Need for innovative models to boost our public health services

Dysfunctional medical laboratory services have been a recurrent challenge within public health care setting for many years. It undermines health care provision by not adequately supporting accurate and timely diagnosis and management of illnesses.

But a recently-concluded four-year project model for laboratory Public-Private-Partnership (PPP) in Taita-Taveta County has demonstrated that innovative modelscan help turn around the performance of the public labs and deliver significant positive multiplier effects on the overall healthsector.

It has attracted attention from the research and donor communities that are keen to take note of creative partnership models for boosting health care within public facilities.

The PPP model, structured as a Build-Operate-Transfer (BOT), involved the Taita-Taveta County which manages the busy public hospital and Lancet Group of Labs, an independent lab network with presence in 14 countries in Africa.

The partnership was initiated by Wildlife Works Carbon (WWC), an international environmental conservation organisation with operations in Taita-Taveta County. The PPP model has seen the lab at Moi County Referral Hospital, Voi deliver a wide range of crucial and subsidised lab services that were previously unavailable.

Health facilities

County residents no longer needed to travel hundreds of kilometers to Mombasa or Nairobi for lab tests, thus eliminating potentially fatal delays in diagnosis and treatment. Frequent operational disruptions of the public lab due to equipment breakdowns and stock outs of lab reagents and consumables became a thing of the past.

The numbers of patients served by the lab under this PPP model more than quadrupled with some being referred from neighbouring counties or from private healthfacilities.Lab revenues increased over 10-fold and the county government no longer needed to inject funds into the facility to keep it operational. Staff morale increased due to favourable working environment and performance bonuses.

Before 2013, WWC sought to invest in a health project that would have high-impact on county residents as part of giving back to its host community. After wide consultations with players in the health sector, it was agreed that upgrading the medical lab at the Voi hospital would enhance health care in the county significantly.

Following the recommendation of stakeholders, WWC approached Lancet to provide the technical expertise in leading the refurbishment of the facility to meet the required specifications and engaging original manufacturers of original laboratory equipment to supply the ideal lab equipment needed to scale up the capacity and efficiency of the lab.

WWC provided the seed capital to the tune of Sh17 million while Lancet provided initial working capital of Sh7 million in the first pilot year of the project. The multi-million shillings lab equipment were thus purchased and placed in the public lab while remaining under the control of WWC and Lancet.

In the first year pilot, Lancet embedded a technical support expert at the public lab to train and supervise the existing hospital lab staff on modern lab operations and upholding standard operating procedures.

Information management

Lancet’s lab specialists and pathologists based in Nairobi and South Africa also provided remote supervision and support through its lab information management system that was installed in the public lab to ensure test results and reports are accurate and of the highest standard.

The pilot year proved that the model would be sustainable as the revenue was higher than the costs, thereby enabling prices of lab tests to be retained at subsidized and unchanged levels to allow affordability to county residents.

The success of the pilot phase prompted the county government and WWC to enter into a service contract and MoU with Lancet to continue supporting the lab for 3 years; April 2015 to March 2018 under the BOT-PPP before it would be handed to the county.

In March 2018 the county requested a 3-month extension to the transfer period, which was completed in June 2018.To ensure continuity of service after Lancet’s exit, the county has been linked directly to the manufacturers of the lab equipment to continue servicing the machines and supplying reagents.

An end-term evaluation report conducted by the author confirmed how the donor-funded BOT-PPP model has increased utilization of quality diagnostic services in the county and beyond.This collaborative project may serve as a model for public-private-partnerships in public hospital laboratories and thereby contribute towards achieving universal health coverage (UHC).

Dr Riro is a Doctoral Fellow, HealthEconomics and Outcomes Research University of Bergen, [email protected]