Counties under scrutiny over Ebola preparedness as cases rise

County governments are facing scrutiny over their preparedness for an Ebola outbreak, with health workers warning that gaps in isolation facilities, protective equipment and emergency response systems could undermine efforts to contain the disease.

Despite health being a devolved function, healthcare providers say counties have yet to demonstrate the level of preparedness expected of them, with much of the visible response appearing to be driven by the national government.

In an interview with the Sunday Standard, health experts and healthcare workers questioned whether counties could manage suspected cases if the disease spread beyond areas currently under surveillance.

The Kenya Medical Practitioners and Dentists Union (KMPDU) has urged county governments to implement guidelines issued by the Ministry of Health and the World Health Organisation (WHO), warning that preparedness must go beyond training healthcare workers.

KMPDU Secretary General Dr Davji Atellah said every hospital with an accident and emergency unit should establish a designated isolation area for suspected cases.

“We know all Level Four and Level Five hospitals have emergency units, but they should also set aside an isolation area,” said Atellah.

“Counties must respond in line with the guidance issued by the Ministry of Health. We need to know how many counties are complying and to what extent,” he added.

Atellah said measures being implemented by the national government, including the management of suspected cases and their contacts, should be replicated at the county level.

“We have seen the measures taken by the Ministry of Health to handle the case and manage contacts. We need to see the same level of response in the counties,” he added.

The national government has designated five laboratories for testing, including two mobile laboratories at the Lwakhaha and Busia border points.

Health Cabinet Secretary Aden Duale said at least 241 isolation beds had been set up in five hospitals in Nairobi, Eldoret and Mombasa, including 50 intensive care unit (ICU) beds at Moi Teaching and Referral Hospital.

The government has also trained 4,917 healthcare workers to handle Ebola.

Kenya has recorded seven cases, including one death, with the Ministry of Health listing at least 130 contacts for follow-up.

Some of the cases involve family members of the first imported case, who had travelled from the Democratic Republic of Congo (DRC) before being diagnosed in Kenya. The patient died on October 5.

Experts have warned that the number of cases could increase, heightening concerns about the capacity of counties to respond.

Atellah expressed concern that the national government appeared better prepared than county administrations, warning that the two levels of government could not afford to work in isolation during an outbreak.

KMPDU Deputy Secretary Dr Dennis Miskellah echoed the concerns, saying laxity among county governments could undermine containment measures.

He accused governors of embracing their devolved health responsibilities when dealing with matters such as recruitment but becoming less visible when emergencies demanded urgent action.

Miskellah questioned how counties would protect frontline workers if suspected Ebola cases were reported in facilities lacking adequate personal protective equipment (PPE), isolation units, medicines and other essential supplies.

With local transmission reported, he said counties should already have identified and communicated the locations and capacities of their isolation facilities to enable health authorities to respond quickly when suspected cases are detected.

“Have counties shared information about established quarantine, isolation wards and ICUs to handle Ebola? Do Kenyans in counties know here to seek services, in case they exhibit symptoms of the disease?” posed Miskellah.

“If someone falls sick in Mombasa or Machakos, will these counties have to transport the patient to Nairobi for care? Counties should know patients are tested and treated where they are, not moned,” he said.

Miskellah also claimed that some facilities previously designated for isolation had since been converted to other uses.

He cited Mbagathi Hospital, where he said an isolation ward had been converted into a maternity unit, and Meru, where he alleged an isolation facility had been turned into an outpatient department.

He warned that without clear referral pathways, counties could struggle to transport suspected cases safely and ensure their prompt management.

Instead of taking immediate action, he claimed, many counties were waiting for funding from the national government.

During the Covid-19 pandemic, counties received Sh11 billion from the National Treasury and development partners for preparedness. However, Miskellah said the funding did not translate into adequate infrastructure, with some counties failing to establish the expected isolation wards and ICU beds, while others procured substandard PPE.

“Counties are just watching from the sidelines, waiting for the Ebola billions to trickle down to them. Yet, even with the money, they will do nothing,” he claimed.

Drawing lessons from the Covid-19 pandemic, Miskellah said the national government should consider taking a more direct role in establishing emergency response infrastructure within counties instead of relying entirely on devolved units.

“I am sure counties are just watching and doing nothing, hoping they will receive money from the national government. We must learn from the mistakes made during Covid-19 and hold them accountable. Even if it means the Ministry of Health has to build isolation wards and ICUs, it should be done,” he said.

Miskellah challenged county governments to publicly account for their preparedness, including the availability of isolation wards, trained personnel, essential medicines, blood supplies and protective equipment.

“We have seen the WHO, partners and the Ministry of Health commit themselves to finding a quick solution to Ebola, but governors are sitting comfortably without doing much,” he said.

Healthcare workers fear shortages and inadequate training

Kenya Clinical Officers Union Chairperson Peterson Wachira said the absence of adequate structures to handle suspected cases could worsen the situation if infections increased.

“If we have many cases, we may not be home and dry,” he said.

Wachira called for more training for healthcare providers, saying preparedness required both infrastructure and skills.

“We are doing well in terms of hardware (infrastructure), but need bare in software, we need training and skills,” he added.

Healthcare workers are also calling for counties to recruit more staff, warning that an Ebola outbreak would place additional pressure on an already stretched workforce.

The strain would affect all cadres, including clinical officers, doctors, nurses, laboratory technicians and public health officers.

Miskellah said counties needed to consider how they would maintain routine healthcare services if workers were deployed to manage Ebola cases or placed in quarantine.

“Counties should know that healthcare workers shall not break their back doing double shifts with Ebola. Remember, women will still deliver, and surgeries done, who then shall respond to Ebola. And if we respond, who will run hospitals for other services?” he posed.

Even as counties announce training programmes for healthcare providers, KMPDU questioned whether the training adequately covered infection prevention and control, including the correct procedures for putting on and removing protective equipment.

“Even training on doffing PPEs, are the PPEs there in the first place? What happens if healthcare workers contract the disease or have to be isolated? Who will continue delivering women, performing surgeries and handling other patients if more workers are quarantined?” posed Miskellah.

Kenya Union of Nurses and Midwives Secretary General Seth Panyako said the country had gained valuable experience in managing infectious disease outbreaks, particularly in isolation, quarantine, PPE use and infection prevention and control.

“Because we managed to navigate Covid-19, although we lost many of our people, I think we are better placed,” he said.

However, Panyako said the availability of quality PPE remained a potential weakness, questioning whether equipment procured for healthcare workers met the required standards.

He cited an incident in Kisumu during the Covid-19 pandemic in which, he said, money donated for PPEs was used to purchase substandard equipment, exposing healthcare workers, particularly nurses, to infection.

“Those in power must ensure that healthcare workers have quality PPEs and receive continuous training,” said Panyako.

He added that training should be continuous rather than treated as a one-off exercise, while health facilities should be ready to activate isolation arrangements when an outbreak occurs.

“If an outbreak of Ebola is reported, isolation facilities shall be converted,” he said.

Efforts to obtain a response from Council of Governors chairperson Muthomi Njuki and the council's Health Committee chairperson Abdulswamad Shariff Nassir were unsuccessful.

Miskellah said the response to the outbreak required stronger coordination between the national and county governments, warning that fragmented efforts could weaken containment.

“There is a breakdown in leadership in healthcare in the country. You cannot run healthcare where every county is doing its own thing. In the current outbreak, we are hearing the voices of the Ministry of Health, the Health CS and the President, but we have not heard anything from counties or governors,” he observed.