A recent audit has exposed a nationwide crisis in emergency medical services, revealing that survival chances are dangerously low for patients facing medical emergencies outside major urban centres.
The Auditor General’s November report highlights systemic failures from ambulance availability to hospital readiness, leaving communities across Kenya exposed to avoidable deaths.
The report tabled in Parliament by Auditor General Nancy Gathungu shows that nearly one in three ambulances across both rural and urban counties are out of service.
Even when vehicles are available, response times often far exceed the global benchmark of 15–20 minutes, stretching up to an hour in some counties. The absence of a national ambulance dispatch system has worsened the situation, with most counties lacking real-time tracking, toll-free lines, and reliable communication networks.
“There is an inefficient ambulance transport system at both the national and county level, mainly due to a lack of established ambulance dispatch centres,” Gathungu said. “These inefficiencies have resulted in slow ambulance response times of up to sixty minutes.”
Of the eight counties with available data, only Machakos dispatched ambulances on schedule. In contrast, Mombasa recorded 60-minute delays, Kisumu and Nairobi 20–60 minutes, Kiambu 30–45 minutes, Narok 30 minutes, Kisii 60 minutes, and Kirinyaga 20–40 minutes.
Shortages and poor maintenance further cripple the system. Kiambu lacked 11 ambulances, Busia seven, Mombasa five, and Nairobi 30—the largest deficit recorded.
Other counties such as Uasin Gishu, Nyandarua, Isiolo, Tharaka Nithi, Kisumu, Tana River, and Garissa faced similar challenges due to missing fuel, equipment, and trained emergency medical technicians.
Overall, 34 per cent of the 269 ambulances audited were non-operational, and many lacked essential life support equipment.
Hospitals, particularly Level 4 facilities, offer little relief. Only nine per cent of these hospitals have dedicated accident and emergency departments, and none of them provide separate paediatric care.
Thirty out of 33 Level 4 hospitals sampled, including facilities in Nairobi, Kisumu, Nakuru, Mombasa, and Machakos, had no proper A&E departments.
“Emergency medical care services in all levels of health facilities in the country are inefficient. Where A&E departments exist, they lack adequate personnel, are not well equipped and often lack required medicine and essential consumables,” the report notes.
Staffing is critically low, with nurse-to-patient ratios as extreme as 1:100 in Level 4 hospitals and 1:122 in Level 5 facilities, far from the World Health Organization’s recommended 1:4 ratio.
Equipment shortages are widespread: 90 per cent of Level 4 hospitals lack piped oxygen, 84 per cent have no ventilators, and essential drugs are frequently out of stock.
Critical care units are also scarce—90 per cent of Level 4 hospitals and a third of Level 5 hospitals have no ICU, and those that exist are poorly equipped and overstretched.
To address these gaps, the Auditor General recommends that county governments set up fully functional A&E departments in Level 4 and 5 hospitals, adequately staffed and equipped with essential drugs, medical devices, and consumables.
