Operational Costs and Revenue Dynamics of Repurposing a Public Hospital into a Covid-19 Isolation Centre in Kenya

A Facility-Based Case Study

Bibliographic Data

ID13775682
AuthorsMagoma Mwancha-Kwasa (Department of Health, County Government of Kiambu, Kenya, corresponding author), Brenda Onyancha (Department of Health, County Government of Kiambu, Kenya), Agnes Wambui Karita (Department of Health, County Government of Kiambu, Kenya), Gerald Kwoba Mang’eni (Department of Health, County Government of Kiambu, Kenya), Emily Ngonyo Muiruri (Department of Health, County Government of Kiambu, Kenya), Hillary Kagwa (Department of Health, County Government of Kiambu, Kenya), P N Nyaga (Kenya School of Government), Patrick Nyaga (Department of Health, County Government of Kiambu, Kenya), Janefer Maina Kinyanjui (Department of Health, County Government of Kiambu, Kenya), Mike Mulongo (KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya), Lizah Nyawira (0000-0002-9287-4586, Amref Health Africa, Nairobi, Kenya), Prabhjot Kaur Juttla (0009-0003-7227-7949, University of Nairobi), Moses Ndiritu (0000-0002-3219-5274, Department of Health, County Government of Kiambu, Kenya), Ryan Nyotu Gitau (Ministry of Health, Afya House, Nairobi, Kenya)
Year2025
Volume62
Pages469580251381969-469580251381969
Publication date2025-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueINQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL)
Journal identifiersISSN: 0046-9580 • E-ISSN: 1945-7243
PublisherSAGE Publishing (PUBLISHER • US)
DOI10.1177/00469580251381969
PMID41108638
OpenAlexW4415321582
LanguageEN
References cited12

Isolation facilities are essential to pandemic response, yet the economic trade-offs of repurposing existing hospitals remain poorly characterised. This study quantifies both the operational costs and the revenue foregone from converting Tigoni Level 4 Hospital (TL4H) into Kiambu County's sole COVID-19 isolation centre. Our study focused on estimating recurrent and labour costs, considering only capital costs incurred during the study period. We conducted a cost analysis at the facility level, assessing all expenditures incurred by TL4H between June 2020 and February 2022, using an activity-based costing approach to allocate costs to specific operational activities. Sensitivity analyses, including one-way and 10,000-draw Monte Carlo PSA, estimated uncertainty in total and per-patient costs. The total operational cost of the isolation centre over the 21 months was KES 489,220,113.98 (USD 4,181,011.14). This translates to an annual operating cost of KES 279,554,350.85 (USD 2,389,149.23). The average cost of managing one COVID-19 patient regardless of severity was estimated as KES 337,626.03 (USD 2885.45). The revenue foregone by waiving user fees for COVID-19 patients was KES 160,678,901.00 (USD 1,374,236). Sensitivity analysis indicated that HRH costs (78.9% of total expenditure) had the largest influence: a ±20% change shifted total costs by ±KES 77.6 million (USD 663,191.18). PSA results showed a mean total operational cost of KES 489,212,852 (USD 4,180,949.08; 95% UI: 414,803,680-573,687,849), and a mean cost per patient of KES 337,621.02 (USD 2885.40; 95% UI: 286,268.93-395,919.84). Repurposing TL4H as a COVID-19 isolation centre was resource-intensive, highlighting the importance of strategic budget planning and resource allocation for future preparedness

Activity-based costing · Capital expenditure · Cost driver · Isolation (microbiology · Operational costs · Public hospital · Revenue · Total cost · Total revenue · COVID-19 epidemiological studies · COVID-19 Pandemic Impacts · Healthcare Systems and Reforms

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