Kenya’s Health System Might Take Longer To Recover From COVID-19

Several researchers are assessing the impact of 2020’s Covid-19-related restrictions on healthcare in Kenya.

After the virus was first reported in Kenya on March 13, President Uhuru Kenyatta announced a nationwide 7pm to 5am curfew. He also ordered the closure of all learning institutions on March 26, 2020.

This was followed by the containment of movement within Nairobi, Mombasa and Kwale beginning April 6, initially for 21 days but extended until July 6, 2020. The lockdown was lifted and the curfew later eased.

But an ongoing analysis by Kenya’s Ministry of Health shows the country might take years to recover from the consequences of these restrictions. Preliminary data show the immediate impact was a sharp drop in the number of Kenyans visiting health facilities.

Dr Hellen Kiarie, head of Monitoring and Evaluation at the Ministry of Health, said the ministry looked at 30 health indicators between January and September, 2020.Then they compared with indicators for a similar months in 2018 and 2019.

These include the utilisation of health services: reproductive, maternal, new-born, child and adolescent health (RMNCA) services, communicable diseases, non-communicable diseases and medical conditions linked to violence.

Sharp drop in hospital visits

The most noticeable change is a sharp drop in the number of people visiting health facilities between April and September, 2020. Read our previous article -Covid-19: Patients Keep Off Hospitals in Kenya

In March 2020, the number of Kenyans visiting health facilities was about 9.4 million, but sharply dropped to 6.5 million in April 2020. April had the biggest drop in outpatient visits throughout last year.

The ministry’s data show in April 2019, 8.5 million Kenyans visited health facilities compared to 8.2 million in 2018. The data were captured through the Kenya Health Information System.

“The 2020 OPD (Outpatient Department) visits are distinctly lower compared to 2018 and 2019.  Nationally, total OPD visits for January – September 2020 declined by 27 per cent compared to a similar period in 2019,” Dr Kiarie said.

Consequently, hospital bed occupancy dropped since March 2020 and remained lower than the previous two years. For instance, in May 2018, bed occupancy was 74 per cent, then increased to 112 per cent in 2019, before crashing to 34.5 per cent in May 2020.

Reproductive health services were not badly affected. First antenatal visits by pregnant mothers between January and March 2020 were generally higher than in the previous two years. However, there was a 23 per cent drop in April followed by consistent recovery in subsequent months.

“The drop in April is consistent with previous years so this may not be due to Covid-19 but seasonal variability,” Dr Kiarie said.

In September 2020, only eight counties experienced a decline in first Antenatal Care (ANC) attendance compared to September 2019. These are Nairobi, Kiambu, Bomet, Embu, Machakos, Tana River, Kisii and Uasin Gishu.

The data suggest a decline in skilled birth attendance for April and May 2020 with recovery observed in the beginning of July.

“Most of the decline in the number of skilled birth attendances were observed in quarter two and involved mainly counties in Northern, Eastern and Western Kenya,” Kiarie said.

Adolescent pregnancy

Surprisingly, the data does not show any increase in adolescent pregnancies in 2020, and actually the numbers are less than the numbers in 2018 and 2019.

Local media had reported a surge in teenage pregnancy, without actual data to back up the claims. There were talks about 4000 girls who got pregnant in Kwale.

In June 2020 an online news story reported that 4,000 schoolgirls had become pregnant since March in the eastern Kenya county of Machakos. The figure was attributed to the county children’s officer commenting on the International Day of the African Child.

The ministry explained that any increase in adolescent pregnancy would likely be realized later as most pregnant women begin attending antenatal care at around five months of pregnancy, while adolescents delay further by about one or two more months.

Nationally, the administration of the three doses of diphtheria-tetanus-pertussis (DTP3) vaccine to children remained relatively stable compared to past years.

However, in some semi-arid counties, there was a 25 percent decline in the number of doses administered compared to 2019.

Pneumonia is the biggest killer of children in Kenya, according to the Ministry of Health. However, in 2020, there was a marked decrease in children with pneumonia symptoms in April and this remained low throughout last year.

In April, cases of pneumonia in children fell by 44 per cent to about 30,000 cases, compared to the average for April 2018 and 2019.

Dr Kiarie explains that this could be a reflection of low OPD utilisation rates and could also indicate decreased pneumonia due to Covid prevention measures.

Reduced HIV tests

Uptake of HIV-related services reduced slightly. The biggest drop was in April 2020 when only 321, 644 HIV diagnostic tests were carried out, compared to 763, 842 tests in April 2019.

However, the tests rose as travel restrictions were eased and in October 2020, 415,363 tests were carried out, compared to 587,861 in October 2019.

HIV/AIDS Trends in HIV test performed  (Jan-Sept, 2018-2020

The ministry attributes the drop to the fact that no mass testing campaign was done last year. Also, the ministry moved to more targeted facility testing, and implemented partner notification services where partners of those who test positive are notified and encouraged to go for tests as well. The slight decline was also likely due to less hospital visits during the lockdown.

Confirmed Malaria cases remained generally low since Covid-19 started, which could be explained by low hospital visits, Dr Kairie said.

The ministry’s data shows a mixed picture for Non-Communicable Diseases (NCD). For instance, save for a slight decrease in newly diagnosed diabetes cases – 35,000 in April 2020 compared to 37,000 in 2019 – new cases remained higher last year compared to 2018 and 2019.

The ministry said reported cases of domestic violence increased sharply since April 2020. July had the highest number of cases at 16,000, compared to about 11,700 cases in July 2019 and about 7,000 in 2018. These cases are likely to be higher because many cases go unreported.

“Women and girls were disproportionally affected as communities were forced to stay home,” Dr Kiarie said.

Similar Covid-19 effects globally

According to the World Health Organisation (WHO), the situation in Kenya was not unique. In June 2020, the WHO released results of a survey completed in 155 countries during a three-week period in May, confirming that the impact was global, but that low-income countries were most affected.

The main finding was that health services were partially or completely disrupted in many countries. More than half (53 per cent) of the countries surveyed had partially or completely disrupted services for hypertension treatment; 49 per cent for treatment for diabetes and diabetes-related complications; 42 per cent for cancer treatment, and 31 per cent for cardiovascular emergencies.

In the majority (94 per cent) of countries responding to the WHO survey, ministry of health staff working in the area of NCDs were partially or fully reassigned to support Covid-19.

The result was that many diseases went undiagnosed and patients missed appointments with healthcare providers.

”It will take some time before we know the full extent of the impact of disruptions to health care during Covid-19,” said Dr Bente Mikkelsen, Director of the Department of Non-Communicable Diseases at the WHO headquarter in Geneva, Switzerland.

What journalists should do:

1.Find out how the Ministry of Health (MoH) plans to catch up. For instance, vaccinate millions of children who         missed their vaccination against polio and measles.

2.Interview people who were affected, for instance, people with scheduled surgeries that did not take place.

3. Interview heads of private hospitals who rely on patient volume to operate and pay workers, whether they          managed to recover from the fall in income.

4. Check on the impact on health workers, how many have died and how many were infected.

5. Check the experiences of other countries that had similar lockdowns to Kenya. How did their health systems cope?

6.Interview health system experts on what is the overall impact of the lockdown on Kenya’s health system.

7. Focus on single areas of health that were affected, for instance, HIV testing, maternal health or Non-Communicable Diseases. Explore the impact and how the government plans to address them.

8. Check our LIST OF EXPERTS for this and other topics.