In November 2025, the Office of the Auditor-General released a landmark Performance Audit Report on the Provision of Emergency Medical Care Services in Kenya, providing the most comprehensive, system-wide assessment to date of how emergency medical care is organised, funded, and delivered across the country.
The findings are sobering, but they also present a clear roadmap for reform.
Why Emergency Medical Care Matters
Emergency medical care in Kenya is not optional. It is a constitutional right under Article 43(2) of the Constitution of Kenya and a cornerstone of Universal Health Coverage. Globally, over half of deaths in low- and middle-income countries are caused by conditions that could be addressed through timely pre-hospital and emergency medical care. Kenya is no exception.
The audit examined four financial years (2021/22–2024/25), assessing emergency medical care at three critical points:
- The community level
- Ambulance and transport systems
- Health facility and hospital care
Its conclusion is clear: systemic gaps at every stage are costing lives.
1. Community-Level Emergency Medical Care: The First Link Is Weak
The audit found alarmingly low public preparedness to respond to medical emergencies.
- Only 8% of surveyed citizens had been sensitised on how to handle emergencies
- Just 26% knew which number to call in an emergency
- Only 21% had basic first aid skills
This deficit was directly linked to:
- Inadequate coverage of community units
- Shortages of Community Health Promoters
- Absence of county budgets or work plans for emergency awareness
In practical terms, this means that when emergencies occur, such as road crashes, cardiac arrests, and obstetric complications, the “golden hour” is often lost before professional care is even activated.
Key implication: Without trained and empowered communities, no ambulance or hospital system can succeed.
2. Ambulance Services: Delayed, Fragmented, and Under-Equipped
The audit paints a troubling picture of Kenya’s ambulance transport system.
Delayed Response Times
In counties where dispatch data were available, ambulance response times ranged from 20 to 60 minutes, far exceeding the 15–20-minute standard set in national policy. Only Machakos County consistently met recommended response times.
No National Dispatch System
Kenya currently lacks a national ambulance dispatch centre; there is no single toll-free emergency access number, e.g., 911. While some counties operate dispatch centres, most face serious operational gaps:
- No real-time vehicle tracking
- No electronic call-logging systems
- No toll-free emergency number
- Poor internet connectivity and power backup
- Insufficient trained dispatch personnel
Too Few, Often Non-Functional Ambulances
Although some counties meet numerical ambulance targets, 34% of ambulances inspected were non-functional. Many lacked:
- Essential life-saving equipment
- Trained emergency medical personnel
- Reliable fuel and maintenance systems
Key implication: Emergency response in Kenya is largely uncoordinated, reactive, and dependent on geography rather than need.
3. Hospital Emergency Medical Care: Facilities Exist, Readiness Does Not
While most Level 4–6 hospitals had designated Accident & Emergency (A&E) areas, functionality was deeply compromised.
Staffing Shortages
- Many facilities had 1–4 emergency nurses instead of the recommended minimum of 10
- Nurse-to-patient ratios reached as high as 1:122, compared to the WHO recommendation of 1:4
- Emergency patients were frequently managed by staff without specialised emergency medical care training
Critical Equipment Gaps
The audit documented widespread shortages of essential emergency equipment:
- Up to 90% of Level 4 hospitals lacked piped oxygen
- Ventilators were absent in the majority of Level 4 and Level 5 hospitals
- Diagnostic and monitoring equipment was frequently unavailable or non-functional
Limited Critical Care Capacity
- 90% of Level 4 hospitals and 33% of Level 5 hospitals lacked Intensive Care Units
- Where ICUs existed, bed capacity, staffing, and consumables were insufficient
- Patients were often referred unnecessarily to Level 6 hospitals, overwhelming tertiary centres
Key implication: Having a building labelled “A&E” does not equate to delivering emergency medical care.
4. Financing: Emergency Medical Care Is Not Prioritised
Perhaps the most structural finding of the audit was the absence of ring-fenced emergency medical care budgets.
- No sampled county had a dedicated emergency medical care budget
- Emergency healthcare services competed with routine health expenditures
- Health facilities themselves had no specific budget lines for emergency medical care
This runs counter to national policy and undermines sustainability, preparedness, and accountability.
Key implication: Emergencies are unpredictable, but funding for emergency medical care must not be.
The Way Forward: From Audit to Action — Building on What Is Already Working
The Auditor-General’s recommendations are clear, evidence-based, and aligned with global best practice. Critically, they also validate and reinforce many of the approaches that the Emergency Medicine Kenya Foundation (EMKF) has been advancing in partnership with national and county governments over the past decade.
This moment, therefore, calls not for reinvention, but for scaling what has already been proven to work.
1. Investing in Community First Response: From Awareness to Action
The audit highlights a fundamental gap at the community level: low public awareness, limited first-aid skills, and inadequate coverage by Community Health Promoters. EMKF’s work directly addresses this first and most fragile link in the emergency medical care chain.
Through its Community Emergency Care Training (CECT©) programme, EMKF has trained Community Health Workers, police officers, boda-boda riders, and other community first responders in:
- Recognition of medical and trauma emergencies
- Immediate life-saving interventions
- Early activation of formal emergency medical services
This approach operationalises the Auditor-General’s recommendation to train community members in basic emergency medical care and strengthens Community Health Promoter networks by equipping them with practical emergency response skills, not just health promotion knowledge.
Audit to action: Kenya does not need to start from scratch. Structured, standardised community emergency medical care training already exists and can be rapidly scaled through county systems.
2. Building a Coordinated Ambulance System: From Fragmentation to Integration
The audit’s call for a national ambulance dispatch centre, real-time tracking, and a single toll-free emergency number speaks directly to one of the most persistent weaknesses in Kenya’s emergency healthcare system: fragmentation.
EMKF has been addressing this gap through the Ambulensi Programme, which currently supports counties to establish and operationalise:
- Centralised ambulance dispatch centres
- GPS-enabled ambulance tracking
- Standardised dispatch protocols and call-handling guidelines
- Real-time visibility of ambulance availability and response times
The programme, already operational in 10 of the 47 counties, has already demonstrated that coordinated dispatch significantly improves response times and accountability, even in resource-constrained settings.
Importantly, EMKF’s work shows that national coordination and county implementation are not mutually exclusive. A national dispatch backbone with county-level operations is both feasible and aligned with Kenya’s devolved health system.
Audit to action: The building blocks for a national and county-linked ambulance dispatch system already exist. What is required is policy endorsement across all 47 counties, sustainable financing, and scale.
3. Strengthening Hospital Emergency Readiness: Beyond Physical Spaces
The audit confirms that many hospitals have designated Accident and Emergency areas, but lack the staffing, equipment, and skills to deliver effective emergency medical care. EMKF’s hospital-focused work has consistently emphasised that emergency readiness is about capability, not just infrastructure.
EMKF has supported counties through:
- Refurbishment and functional design of emergency departments through our Adopt-an-ED Project
- Provision of essential emergency medical equipment through our EQUIP Project
- Targeted training for nurses, clinical officers, and doctors in emergency medical care through our various Training Programs
- Mass casualty and triage training for public emergency departments
This work directly aligns with the Auditor-General’s recommendations to equip and staff emergency departments, expand emergency medical care training, and strengthen referral hospitals’ capacity to stabilise patients before escalation.
Audit to action: Investing in emergency departments yields immediate returns in lives saved. The focus must shift from buildings to systems.
4. Ring-Fencing Emergency Medical Care Financing: From Competing Priorities to Protected Services
The audit’s finding that emergency medical care is not ring-fenced in county budgets exposes a structural weakness that undermines sustainability. EMKF has consistently advocated treating emergency medical care as a core public service, not a discretionary expenditure.
Through policy engagement and technical support, EMKF has contributed to:
- Embedding emergency medical care within county health planning
- Aligning emergency services with national legal frameworks, including the Social Health Insurance Act
- Demonstrating how emergency medical care financing can be linked to system performance, preparedness, and outcomes
See the summary document on Legislation & Policies around Emergency Medical Care in Kenya
Working with the national government to establish the Emergency, Chronic and Critical Illness Fund created a historic opportunity to correct long-standing financing gaps, if emergency medical care is deliberately prioritised and protected at both national and county levels.
Audit to action: Without ring-fenced financing, emergency systems cannot be reliable. The policy tools exist; implementation must now follow.
Conclusion: A Defining Moment — and a Clear Path Forward
This audit is not merely an accountability exercise. It is a strategic inflexion point for emergency medical care in Kenya.
The policies are in place. The legal mandate is clear. Practical, Kenyan-led solutions already exist and are operating within county systems today. What is now required is decisive leadership, coordinated investment, and intentional scale-up of proven approaches across community, pre-hospital, and facility levels.
The work ahead is substantial—but the direction is clear.
Lives depend on what happens next.
