but only 63 per cent of Level 3 facilities. 

“Generally, hospitals and faith-based organisations had higher scores compared to primary level and public facilities,” he said.

Patient safety indicators show particularly weak results. Maternal and perinatal death reviews are carried out in most facilities, 84 per cent and 76 per cent respectively, but only 34 per cent review surgical deaths. Just 28 per cent track adverse surgical events, such as infections or deaths within 24 hours, and fewer than 40 per cent monitor antibiotic use or review prescriptions to detect antimicrobial resistance.

The data reveal wide disparities across facility levels and ownership. Level 5 hospitals lead in surgical death reviews and event tracking, while Level 2 and 3 facilities perform poorly. Public facilities are more consistent in conducting formal death reviews, but private centres are more likely to monitor surgical outcomes. 

Counties such as Kajiado and Bomet perform strongly, whereas others, including Tana River, lack systems for surgical safety surveillance altogether. The report also highlights challenges facing healthcare workers. Only 25 per cent of facilities monitor staff safety, and just 21 per cent of medical staff have received promotions in the past three years. Incidents of assault against health workers, mostly by patients, were reported in 17 per cent of facilities, with Busia County recording the highest rate at 33 per cent. 

Despite these concerns, 85 percent of staff reported timely salary payments, and nearly 70 percent said workloads were fairly distributed. Registered nurses make up the largest share of the workforce at 28 per cent, followed by clinical officers and laboratory staff. Most employees hold diploma-level qualifications, and fewer than half are on permanent contracts. Routine performance reviews take place in 63 per cent of facilities, with Bomet and Kajiado counties showing the strongest adherence.

Patient satisfaction levels remain high in family planning services, with 98 percent of clients reporting respectful treatment and 82 per cent receiving their preferred method. However, 15 percent said they felt pressured to accept alternatives, raising questions about consent and autonomy. CS Duale said the assessment provides essential data to guide improvements in healthcare delivery. 

“Despite progress in coverage, we continue to face high maternal and childhood mortality rates and a growing burden of non-communicable diseases,” he noted. 

The report, he added, is intended to help policymakers identify service gaps and direct reforms accordingly.