A recent government audit has exposed major gaps in critical care across county hospitals, showing that most Level 4 facilities in Kenya are operating without intensive care or high dependency units.
This shortfall leaves critically ill patients with few options and has forced many to travel long distances for emergency treatment.
Auditor General Nancy Gathungu, in her report for the financial year ending 2025, revealed that 90 per cent of Level 4 hospitals lack ICU and HDU facilities, while one-third of Level 5 hospitals are also without these essential units.
The findings indicate that national standards for emergency care are not being met, putting patient lives at risk and overburdening higher-level hospitals.
“Interviews and physical verification in the sampled hospitals revealed that 30, representing 90 per cent out of 33 Level 4 hospitals, and five, representing 33 per cent, out of 15 Level 5 hospitals did not have ICUs and HDUs, respectively,” Gathungu said.
The Kenya Medical Practitioners’ Hospital Checklist for Categorisation of Health Institutions requires that Level 4, 5, and 6 hospitals operate ICU and HDU units with at least six, 12, and 24 functional ICU beds respectively.
The audit found that none of the sampled Level 4 hospitals met the minimum six-bed standard, and only Coast General Teaching and Referral Hospital among the Level 5 facilities complied with the 12-bed requirement.
Beyond infrastructure, the report flagged severe staff shortages. Many ICUs that do exist are poorly staffed, with too few nurses trained in critical care to monitor and manage patients needing continuous attention.
The report points to weak financial governance at the county level as a major contributing factor.
“Counties do not have ring-fenced emergency medical care budgets. Funds for emergency care are mixed with other health expenditures, and even hospitals lack specific budget lines for emergency services,” reads the audit.
Without dedicated funding, hospitals are unable to build ICU capacity, train nurses, maintain equipment, or stock essential medicines. The audit also revealed that 90 per cent of Level 4 hospitals lack piped oxygen, a basic necessity for intensive care, while the absence of step-down units further strains ICU resources.
“Due to a lack of functional HDU beds, patients would be moved from the ICU directly to the wards or be retained at the ICU for recuperation; this further limits the availability of already strained ICU bed capacity in the hospitals,” Gathungu added.
According to the Kenya Master Health Facility List, as of 2022, Kenya had 358 Level 4 hospitals and 14 Level 5 hospitals. Level 4 hospitals serve as sub-county referral centres, while Level 5 hospitals act as county referral facilities offering broader secondary care, medical internships, and paramedical training.
