Why Kenya must move beyond access and build a truly responsive emergency healthcare system

 A well-equipped ambulance service nearby can mean the difference between life and death. [iStockphoto]

When a medical emergency strikes, seconds matter. Whether it is a road traffic crash, a heart attack, a stroke or a pregnant woman with severe bleeding, the difference between life and death often depends not only on how close a patient is to a hospital, but also on how quickly and effectively the emergency healthcare system responds.

 According to BMJ Global Health, 2026 approximately 93.7 per cent of Kenyans can reach an emergency department within one hour and 98.2 per cent within two hours.

An indicator of progress in expanding geographic access to emergency medical care. However, access alone does not guarantee survival. Response time, quality of care and system readiness are often what determine patient outcomes. At a recent Emergency Medicine Forum held at the Aga Khan University in Nairobi, one message emerged clearly: Kenya must shift its focus from simply improving access to healthcare facilities to building a coordinated, responsive emergency healthcare system that saves lives.

Many preventable deaths occur because symptoms are not recognised early or because bystanders do not know how to provide basic first aid while waiting for professional help. A person experiencing a stroke may not be taken to hospital quickly enough. A patient with severe bleeding may not receive immediate bleeding control. A person in cardiac arrest may not receive cardiopulmonary resuscitation in the critical first minutes. In a truly responsive system, the public is not a passive observer. Communities are the first link in the emergency medical care chain.

This is why public awareness and community preparedness must become part of the national conversation. Ambulance services and pre-hospital emergency care deserve greater attention because even when an emergency is recognized, the patient must still reach care in time. Ambulance response takes an estimated 15-25 minutes in urban centres.

 The same is not true for rural communities. Poor road infrastructure, long distances and uneven distribution of emergency resources can significantly delay response. Ambulances are not simply transport vehicles. In a working healthcare system, they serve as professionalized mobile treatment units.

Developing ambulance services, must therefore remain national priorities. , Ambulance services and emergency departments across the country are increasingly prioritising Basic Life Support and Advanced Life Support training for their staff.

 This is an important step because the first healthcare provider to reach the patient must be prepared to act quickly and competently. At the health facility, the system must be ready administer the right level of care. This does not mean that every health facility can provide the full range of emergency medical care. Kenya needs fully operational emergency departments across the country, particularly in county referral and high-volume hospitals.

Lower-level facilities must recognise emergencies, provide initial stabilisation and activate timely referral. Basic interventions such as airway support, bleeding control and resuscitation should be available early in the patient journey, while definitive emergency care should be provided in properly designated and equipped emergency departments.

Without this, patients lose valuable time and increase the risk of complications and death. The growth in investment in emergency medicine training is encouraging. For years, emergency departments across the country relied largely on general practitioners who, despite their dedication, often lacked specialised training in emergency medical care.

 This contributed to inconsistencies in the management of critically ill and injured patients with life-threatening conditions. Institutions such as Aga Khan University, Nairobi, are helping address this gap through emergency medicine training programmes. These initiatives are building a cadre of healthcare professionals with specialised emergency medical care skills.

As this workforce grows, Kenya has an opportunity to strengthen the quality of care delivered in emergency departments and improve outcomes for patients who arrive in critical condition. Financing remains another critical challenge along the patient journey. In many emergency situations, treatment delays are not caused by clinical limitations but by financial uncertainty.

Patients and families are often forced to consider costs before care can begin, even when every minute counts. Recent reforms under the Social Health Authority offer reason for optimism. The Emergency, Chronic and Critical Illness Fund is intended to reduce financial barriers during life-threatening situations, allowing healthcare providers to focus on stabilising patients without unnecessary delays.

The Primary Health Care Fund is equally important because it strengthens lower-level facilities and provides access to essential services without out-of-pocket payments.

By supporting primary healthcare, the system can reduce unnecessary referrals and prevent higher-level hospitals from becoming overwhelmed. The greatest threat to Kenya’s emergency healthcare system is coordination. It takes more than individual components functioning in isolation.

It demands seamless coordination among Sector players Weakness in any part of this chain can undermine the entire emergency response. Kenya has made important strides in emergency medical care, but the work is far from complete.

The next phase must focus on building a complete emergency care pathway: communities that can recognise emergencies and call for help, dispatch systems that can coordinate rapid response, ambulance services that can provide pre-hospital care, health facilities that can stabilise and refer appropriately, dedicated emergency departments that can deliver definitive emergency medical care, and financing mechanisms that allow treatment to begin without delay.

Building a system that is ready to act when lives are on the line must therefore be the ultimate goal. Because in emergency medical care, every minute, every decision and every intervention has the potential to save a life.

Dr Wachira is a consultant emergency medicine physician