Dr Richard Ayah
The ministry of health announced 421 new covid-19 cases after 3,895 tests in the last 24 hours. The crude fatality rate is 1.86% (217 covid-19 deaths reported/11,673 covid-19 diagnoses made).
Four weeks ago, with the focus on testing truck drivers at the borders it appeared that the Covid-19 was leaving Mombasa, passing through Machakos (but not stopping) to go and sit in Busia and Kajiado with guest appearances in Migori, Wajir and Marsabit. The narrative was still ‘there is community spread’, but the borders have a problem.
As at 16th July the picture emerging is a little different. Nairobi and Mombasa are now the same as far as Covid-19 cases at 1,448 and 1,466 persons per million population. Nairobi County has diagnosed almost four times the number of cases present a month ago compared to x1.5 times for Mombasa.
Could if be that Covid-19 cases are peaking in Mombasa or is it an example of counties taking over more of the burden of testing?
There are three ‘Nairobi’ to compare against Mombasa or any other county. There is Nairobi County, which is not fully functional, there is Nairobi Metropolitan area which includes parts of Kiambu, Kajiado and Machakos counties and there is the national government in Nairobi. The national government testing really should not be counted as part of Nairobi County and it is inequitable for national government to offer testing only for select people, who have not been referred by county facilities. The reality is that Nairobi is the centre of Covid-19 testing and the above probably explains the inequity in health service access, especially of the new test for a new disease.
The role of national referral health facilities in the Covid-19 pandemic needs to be reviewed to ensure that they serve the whole country and not just those counties who happen to be nearest. Equity is a key part of implementing Universal Health Coverage.