NAIROBI, Kenya — Ninety per cent of Level 4 hospitals in Kenya lack Intensive Care Units (ICUs) or High Dependency Units (HDUs), leaving critically ill patients with limited access to emergency care, a report by Auditor General Nancy Gathungu has revealed.
The audit covering the period ending 2025 found that 30 out of 33 sampled Level 4 hospitals had no ICU or HDU facilities.
Among 15 Level 5 hospitals reviewed, five — representing 33 per cent — lacked the required units.
“Interviews and physical verification in the sampled hospitals revealed that 30, representing 90 per cent out of 33 Level 4 hospitals, and five, representing 33 per cent, out of 15 Level 5 hospitals did not have ICUs and HDUs, respectively,” Gathungu said.
The Kenya Medical Practitioners’ Hospital Checklist for Categorisation of Health Institutions requires Level 4 hospitals to have at least six ICU beds, Level 5 hospitals 12 beds, and Level 6 hospitals 24 beds.
The audit found that none of the sampled Level 4 facilities met the minimum ICU bed requirement.
Among Level 5 hospitals, only Coast General Teaching and Referral Hospital complied with the mandatory 12-bed standard.
The report indicates that the shortfall has increased pressure on Level 6 national referral hospitals, which are intended to handle complex tertiary cases rather than stabilise emergencies from counties.
The audit attributes the crisis largely to governance and budgetary failures at the county level.
“Counties do not have ring-fenced emergency medical care budgets. Funds for emergency care are mixed with other health expenditures, and even hospitals lack specific budget lines for emergency services,” the report states.
The absence of dedicated funding has hindered procurement of ventilators, maintenance of equipment, recruitment of trained ICU nurses and installation of piped oxygen systems.
The audit found that 90 per cent of Level 4 hospitals lack piped oxygen infrastructure.
The situation is worsened by the absence of functional HDUs, which serve as step-down units for patients transitioning out of intensive care.
“Due to a lack of functional HDU beds, patients would be moved from the ICU directly to the wards or be retained at the ICU for recuperation; this further limits the availability of already strained ICU bed capacity,” Gathungu added.
As of 2022, Kenya had approximately 358 Level 4 hospitals and 14 Level 5 hospitals nationwide, according to the Kenya Master Health Facility list.
The findings raise fresh concerns about compliance with national health regulations and the constitutional right to the highest attainable standard of health under Article 43.