By The Weekly Vision Reporter
Somewhere in Kenya, right now, someone is dialling for help that will not arrive in time. The ambulance parked outside the county hospital has no fuel. The toll-free line rings into silence. The ward that should be stabilising a dying patient has no oxygen, no ventilator, and one nurse for every hundred people who need her. This is not speculation. It is the documented, audited state of a system meant to stand between Kenyans and death, and the Auditor-General has now put it on the record
Perhaps the most harrowing of the Auditor-General’s recent specialised evaluations is the audit of emergency medical care services, tabled before Parliament early this year. The audit examined 114 health facilities across 16 counties: Tharaka Nithi, Nairobi, Kisumu, Mombasa, Kiambu, Kisii, Busia, Narok, Nakuru, Kirinyaga, Tana River, Garissa, Isiolo, Machakos, Nyandarua and Uasin Gishu, over the four financial years from 2021/22 to 2024/25. Its findings amount to a systemic indictment of Kenya’s pre-hospital and hospital-based emergency response capacity.
Across multiple counties, vehicles recorded in government asset registers as operational ambulances were found to be non-functional, grounded by mechanical failure, out of fuel, or missing critical equipment, in some cases for months or years without repair. The audit also flagged procurement irregularities, including vehicles bought at inflated prices, delivered without the equipment specified in supply contracts, or sourced from suppliers who did not meet tender requirements.
Against an internationally accepted standard of 15 to 20 minutes for an ambulance to reach a patient, the audit found delays of 20 minutes to a full hour in counties where dispatch records were available, and longer in some cases. Nairobi County, despite being the country’s best-resourced, was found to have only 20 of the 50 ambulances its population requires, with response times ranging from 20 to 60 minutes depending on traffic and time of day. Mombasa and Kisii recorded the worst response times among the counties assessed, with ambulances taking up to an hour to reach patients.
Of the Level 4 hospitals audited, only nine per cent had a dedicated accident and emergency unit, and none had a separate paediatric emergency section. Thirty of the 33 Level 4 hospitals examined, including facilities in Nairobi, Kisumu, Nakuru, Mombasa, Machakos and Kisii, lacked proper accident and emergency departments altogether. Ninety per cent of Level 4 hospitals had no piped oxygen, and 84 per cent had no ventilators.
Nurse-to-patient ratios stood at 1:100 in Level 4 hospitals and 1:122 in Level 5 referral hospitals, far below the World Health Organisation’s recommended ratio of one nurse to four patients. The audit further found that ambulances were frequently staffed by drivers with no formal training in emergency vehicle operations. That counties were not employing Emergency Medical Technicians or paramedics as a standard part of the emergency workforce, relying instead on nurses pulled from hospital wards.
Of the 16 counties reviewed, 12 reported having dispatch centres, but even these were frequently non-functional in practice, lacking real-time electronic tracking, toll-free public numbers, reliable internet connectivity or backup power. The human cost of these gaps is not abstract.
Michael Wafula, a hit-and-run victim in Machakos County who died after more than 30 calls to hospitals, county emergency lines and the national toll-free numbers, 999, 112 and 911, went unanswered over five hours, before he succumbed on the way to hospital in a school bus.
The Auditor-General’s report notes bluntly that a vehicle without functioning medical equipment is not an ambulance but a transport vehicle, and that a patient loaded into one without oxygen, airway management capacity, or the means to communicate with a receiving hospital is not receiving emergency care, but is simply being moved from one location to another while their condition deteriorates.
In response, the Social Health Authority (SHA) has announced plans to launch a national ambulance dispatch service, under which the government would cover Sh4,500 per emergency evacuation along with 24 hours of free emergency care at the receiving facility. Health Cabinet Secretary Aden Duale has said the dispatch centre is in the final stages of onboarding both public and private ambulances, though the rollout has faced delays.
Under Article 229 of the Constitution and the Public Audit Act, 2015, Parliament is required to debate and act on the Auditor-General’s reports within three months of receipt. For a system where the difference between life and death is measured in minutes, the question is no longer whether the failures are known; the audit has settled that, but whether anyone in a position of power will act before the next Michael Wafula is buried.
