REIGNING IN ON THE CHAOS IN THE HEALTH SECTOR

The last few weeks have been chaotic in the health sector. The press has been awash with stories of medical negligence in various institutions, leading to varied responses. The public is furious; the regulators are cracking the whip while the health workers are feel besieged.

In the background of a country focused on achieving universal health coverage, the recent happenings are not encouraging. It is a fact that for universal health coverage to be achieved, there is need for multiple players to pull together to achieve meaningful health outcomes for Kenyans.

To this end, the role of the private health sector cannot be underestimated. This sector has been complementing the public health sector for decades. Most modern medical technology has been availed in the private sector first, enabling patients to access care while the government worked to achieve the same in our public institutions.

The private hospitals and diagnostic centres have enabled patients in public hospital to get expensive tests done locally to improve their care. For many years, imaging tests that are now commonplace such as magnetic resonance imaging (MRI) and computerized tomography (CT) were unavailable in public hospitals. Patients, even those admitted in the wards, would have to get them done in private hospitals and then go back for continued care.

Over time, these services have been availed all over the country, making them part of mainstream care for patients. This couldn’t be better demonstrated than by the availability of an MRI machine at Garissa County Referral Hospital. This signals positive trends in the public health sector, with ability to provide multiple and advanced treatment options for improved patient outcomes.

Despite the hiccups that haunt the sector, it is undeniable that the positive impact is a welcome relief to many. It is encouraging to know that we can undertake highly technical interventions as demonstrated by the separation of Siamese twins or the reattachment of a severed hand at Kenyatta National Hospital. Renal transplants and complicated cancer surgeries are now regular procedures at the Moi Teaching and Referral Hospital.

It is also refreshing to know that the problems that ail the public sector are mostly governance issues, which can be easily addressed with commitment and goodwill. Makueni County has clearly demonstrated what universal health coverage can do. This is the only county that one will struggle to find a thriving private clinic as potential clients gladly flock the county hospitals. Moi Teaching and Referral Hospital’s growth in the last two decades has been formidable. From a nondescript district hospital to a level six institution that is not only providing care but also driving teaching and research is no mean feat.

It is clear that we do not need to cross borders to  benchmark in health care and its management.  We have our own success stories in-house that we can learn from and make health care safe and accessible. For this reason, we cannot shy away from asking the hard questions when things fall apart in public hospital such as what was happening at Kerugoya County Referral Hospital. Most especially when these are facilities fully funded by the taxpayer who is clearly not getting value for their money.

For this reason, we need to take a hard look at the chaos being demonstrated in the sector, with special focus on middle level private health institutions. Faith-Based institutions have generally done well in alleviating the burden of care in the country. For this reason, the government partnerships with them have been very strong, to the extent of supporting these institutions with human resource for health.

The key reason for this is that for many years, these institutions provided care in hard to reach areas where even the government had not invested in health facilities yet. Missions put up facilities like Wamba Catholic Mission Hospital in Marallal, Ortum Mission Hospital in West Pokot, and AIC Kapsowar Mission Hospital in Marakwet, to fill huge gaps in health care and the government responded in kind by seconding doctors to these hospitals.

Both parties recognized the prohibitively high cost of a skilled workforce necessary for appropriate service delivery. This is the reason why the most highly qualified specialists in Kenya will be found in the high-end private institutions where they can bill for their skill, or in higher level public institutions, on the government payroll. This is a key component that perhaps many middle level privately owned health institutions fail to plan for when they are starting out or they are expanding.

They fail to recognize that as they grow in capacity, their expand their scope of services and hence their patient numbers rise. In addition, by availing specialized equipment, the need for skilled manpower to utilize these efficiently for patient care increases. The higher the level of skill required, the higher the need for support services and the higher the numbers of experienced staff required.

To meet these needs, the cost of healthcare spirals upwards because the skill is ultimately expensive. Unfortunately, to manage the cost of providing the services against the cost to patient becomes a problem. These institutions, in a quest to balance the figures, must sacrifice something along the way.

Unfortunately, what has been sacrificed for the most part, has been the cost of skilled workforce in an effort to remain “affordable” to their clients. This is how we end up with facilities running on unskilled or inexperienced workforce, with a higher likelihood to attract medical negligence issues, especially when inadequately supervised. It is not necessarily a quest to maximize profits.

It is therefore important to ask yourself two critical questions the next time you walk into a middle level facility with “affordable” costs. The first is, who is subsidizing the cost of your care while the second is that if there is no subsidy, what has been compromised along the care chain. We cannot have our cake and eat it!