NAIROBI, Kenya – Counties across Kenya are failing to meet basic emergency response standards, leaving critically ill and injured patients waiting hours for life-saving care, according to new audit reports by Auditor General Nancy Gathungu.
The findings paint a grim picture of emergency medical services, with nearly a third of ambulances non-functional, weak dispatch systems and hospitals ill-equipped to handle emergencies — gaps that auditors warn are costing lives.
The two performance audits, covering the periods 2017/2018 to 2021/2022 and 2021/2022 to 2024/2025, reveal systemic failures stretching from ambulance availability and response times to hospital preparedness for emergency care.
According to the latest report, 34 per cent of the 269 ambulances reviewed were non-operational, many lacking basic life-support equipment, fuel or trained staff.
In several counties, ambulances were grounded altogether due to missing supplies or personnel shortages.
The lack of a coordinated national emergency dispatch system has further worsened response times.
Most counties rely on outdated communication methods, with no real-time ambulance tracking and, in many cases, no toll-free emergency numbers.
As a result, response times routinely fall far below international standards, which recommend ambulance arrival within 15 to 20 minutes.
In some regions, patients waited up to one or two hours before receiving emergency transport.
“Response times of up to 60 minutes often lead to loss of life,” Gathungu noted, attributing the delays to inefficient ambulance transport systems and the absence of properly established dispatch centres at both national and county levels.
Data from eight counties show that only Machakos met the recommended dispatch time.
Elsewhere, delays were recorded in Mombasa (60 minutes), Kisumu and Nairobi (20–60 minutes), Kiambu (30–45 minutes), Narok (30 minutes), Kisii (60 minutes) and Kirinyaga (20–40 minutes).
Ambulance shortages are also widespread. Nairobi alone faces a shortfall of 30 ambulances, while Kiambu needs 11 more, Busia seven and Mombasa five.
Hospitals offer limited relief once patients arrive. The audits found that only nine per cent of Level 4 hospitals had dedicated accident and emergency (A&E) units, while none had separate paediatric emergency sections.
Thirty out of 33 Level 4 hospitals reviewed — including facilities in Nairobi, Kisumu, Nakuru, Mombasa, Machakos and Kisii — lacked proper A&E departments.
Staffing levels were critically low, with nurse-to-patient ratios reaching 1:100 in Level 4 hospitals and 1:122 in Level 5 hospitals, far below the World Health Organisation’s recommended ratio of 1:4.
Equipment shortages were equally severe, with 90 per cent of Level 4 hospitals lacking piped oxygen, 84 per cent without ventilators and most lacking intensive care units. Essential emergency drugs were frequently unavailable.
A previous audit released in June 2024 linked weak ambulance services and poor referral systems to high maternal and newborn deaths.
Reviews of 146 death cases showed many were caused by delays in accessing ambulances at the community level or during referrals between health facilities.
Gathungu has now urged county governments to urgently establish fully operational A&E departments in Level 4 and 5 hospitals, staffed with trained personnel and equipped with essential drugs and functional equipment.
Without swift reforms, she warned, preventable deaths will continue to rise.
