Kenya needs to train more personnel for cheaper, quality healthcare

The Aga Khan University Hospital Chief Operations Officer Outreach Network, Khurram Jamal. Khurram Jamal, the Chief Operating Officer at Aga Khan University Hospital's Outreach Health Network East Africa, says that students the University trains are "superstars", ready to take on challenging working environments to deliver the best possible healthcare. While many associate the Aga Khan University Hospital with prestige and would expect unbearably high costs of services, Mr Jamal says general physician consultation fees are lower here than in many hospitals and are "competitive", and that their outreach hospitals, which provide the same services the main hospital does, have even lower charges. He spoke to us about the state of healthcare in Kenya and the university hospital's contribution to the same and gave his take on many Kenyans' travels to India for specialized medical care. What are the most critical issues in Kenya's healthcare landscape now? Access to quality care is one of the major challenges here. Getting the right qualified staff like doctors, nurses and technologists is a problem, as is the availability of caregivers. In Kenya, we are significantly below the required level of physicians or nurses per 1,000 people according to the World Health Organisation's (WHO) standards. The availability of specialists like neurologists, gastroenterologists, and cardiac surgeons is becoming increasingly important. The cost of supplies is high since Kenya is a net importer. There needs to be a concerted effort towards establishing industries that can manufacture medicine, medical equipment and so on. Perhaps the government can look into giving tax reliefs to healthcare providers that import medications and high-end equipment that is needed. Amid all these challenges, what makes a university hospital different, or special? A teaching hospital, specifically ours, provides evidence-based care. That to me is the key distinction. Since we are a teaching hospital and we train postgraduate medical students, we have, over the years, developed our full-time faculty model who not only provides care to our patients but also spends a significant amount of their time in training Residents and conducting extensive research across the entire spectrum of medicine. Research, therefore, is a key component that enriches our care. Another distinction is our global system of integrated hospitals and medical centres across Africa and Asia which enables us to provide care to our patients through our connected consultants across various geographies. Our Residents who are the future of healthcare have access to the best available technology in the form of state-of-the-art equipment and they are trained not to just provide care to our patients, but in future, they can compete and practice medicine with the best physicians around the globe. You also have a strategy for neighbourhood clinics ... Yes. Aga Khan University Hospital's core values are impact, quality, relevance and access, which tie into our strategy of neighbourhood clinics or outreach medical centres. We're attempting to bring quality care closer to patients. This in itself creates access. Our specialists from the hospital visit many of our medical centres and provide the same level of care as one would expect in the main hospital. Our prices in the medical centres, in many cases, are also lower than the main hospital, thereby, creating access. Where are these outreach medical centres? We exist in Nairobi, Mt. Kenya, Rift Valley, Eastern and North Eastern regions of Kenya, and in Uganda. We bring relevant services to the communities that don't normally have access to quality health care. This strategy really does touch across our values of quality, relevance and access and we're creating a positive impact wherever we are. The services we offer are pegged to what our patients seek and this is established through the patient satisfaction surveys that we do thrice a year. As such, what we do and offer is relevant to what is being demanded. Our network of medical centres comprises more than 50 facilities and just in Nairobi, we have 33 such facilities. Across the network, we provide primary and secondary care to our patients. We are moving into specialist care as well. Is this model profitable? We are a private, not-for-profit institution so we're not in it for the money. Our business model is financially sustainable and whatever surpluses we generate we plough back into the system to introduce new technologies, expansion of the outreach healthcare network and supporting and further the academic mandate of the university. Kenya has a problem with standards of care, especially in small facilities. What, really, is the problem and how do we address it? The challenge is multipronged and requires stakeholders to come together to address it. There is a need for closer monitoring of the mushrooming of facilities. There is also a problem with the regulatory framework. We appreciate that government agencies are doing more and you have seen for example the closure of pharmacies that operate illegally. But we need to empower and encourage facilities to do more self-regulation and to follow globally recognised standards of care. It is important to create value for the patients in order to provide the right care. How do you ensure that the quality of care at the outreach clinics is maintained at the same level as in your main hospital? All our staff undergo rigorous training at the main hospital before they are sent to the medical centres to ensure that the care our patients receive is no different to the care one would receive in the main hospital. We conduct CMEs (continuing medical education) for all our clinical staff twice a month which ensures that they are up to date with the recent or upcoming medical practices and are, therefore, better equipped in providing the right care We are now going for a specific accreditation for the outreach centres - Safe Care. Many Kenyans travel abroad, especially to India, for medical treatment, cheaper costs being one of the major excuses. Can Kenya do better to prevent this situation? Kenya needs to manufacture more supplies to make the cost of care more affordable as 30 per cent of the bills are on supplies. We also need to train more specialists. The current pool of specialists for a number of specialities is insufficient, which means the available consultants come at a higher cost. However, people only talk about the cost of treatment and leave out travel costs, accommodation costs, the mental weight of being in a far country and other associated costs when discussing India. At times they have to stay there longer as they wait for diagnosis and post-care as well which also adds to the overall cost of care. We also have cases of people who have gone abroad and the care is not up to standards because there are also varying tiers of facilities. People need to appreciate that we have thousands of Africans who also choose to come to Kenya because it is closer to home, it is cheaper, the culture is similar and to have them at our facilities and for us, they appreciate our global accreditations the quality of care is as good as you'd get in the best hospitals abroad. Aga Khan University is celebrating its 40th anniversary this year. What has been its impact in the four decades? We are training the doctors and nurses of tomorrow, a majority of who go to work in public, mission and private facilities. We are therefore impacting the quality of care in the community. Between the main hospital and the network of outreach medical centres, we see diagnostic imaging scans. This demonstrates our commitment to making a positive impact on the communities that we serve. We are part of a global network of healthcare institutions within the university that ensures the best and latest practices. What next for AKUH? We will open more outreach centres across Kenya and Uganda, and more speciality care centres like the one in Roysambu with distinctive services. We are also going to expand the list of services available in terms of specialists available in the neighbourhoods as well as diagnostic services. We will be introducing the Home Health Services fairly soon.

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