Kenyatta
National Hospital is the oldest and largest referral Hospital in East
Africa, with a bed capacity of 1,800 and more than 6,000 staff members.
It
was founded in 1901 as the Native Civil Hospital (later renamed King
George VI Hospital in 1952, and after independence it became Kenyatta
National Hospital), with the neighbouring Nairobi Hospital serving the
Europeans.
Sitting
on 45.7 hectares of land, it has the most qualified doctors in the
region, and houses the University of Nairobi’s School of Medicine. There
are also several other government agencies located there. But it is
sinking into despair and hopelessness in the jungle of neglect.
The
floors cry for a broom to wipe the piling dust. The walls are hungry
for paint as patients’ relatives saunter around aimlessly. Patients lie
yearning for more beddings in crowded wards. Others lie outside on the
grass hoping that a bed will be found for urgent surgery.
Sophia
sits on a ledge outside the hospital with her face down. Her surgery to
remove pre-cancerous fibroids will not happen until after nine
months. She is worried it may turn into full-blown cancer before the
remedy comes. This is unnecessary, because in modern days lack of
finance is not an excuse any more. Underneath all the despair lies an
opportunity to build a hospital that we can all take pride in.
With
a little ingenuity, we can turn the problems at Kenyatta into a great
opportunity. Here is why. You may have missed a news item in one of the
dailies on India’s Apollo Group of Hospitals in which they said that
they receive patients from 120 countries. More than 152,000
cardiothoracic surgeries, 1,000 joint transplants and 13,000 kidney
transplants are performed each year and 20 per cent of these procedures
are done on Kenyans.
AFFORDABLE HEALTHCARE SYSTEM
They
also receive other patients with several different diseases like cancer
and other conditions. The story is the same with other Indian
hospitals. This proves that we have the numbers to build an affordable
healthcare system for all, and more from the African continent.
India
benefits from economies of scale and as such, a patient can have a
full-body examination with all the scans, X-rays and endoscopies at a
cost that will only pay for a single scan in Kenya. Fees for a single
doctor in Kenya are enough to pay seven to eight consultants in
India. In Kenya, investment on capital expenditure has pushed the
healthcare cost to levels that more than 70 per cent of the population
cannot afford.
Within
a single block, doctors invest in similar capital expenditure and
charge for a procedure. What sense does it make to have ultrasound
equipment in every doctor’s office when they are used only 10 per cent
of time? There is no justification for hospitals investing in expensive
diagnostic equipment when their core competence is in patient care. Such
services should be outsourced within the hospital, and equipment
manufacturers have been doing this globally.
Some
of the changes needed at Kenyatta National Hospital do not require
money. What is needed more than anything is discipline among employees
and the public, common sense, and the courage to take responsibility.
POOR WORKING CONDITIONS
Maintenance
here is a foreign word since only three of the eight lifts at the main
nine-floor building are functional. This forces people to act
aggressively as they try to get into the lifts. If you attempt to use
the stairs, as I did, you find the entrances into the wards padlocked
(God knows if there were to be a fire), forcing the hikers to look for
the lift used by both patients and the public.
On
every floor, there is a patient needing to be moved elsewhere, once
again forcing people out of the lift. It takes at least 30 minutes to
move from the ground floor to the ninth floor when you are
aggressive. It can take longer if you are gentlemanly. Common sense
dictates that you separate patients from the general public by
dedicating at least one lift for utility.
In
general, the work environment and working conditions are not conducive,
not just to the workers, but for the public too. These are some of the
issues striking doctors and nurses were raising. In their words, they
feared for their safety within a poor work environment and working
conditions. Wikimedia confirms that there is such a thing as hospital-acquired infection,
also known as a HAI, whose development is favoured by a hospital
environment, and may be acquired by a patient during a hospital visit or
may develop among hospital staff.
HAI
is a serious matter. Wikimedia says in the United States, the Centers
for Disease Control and Prevention estimated roughly 1.7 million
hospital-associated infections, from all types of microorganisms
(including bacteria) combined, cause or contribute to 99,000 deaths each
year.
PARTNERSHIPS WITH PRIVATE SECTOR
In
Europe, where hospital surveys have been conducted, the category of
Gram-negative infections is estimated to account for two-thirds of the
25,000 deaths each year. We complicate matters when the hospital
environment is not clean. Yet there is water and people employed to do
the same, with so many unemployed people who can do the cleaning. It is
simply inexcusable to risk the lives of so many people.
It
is possible to partner with the private sector to build more ward
facilities for patients who can afford to raise enough money to
subsidize those who cannot afford the care. There is a glaring
opportunity to leverage technology to improve workflow within the
hospital. This will free up the doctors to concentrate on their core
activities. There should be a call centre manned by a general physician
to screen patients, direct them to appropriate locations and leave only
referral cases to consultants. A 2012 study on the workflow changes
revealed that the hospital could save as much as 40 per cent of the
healthcare cost.
Since
more than 80 per cent emergency room cases are accident-related, there
is need to create trauma centers at strategic locations, such as
Mombasa, Muranga, Waiyaki and Limuru roads and train first
responders. The same can be used for other emergencies, with complex
cases being referred to Kenyatta. This is what will free up Kenyatta
Hospital to undertake its core mandate and ease the congestion. To
finance such changes, we need legislation to force insurers to pay for
the cost of caring for accident victims upfront.
INCUBATE START-UPS
There
is need to leverage the university students as labour to create
industrial production of some of the bulky essential materials, such as
infusions, which cost more in transportation than the content. Most
universities globally incubate start-ups that eventually become big
companies that boost university endowment funds. Sections of Kenyatta
National Hospitals should be used to set up these incubators. They can
even start with the manufacture of generic drugs that we now import from
India.
Chances
are that when the students graduate, they will replicate what they have
learnt and create jobs. It is inexcusable to have knowledge, labour and
resources and become a net importer of generic drugs. Without making
the generics, we may never have the confidence to innovate new drugs.
The
story of our healthcare is similar throughout the country, but we now
have the opportunity to correct at least one facility that can become
the centre of excellence for others to follow. It requires a county
government that can take the risk to build a public-private partnership
around equipment and capacity building.
On
equipment, you do not even have to lease it, as it is not a core
competence for the hospital. It is possible to rent space to equipment
manufacturers and give them targets on pricing and number of
patients. After sometime, and as throughput improves, the price will
significantly drop to the extent that the majority of Kenyans will begin
to afford healthcare. We did it in the telecommunications sector and it
can be done in the healthcare sector too.
William
Pollard said, “Without change there is no innovation, creativity, or
incentive for improvement. Those who initiate change will have a better
opportunity to manage the change that is inevitable.”
Let’s change things so the poor can afford healthcare.
Dr
Ndemo is a Senior Lecturer at the University of Nairobi, Business
School, Lower Kabete Campus. He is a former Permanent Secretary,
Ministry of Information and Communication. Twitter:@bantigito
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