The Ministry of Health Director General, Patrick Amoth, postulated that with increased testing, the number of coronavirus cases may increase to 1000 cases by first week of April, 5000 by mid-April and 10,000 by end of April.
With thousands of cases, it is conceivable that Kenya may decide to implement a complete lockdown, for 14 days, for 21 days, or maybe a whole month. Anything to ‘starve off’ the virus from the population. But how much would the government need to avoid complete breakdown and deterioration to anarchy and political instability in the midst of a health and economic crisis?
Let us look at some figures. We’ll make assumptions and when we do, we’ll explain the roots of those assumptions. Take it easy and let us just have some fun and some thinking of possibilities.
People are broke in Kenya. Hatuna pesa. Around the world most countries offering a stimulus package are including a cash subsidy to households to insure families against lost income. In Canada, anyone who has lost income due to the Covid-19 pandemic qualifies for up to $2,000 a month for up to four months. The United States is working on a “Phase Three” stimulus package proposal that includes $500 billion in direct payments, including a $1000 payment to all adults, excluding millionaires and billionaires. Most of these would be available to anyone with a taxpayer identification number. See what Australia, China, Germany, France, Italy, UK, India, Brazil etc are doing here.
In the United States, the conversation is now changing to coronavirus checks aka direct deposits to citizens. How will it be sent, when, and who will get the money? Millions of Americans are about to receive help from Congress in the form of direct cash payments. An American that made less than $75,000 in 2009, will be eligible for the full payment of $1200. Couples that jointly made less than $150,000 will get $2,400 and “heads of household” who earned $112,500 or less will get $,1200. For every child in the household, you will receive an additional $500. These checks will be received in April.
So why not us? We need money to go directly into people’s pockets. The informal sector represents 83.1% of the country’s total labor force, that is 13.1 million. A majority of these jobs will be lost in a lockdown. This is also the sector that employs over 60% of the country’s youth.
According to the Kenya National Bureau of Statistics (KNBS), 74% of Kenyans in the formal sector earn less than Kshs 50,000, that 1.9 million at the end of 2017. Out of the 2.6 million salaried workers, 36% earn between Sh20,000 and Sh29,999 per month. The bottom wage bracket (earning below Sh20,000 a month), mainly made up of minimum wage workers such as house servants, drivers, secretaries and low-ranking teachers and police officers, that is according to Business Daily. The World Bank reported in 2018 that the proportion of Kenyans living on less than the international poverty line (US$1.90 per day in 2011 PPP) declined from 46.8% in 2005/06 to 36.1% in 2015/16. However, the Kenya National Food and Nutrition Security Policy Implementation Framework (2017-2022) estimated that “about 50% of the Kenyan population fall below the poverty line.” These are the people most affected by food and nutrition insecurity.
We can estimate that 50% of Kenyans will need some kind of financial support to buy food. However, identifying the poor and food insecure households will open all manner of corruption games. Kila mtu apewe yake. Opt-in upewe or you can voluntarily opt out of the scheme. Should this money be sent to individuals or households? The first volume of reports released by the Kenya National Bureau of Statistics on the 2019 Population and Housing Census reported that the country’s population was 47,564,296 people, or 12,195,973.33 households. The average household size was estimated at 3.9. If we use households, then:
|Cash transfer to households (Kshs)||5,000.00|
|Number of months (1 month)||1|
|Number of households||12,195,973|
The government can set aside Kshs 61 billion to support households to access food for 1 month, as the country implements a 21-days to 1-month lockdown to ‘starve off’ the virus, flatten the curve, or eliminate it from circulation. The government can impose a rent freeze for the duration of the lockdown.
From the recently concluded National Census, we can assume KNBS has the details of each head of household.
This money can be distributed to household heads through mobile money transfer. During the FY 2019, Safaricom carried out over 11 billion transactions, averaging 500 transactions per second. This means that Safaricom has the capacity to transfer money to all the 12.2 million households in a single day. Safaricom also has a database of the identity of all persons registered on M-Pesa and can be used to carry out additional screening and authentication of recipients. The government can also work with Safaricom or any other appointed telecommunications provider, under a special law established by parliament, to create specific accounts for these kinds of transfers, and also include additional security such as the ability of a spouse to authenticate withdrawals pesa ikiingia.
Invest in Personal Protective Equipment (PPE) and Intensive Care Units
We need goggles, faceshield, fluid resistant medical or surgical masks, gloves, disposable gowns, disposable overalls, surgical aprons, waterproof aprons, waterproof boots, head covers etc.
During the heart of the Ebola virus epidemic, the CDC created a PPE Calculator that health facilities can use to establish their PPE needs. For an ICU, these are the PPE the frontline health workers need:
|Nurse with patient contact||Doctor with patient contact||Trained observer||Env cleaning||Lab staff||Total PPEs/day||Item cost||Total Cost/ICU/day|
|Masks (N95 respirator + surgical hood and full–face shield)||10||10||5||5||5||35||1000||35000|
|Glove, extended cuff||12||2||2||12||4||32||1000||32000|
|Fluid resistant apron||2||1||0||2||2||7||5000||35000|
|Number of persons per shift||3||1||2||2||1||9|
|Number of shifts per day||2||2||2||2||2||10|
|Number of staff per day||6||2||4||4||2||18|
Note: While the estimations of recommended PPEs for nurses, doctors, observers, cleaners and lab staff, and shift planning are obtained from the CDC PPE Calculator, the prices are obtained from various online sources, including Nairobi Safety Shop, Alibaba, Chinese manufacturers pages, Amazon etc
These are the PPEs frontline healthcare workers need per day per ICU. If we estimate the costs, from various market price sources, we can estimate how much is needed to safely and efficiently run an ICU that can deal with Covid-19 patients.
We can deduce from these numbers, that healthcare workers will need PPEs worth 193,500 for each ICU each day.
But do we have adequate ICUs? No. Let us assume that we want 1000 ICUs build our capacity to a level where we can manage an upsurge in Covid-19 infection rates and disease severity.
How much does an ICU cost?
Some years back, the World Health Organization did a survey on what constitutes an ICU at district level hospitals and the cost of medical equipment that constitute what we can an ICU. I don’t know the extent to which these figures deviate from what can be sourced now from manufacturers, but here they are:
|No of items||Cost||Total|
|trolley, general purpose||1||25000||25000|
|Infant radiant warmer||1||118000||118000|
|Mobile X-ray unit||1||4700000||4700000|
|Sunction machine, electric||2||70000||140000|
From those WHO estimations, we’ll need Kshs 10,879,432 to establish 1 ICU. A thousand ICUs will cost Kshs 10,879,432,000.
We need PPEs worth 193,500 for ICU every day. For a three-months (90 days) intensive battle with Covid-19 across 1000 ICUs, we’ll need PPEs worth 193,500*90*1000 = 17,415,000,000
In terms of personnel, 18 frontline healthcare professionals (nurse – 6, doctor – 2, observer – 4, cleaner – 4, lab staff – 4) every day, covering all the shifts are needed. That translates to 18000 healthcare professionals to treat patients in the 1000 ICUs (6000 nurses, 2000 doctors, 4000 observers, 4000 cleaners, 4000 lab staff) and isolation centers.
I’m assuming the personnel will be drawn from the existing workforce and trained. However, since the healthcare capacity is already stressed, additional recruitment is necessary.
It is still not clear how much the coronavirus testing kits will cost. The values range from $1 to $20 to $350. Researchers began validation trials on a Covis-19 diagnostic test that can be done at home and produce results in as little as 10 minutes – all for $1.The plan is to manufacture the tests in Senegal and the United Kingdom and, if the validation testing meets regulatory standards, they could be distributed across Africa as early as June.
The UK government has also bought 3.5 million finger-prick antibody tests to be used for testing Covid-19. Tests by SureScreen, a British company, cost £6.
The Northern Ireland-based firm Randox Laboratories is seelling home Covid-19 testing kits for £120.
Most of the tests sourced from China, including the ones returned by Spain and Turkey over quality issues, cost £15.
In the United States, Bloomberg estimated that commercial tests will cost between $50 and $100, according to physicians. The physicians provided those numbers based on conversations they had directly with commercial labs, like Quest Diagnostics Inc and Lab Corp.
Since Kenyan government procurement notoriously tends to be a little bit on the higher side, we can estimate that each kit will cost $100
For 10,000 kits to be deployed for random testing across the country, that would translate to Kshs 10,000*10,000 = 100, 000,000.
This week, photos hit us on social media about the Lagos Isolation Center, a 110-bed facility which is located within the Mobolaji Johnson Arena to combat the coronavirus pandemic. The isolation facility is divided into operational sections, including Intensive Care Unit (ICU), regular-bed wards, pharmacy department, doctors’ quarters and consulting rooms. The facility is also equipped with ventilators for the use of patients that may develop acute respiratory symptoms. They are marvelous!
It is not clear how much these cost to build but we definitely need something like that.
We’ve already budgeted for 1000 ICUs, which will have ventilators for those with acute respiratory symptoms, so we can estimate the cost of isolation centers with mostly regular-bed wards, pharmacy department, doctors’ quarters and consulting rooms. We can estimate the cost at Kshs 150,000 per bed, translating to 150,000*1000 = 150,000,000.
Patients in isolation centers as well as healthcare professionals working in the isolation centers also need PPEs. The government also needs to procure drugs as well as provide other essential services in medical settings. There is no easy way to estimate this, but according to the Kenyatta National Strategic Plan (2013-2018), the recurrent expenditure was projected to rise from Kshs 11.907 billion in 2013 to 15.643 billion in 2018 Kenyatta hospital has a capacity of 1800 beds with over 6000 staff members.
If we were to assume similar spending patterns, then annual expenditure for the 1000 bed isolation and treatment center will be Kshs 8.690 billion, and if the centers were only to operate for 3 months, the expenditure would be Kshs 2.172 billion.
So how much does the government need to respond effectively to coronavirus?
|Cash transfers to citizens||60,979,866,650|
Kshs 92 billion. Let’s just say the government needs Kshs 100 billion in its pocket to be on the safe side.
In brief, if the government was to implement a complete lockdown for 1 month, support families to buy food, invest in PPEs that can last frontline staff for 3 months, add 1000 ICUs to the healthcare capacity, procure 10,000 Covid-19 testing kits, and establish 1000 isolation centers across the country, the government would need an estimated Kshs 100 billion.
The Economist, David Ndii, suggested a lifeline fund in the order of 0.5-1% of GDP or Ksh 50-100 billion as sufficient to save the situation.
I’m inviting people who are better than me to also try to crunch the numbers to see if the government has the money to back some of the things it is saying, and whether it is serious about implementing them.
Disclaimer: These approximations are based on the sources that have been linked throughout the document. This is just an exercise in critical thinking. I’m not the government.