Preparedness and Response to the COVID-19 Pandemic in a Hospital in Nairobi County, Kenya
No Thumbnail Available
Date
2022-06-05
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Ababa University
Abstract
Background: Historically, pandemics and epidemics of infectious disease have caused devastating impacts in Sub Saharan Africa (SSA). In particular HIV/AIDS and Ebola Virus Disease (EVD) were associated with very high death rates. Knowing the extent to which previous experiences have equipped countries of SSA to prepare for and respond to the COVID-19 pandemic helps policy makers to make appropriate preparation for future pandemics.
Objective: This study assessed preparedness for and response to the COVID-19 pandemic in a hospital in Nairobi County in Kenya at the start of the pandemic and the current status of preparedness and response.
Methods: This case study was conducted in a level four private hospital located in an urban setting in Kenya with a catchment area population of 191,207 Kenyans in its catchment area. Data was collected using qualitative methods) that is observation, in-depth interviews, focus group discussions), a cross-sectional survey and a literature review. Data was collected from a total of seventy-two participants. The sample for the cross-sectional quantitative survey was fifty-one hospital employees. In-depth interviews were conducted with 17 participants (hospital managers, clinical services administrators, clinical department head of departments and public health staff). A focus group discussion was held with ten participants including the hospital management, consultant physicians, community health workers and a social worker.
Observation was conducted in the hospital for a total of forty-five and a half hours to understand and to investigate implementation of COVID-19 prevention protocols in the hospital which were recommended by ministry of health. Qualitative data was coded and analyzed thematically while quantitative data were analyzed descriptively using SPSS software. Findings were triangulated across the data sources to address the research question. Prior permission and ethical clearance were obtained to conduct this study.
Findings: In depth insight was gathered from the qualitative data on the initial lack of clarity around the COVID-19 case definition, inadequate resources including staff, medication and personal protective equipment at the onset of COVID-19. COVID-19 Protocols endorsed by the Ministry of health were implemented in the hospital, with some challenges. The response to COVID-19 greatly impacted delivery of other primary healthcare services. Quantitative data indicated that visual cautions about COVID-19 were adequate (100%) and a system response plan was implemented at a good level (72.6%). However, resources were quite constrained 11 (staff (62.7%), medication (60.8%) and Personal Protective Equipment’s (PPEs) (66.7%)). Overall, the hospital was not prepared to respond to COVID-19 (66.7%). More than half of the respondents (66.7%) said that infection control was implemented in the hospital premises and wards. Resources for COVID-19 response were constrained in the hospital (64.7% of participants) and the hospital did scarce resource allocation in response to COVID-19. Finding from the observation of service delivery and the hospital compound during the data collection showed that staff were in personal protective equipment, isolation protocols were displayed, personal protective equipment precautions were displayed, sanitizers were available and COVID-19 testing was outsourced. The literature review highlighted the need for strengthening of the healthcare system in relation to pandemic preparedness. A pandemic preparedness response plan was lacking. COVID-19 majorly impacted maternal and child health due to reduced clinic attendance and the cost of COVID-19 management was a burden to the healthcare infrastructure.
Conclusion: At the onset of the pandemic the hospital was not prepared to respond to COVID 19 in terms of space, staff, (resources) and system coordination. However, capacity has been built and structures implemented over the pandemic period. Hence, the hospital is currently more prepared and well equipped to respond to COVID-19 pandemic. Findings from the primary quantitative study we have learned how pandemics overwhelm the healthcare system by creating an increased demand for medical supplies and the unforeseen increased costs to meet healthcare needs. Policy Implications: This study showed that hospital preparedness and response relied heavily on the country’s healthcare infrastructure, human resource capacity, medical supply, surveillance information and pandemic preparedness and response plans that the country should put in place before a pandemic hits. All these pillars form the backbone for adequate pandemic preparedness and response. The results from this study have a potential of informing policies on contagious disease outbreak surveillance by emphasizing the need for adequate health system preparedness for potential outbreaks through adequate resource mobilization and implementing a working pandemic response plan in Kenya’s healthcare system. Extrapolation of the lessons in this study’s findings to Sub Saharan Africa should take the country into account.
Description
Keywords
the COVID-19 pandemic in a hospital