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Our healthcare system went to the dogs long ago

By Alexander Chagema | Published Thu, June 14th 2018 at 00:00, Updated June 13th 2018 at 22:38 GMT +3

Healthcare constitutes part of President Uhuru Kenyatta’s Big Four agenda, and rightly so. Ours is a dysfunctional health care system that unwittingly contributes to poverty in the country. Families have, and continue to dispose of property, land in particular, to raise funds for treatment.

The deterioration of medical services can be traced to the advent of cost-sharing in public hospitals, but later became more apparent with devolution. Doctors, evidently, did not buy into the idea of devolving healthcare, but their objections were resisted by Governors who insisted they could effectively manage the docket but found-to their consternation-that there was much to it than merely tucking it under their wings. Like the security docket, health should not have been devolved to counties, at least not when most of them were groping in the dark and trying to find their footing.

While previously a patient’s conviction was that going to hospital guaranteed recovery, today it is more of a hit-and-miss affair, and quite a number of factors contribute to this.

Corruption sneaked into the healthcare system with cost-sharing; an occurrence that not only occasioned the disappearance of medicines from hospital pharmacies, it birthed substandard medication that passes off as generic drugs. Unfortunately, the pharmacy and poisons board either lacks capacity to police the entry of poisonous substances introduced in the market as medicines, or is sleeping on the job. Generics, often taken as self-medication, pose greater harm than most of the pathogens we get exposed to in the course of any day.

Technical appearances

Like the undesirables who patronise Parliament in Nairobi, doctors and senior clinical officers resort to making technical appearances in hospitals. The explanation for their cavalier behaviour is their disillusionment with government, and that inevitably leads to moonlighting. The comatose state of public hospitals has led to the proliferation of private clinics and hospitals that also take up much of the time that doctors who operate them should spend in their duty stations in public hospitals.

Private medical facilities outnumber public hospitals anywhere in the country, and that says a lot about the state of public hospitals and the citizen’s perception of them. But while private facilities fill in the void left by public hospitals, they pose more danger to patients.

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First, such clinics, just like public hospitals, are left in the care of trainee clinical officers, nurses, or doctors who for one reason or another cannot secure licenses to practice. Proliferation of private clinics contributes to the disappearance of medicine supplies from government hospitals as such drugs end up there or in private pharmacies strategically set outside public hospitals. Not surprisingly, a doctor in a public hospital would prescribe medicine and refer a patient to a specific pharmacy.

These pitfalls often go unnoticed by patients who do not have time to peruse licenses and documents. With stringent controls, such vices are rare in public facilities, but laxity in bearing its own toll. With quack doctors on the prowl, the attendant risks of wrong medication and misdiagnosis have risen exponentially. Misdiagnosis has inevitably led to excessive cost of medication, which many cannot afford. Equally worrying is that misdiagnosis leads to longer periods of convalescence, yet workers constantly on sick leave are unproductive.

Experienced doctors

Negligence in public hospitals has seen a rise in litigation cases. So far, gynecologists have been slapped with 150 cases of malpractice, surgeons come a close second with 130 cases. Reports show several hospitals have been ordered to pay more than Sh38 million for mistakes arising from negligence, and all this, in the space of only two years.

There are incidences in which people suffering what can easily be diagnosed by experienced doctors have had to undergo several tests, most costing between Sh1,500-3,500. By a twist of fate, the wrong tests usually come first, thus draining the patients’ meagre resources. By late 2016, close to 2,000 doctors had voluntarily left public service in a country where slightly over 3,300 doctors are employed against an estimated population of 45 million.

With the mass exodus of doctors and lethargy among those still in public service, it is hard to see how the Cuban doctors will make an impact. Medical services cannot be effective when a referral hospital like Kakamega, either out of design or negligence refers patients who can barely afford it, for simple tests like EEG to Eldoret or Kisumu.

Moreover, the impact of the vaunted Sh38 billion medical equipment scheme is yet to be felt. Most of the machines are dysfunctional, having broken down, or for lack of trained personnel to operate them. Testing kits in public hospitals are mostly obsolete or lacking. We have had cholera cases that took eternity to confirm. Malaria testing kits in dispensaries - the microscope type - are unreliable. Most patients are referred to private labs for malaria and typhoid tests. Most critically, the government must work hard to meet World Health Organization’s recommendation of one doctor per 1,000 patients to improve healthcare.


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