Emergency Care Capacity and Accessibility for Non-Communicable Diseases in Kenyan EDs: A Regional Analysis

ABSTRACT Background Emergency Departments (EDs) are crucial to managing non-communicable diseases (NCDs), a leading cause of death, yet there is limited information about the capacity and accessibility of emergency care in Kenya. Methods Using data from Project 47, a national dataset on EDs, we conducted a secondary analysis to assess capacity for NCD care, as guided by the WHO Package for Essential NCD Interventions for Primary Care (WHO PEN). Results Of the 186 facilities included in the assessment, 45.7% (n=85) had a designated ED. ED capacity, distribution of facilities, number of patients seeking care, and WHO PEN indicators varied by Regional Economic Bloc (REB). Mount Kenya and Aberdares (MKAREB) and Lake Region (LREB) REBs included the greatest number of facilities and served the largest patient catchment areas nationally (8.5 million and 17.8 million, respectively). Key diagnostic tools and treatments were inconsistently available, with ECGs lacking outside of Nairobi (100% of EDs in Nairobi, 14.8% to 33.3% outside of Nairobi, P=0.1021). Oxygen was consistently available in only 44.8% of facilities in FCDC-Pwani, 59.3% in LREB, and 42.9% in NAKAEB, highlighting significant regional gaps, despite the LREB serving a disproportionately larger patient population. Glucometers, similarly, were universally available (100%) in Nairobi, but only available variably in other regional blocs (51.7% to 93.3%, P=0.001474). Conclusion Major disparities exist in emergency care capacity and NCD management resources across Kenyan regions, especially in LREB and NAKAEB, where majority of care occurs in the country. Targeted, equitable investment is required to expand essential infrastructure and diagnostics. Decentralizing emergency services beyond Nairobi must be prioritized to improve timely access to care, enhance quality, reduce patient costs, and address the needs of high-burden regions. KEY MESSAGES What is already known Emergency departments in Kenya provide a key role in treating and managing non-communicable diseases. The most comprehensive data available about emergency department infrastructure, resources, and clinical visits in the country were collected via Project 47, conducted by the Emergency Medicine Kenya Foundation. What this study adds This secondary analysis of Project 47 data provides information about the capacity and accessibility of emergency care in Kenya, particularly as it pertains to Noncommunicable Diseases, focusing on cardiovascular disease, chronic respiratory disease, diabetes, and cancer, acute and emergency care, and the variability across different regions. How this study might affect research, practice, or policy Resources to improve the capacity and accessibility of emergency care in Kenya can be directed to the areas of highest need in order to maximize the impact on patient care. Similar assessments can be conducted in the region to guide emergency care resource allocation.