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Only two out of 10 Level Four hospitals have a surgeon

 Medics preparing for surgery at Tenwek Mission Hospital. [Gilbert Kimutai, Standard]

The curtains recently came down on the 22nd Annual Scientific Conference of the Surgical Society of Kenya.

The theme of this year’s conference was ‘Safe affordable and accessible surgery: How to deliver and plan for the future.’

This was a topical theme, coming at the sunset years of a political administration that had Universal Health Coverage (UHC) at the top of its delivery agenda.

When you look at the adjectives- Safe, Affordable and Accessible- the bottom line becomes the surgical care provider.

For us to deliver safe surgery, we must have qualified staff working within reasonable time to avoid burnout and thus remain safe to the patients. To make surgical care and healthcare by extension affordable, the forces of demand and supply need to be optimised. Having few providers (low supply) will drive up the cost of care as Kenyans compete for the few available surgeons (high demand).

In a similar way, to make surgical care and healthcare accessible, you must not only take care of the supply per capita, you have to get the care providers closer to the consumers.

As a background, it is important to know that only two out of every 10 level IV hospitals in Kenya have a surgeon. The scenario is worse for anaesthesia providers (nine out of 10 such hospitals lack a single anaesthesia provider).

According to The Lancet Commission on Global Surgery, there should be 20 surgery and anaesthesia care providers per 100,000 population. As a country, we are at a paltry two per cent. This magnitude of inequality was not lost on the surgical fraternity over the three-day conference.

Through keynote lectures, moderated panel discussions and round tables, several thematic areas came up. Key among these was the training of more surgeons to bridge the safety, access and affordability gap.

 More training centres are becoming available which is a good start. [iStock]

Significant policy and operational interventions have been put in place already. More training centres are becoming available which is a good start. There are various players that need to actively engage in the training agenda.

First, the national government. The national government through the various health and education regulatory authorities and state agencies has the responsibility to oversee standardisation of the training curriculum including a common exit exam for surgeons.

As it stands now, there are two models of training surgeons. The university system where a thesis by research is mandatory besides the theory and the clinical skills training. Then there is the collegiate system where the primary emphasis is on gained clinical and surgical skills within a hospital setting and with additional training in research without need for a thesis.

This model is taking place in many county and faith-based hospitals supported by an online learning platform that brings together hospitals across 14 sub-Saharan African countries under the College of Surgeons East Central and Southern Africa (COSECSA).

Besides, having the National Treasury over the payrolls of doctors released for training would open up space for absorption of more doctors by the releasing counties.

Equally crucial is the consideration for the Exchequer to fund research in the hospitals undertaking collegiate training of surgeons. This will encourage generation of vital local surgical data to guide policy.

Secondly, county and hospital leaders can continue to invest in infrastructure and equipment to ensure hospitals can handle higher volumes and wider mix of surgical cases to assure adequate exposure for the trainees. This would also provide places that the trainees can work and function after training.

The other responsibility would be prompt release of trainees admitted for training outside the respective hospitals or counties to ensure smooth running of the training programmes. Adherence to set standards and norms on areas such as staffing, work hours, maternity and paternity leaves will standardise training across the country.

Dr Stanley Aruyaru is chair, Scientific Committee of the Surgical Society of Kenya while Dr Michael Mwachiro is Secretary, the Surgical Society of Kenya

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