We have heard of or witnessed too many incidents where Kenyan citizens have suffered serious losses due to being denied emergency medical treatment, the most recent illustration being the sad story of the little boy who had a fork lodged in his head.
Usually, the denial of such treatment is tied to the victim’s inability to raise the funds required to facilitate the institution to administer the necessary and immediate care. At one point or the other, we have been approached to contribute to a fundraiser following a medical emergency. On other occasions, the patient was unable to receive emergency care and treatment due to the specialists needed not being available, the distance to health centers,
Kenyan Law on Emergency Medical Care and Treatment
The Kenyan Health Act defines a medical emergency as an acute situation of injury or illness that poses an immediate risk to the life or health of a person or has the potential for deterioration in the health of a person, or, if not managed timely, would lead to adverse effects in their well-being.
The same Act defines emergency treatment as the necessary immediate healthcare that must be administered to prevent death or the worsening of a medical situation.
Additionally, the Health Act states that every person has the right to emergency medical treatment which includes pre-hospital care, stabilizing the patient’s health status, or arranging for referral for cases where the health provider of the first call does not have the facilities or capabilities to stabilize the health status of the victim. Most importantly, this Act states that any medical institution that fails to provide emergency medical treatment while having the ability to do so commits an offence and is liable upon conviction to a fine not exceeding three million Kenya shillings.
Similarly, all healthcare providers, whether in the public or private sector, shall have the duty to provide medical emergency treatment. However, the healthcare providers are exempted from this duty where such treatment would go against the best interests of the patient, with the same being communicated to the patient’s next of kin or guardian.
The Constitution (Article 43 (1)) states that every person has the right to the highest attainable standard of health, which includes the right to healthcare services, including reproductive healthcare. No person should be denied emergency medical treatment courtesy of Article 43(2) of the Constitution of Kenya. In light of this, any Kenyan citizen faced with a medical emergency is entitled to receive the best emergency medical care and treatment.
Section 15 of the Health Act imposes a duty on the national government to establish an emergency medical treatment fund for emergencies to provide for unforeseen situations calling for supplementary finance as well as to provide policy and training, maintenance of standards and coordination mechanisms for the provision of emergency healthcare.
The national government is also obligated under the Health Act to develop health policies, laws and administrative procedures and programs in consultation with county governments and health sector stakeholders and the public for the progressive realization of the highest attainable standards of health including reproductive healthcare and the right to emergency medical treatment.
In light of this, the Ministry of Health launched the Kenya Emergency Medical Care (EMC) Policy in July 2021, in line with the World Health Organization (WHO) Emergency Care System Framework, to ensure emergency medical care is provided to all who need it thereby minimizing the morbidity and fatality caused by emergencies.
What Hinders Effective Emergency Medical Care & Treatment, and How can Technology help?
The Kenyan Healthcare Sector is riddled with challenges that hinder effective service planning and delivery. At the top of that list, undeniably, is corruption. At the height of the Covid-19 pandemic, the Kenya Medical Supply Authority (KEMSA) 7.8 Billion Kenya Shillings procurement scandal broke out and remains unsolved till date.
We know of numerous health centers across the country that are either understaffed, ill-equipped, or underfunded as a direct result of either corruption, mismanagement or poor monitoring mechanisms.
The modern lifestyle has brought with it a plethora of diseases that are increasingly affecting the population such as diabetes. The Kenya EMC Policy states that there is an increasing number of patients with acute diseases being presented to emergency departments across the country which is due to the already existing large burden of communicable diseases, the rising incidence of non-communicable diseases such as cancer, hypertension and diabetes, mental illness and trauma, and road traffic injuries.
Another challenge is the inadequate number of health centers to cater to the general populace. The cost of upgrading equipment and modernizing health services for increased efficiency is increasingly higher with each financial year.
More specifically, the absence of the national and county-level institutional and legislative framework and policy to guide both levels of Government on how to effectively deliver the necessary EMC services to citizens makes the implementation of measures to streamline this sector an uphill task.
The Kenya EMC Policy advocates for the establishment of an Emergency Medical Treatment Fund to ensure Kenyans can afford such treatment. The National Health Insurance Fund (NHIF) Amendment Act of 2022 contained a provision for such a Fund though the implementation is still pending. The Policy recommends additional funding allocation by National and County Governments to facilitate capacity building and training of EMC practitioners. This could potentially put a financial strain on county government budgets which would struggle to set aside such funds in the current economic climate.
These challenges enlighten us on the numerous improvements we need to make in the Kenyan health sector service planning and delivery which would in turn improve our emergency medical care and treatment systems. The Government has taken steps towards making such improvements as evidenced by the partnership with WHO to have a medical emergency hub in Nairobi which will have a training center and medical emergency responders.
The Nairobi Governor recently hinted at a partnership with the Kenya Red Cross to enhance the County’s medical emergency response. There is still more to be done to reciprocate such initiatives in other counties as well.
The Kenya Council of Emergency Medical Technicians has made efforts to educate the public about how to respond in emergency situations. In addition to ensuring the public is well informed about how to respond to medical emergencies at the community level, incorporating the use of technology could enable us to make great leaps toward providing the best emergency medical care and treatment.
The Kenyan healthcare system is structured to comprise community facilities, health dispensaries and centers, county hospitals, county referral hospitals, and national referral hospitals, cumulatively referred to as healthcare centers. We need to have an integrated decentralized system capable of being updated and accessible by authorized personnel from any of these healthcare centers. This would enable accurate mapping out of emergency medical care services and service providers across the country, such as public ambulances and emergency departments, in order to ensure full geographical coverage as well as facilitate smooth delivery of such services in all parts of the country.
Blockchain technology should be considered in making such a system due to its capability to securely keep a record of transactions and data maintained over a decentralized peer-to-peer network, with the specific network being controlled and accessed privately by authorized stakeholders in the EMC health sector.
Digital healthcare technologies can help by turning the patient into the point of care, as opposed to the actual health centers, thereby shortening the response time and increasing their recovery rate.
The Ministry of Health could consider incorporating the use of high-tech camera equipment and software for telemedicine which would enable health centers based in rural areas to access specialists’ services from anywhere in the country. Such arrangements would promote a faster response and treatment time as the patient would not have to organize for transferals to get the care that they need when faced with a medical emergency. Moreover, the software can be used to develop apps that not only help to diagnose patients quickly but also reduce medical errors caused by miscommunication between practitioners.
Artificial intelligence (AI) and tailor-made algorithms can be used to pre-check patients to help them determine whether they actually need to seek emergency medical care and treatment. Some patients may discover that their situations do not warrant a trip to the emergency department of their health center thereby saving them from unnecessary expenses in addition to leaving the emergency departments free to attend to those who direly need their services. The health sector in Hungary uses artificial intelligence to allocate logistics and capacity in the daily operations of their National Ambulance Service. Public and private organizations such as E-Plus Ambulances Kenya should lobby the Government to integrate such technology in the service delivery of emergency care and treatment.
These are just some of the ways technology can be used to improve emergency medical care and treatment in Kenya. Implementation, which would require strategic planning and sufficient funding by the Kenyan Government, would greatly improve our chances of survival when faced with a medical emergency by shortening the response time and bringing the required care and treatment closer to the patient. Furthermore, such improvements would create numerous employment opportunities for the Kenyan youth.