Counties across Kenya have failed to meet basic emergency response standards, leaving patients to wait hours before receiving urgent care, according to recent reports from Auditor General Nancy Gathungu.
The audits reveal a dire state of emergency medical services, with nearly one-third of ambulances across the country sitting idle and hospitals poorly equipped, creating life-threatening delays in both urban and rural areas.
Covering financial years 2017/2018 to 2021/2022 and 2021/2022 to 2024/2025, Gathungu’s performance audit reports highlight systemic weaknesses affecting ambulance availability, hospital preparedness, and overall patient care.
Ambulance Shortages and Delays Put Lives at Risk
The reports show that ambulance services are severely under-resourced. Across multiple counties, response times fall far below international standards, which recommend ambulance arrival within 15–20 minutes. In some regions, patients wait up to one or two hours for help.
“Of 269 ambulances reviewed, 34 per cent were non-functional, with many lacking basic life-support supplies,” the audits reveal.
Counties like Kiambu, Busia, Mombasa, and Nairobi face severe shortages, with Kiambu lacking 11 ambulances and Nairobi missing 30. In other counties – including Uasin Gishu, Nyandarua, Isiolo, Tharaka Nithi, Kisumu, Tana River, and Garissa – ambulances remain grounded due to lack of fuel, missing equipment, or insufficient trained staff.
The absence of a coordinated national dispatch system worsens the problem. Counties rely on outdated communication methods, have no real-time tracking, and in many cases, lack toll-free emergency contact lines. Only Machakos met the recommended dispatch time, while Mombasa recorded delays of up to 60 minutes, Kisumu and Nairobi 20–60 minutes, Kiambu 30–45 minutes, Narok 30 minutes, Kisii 60 minutes, and Kirinyaga 20–40 minutes.
Hospitals Ill-Equipped and Understaffed
Hospitals provide limited relief. Only nine per cent of Level 4 hospitals audited had dedicated accident and emergency (A&E) units, and none had separate pediatric emergency sections. Thirty out of 33 Level 4 hospitals – including facilities in Nairobi, Kisumu, Nakuru, Mombasa, Machakos, and Kisii—lack proper A&E departments.
Staffing levels are critically low, with nurse-to-patient ratios at 1:100 in Level 4 hospitals and 1:122 in Level 5 hospitals, far below 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 unavailable. Most hospitals also lack intensive care units.
Previous audits released in June 2024 linked inadequate ambulance services and weak referral systems to high maternal and newborn deaths. Reviews of 146 death cases showed many fatalities resulted from delays in accessing ambulances at the community level or during inter-facility transfers.
Auditor General Calls for Urgent Reforms
Gathungu has urged county governments to establish fully operational A&E departments in Level 4 and 5 hospitals, staffed with trained personnel and equipped with essential drugs and functional equipment. She warned that without urgent reforms, preventable deaths will continue to rise.
“This is a wake-up call for counties to prioritize emergency medical services. Every delay in response could cost a life,” the report notes.
The findings highlight the urgent need for investment in ambulance fleets, hospital preparedness, and a coordinated national emergency response system to safeguard Kenyan lives.
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