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UHC achievable only through innovation and modernisation

Laikipia Governor Ndiritu Muriithi. [Elvis Ogina, Standard]

I applaud the launch this week of UHC. Universal healthcare is a cornerstone in development.

It is not possible to have a high quality of life when there is ill-health. 

That is why the mission of the Laikipia Health Service is quality healthcare for all.

Across the globe, all nations strive to achieve UHC.

To achieve UHC requires that everyone in the population is covered with the services they need, when they need them and at the least out of pocket financial expense.

Every day, thousands of families face financial ruin, the result of medical bills.

Many families and friends gather in restaurants in cities and towns across Kenya organising harambees to meet medical bills.

This usually presents a double tragedy when the loved one has died, and the bills have to be cleared before the body can be released for burial.

Social insurance, such as the National Hospital Insurance Fund (NHIF) is globally recognised as the keyguard against financial ruin.

That is why it is critical for all families to be enrolled. And although the indigents need support, the daily premium of Sh17 is roughly the price of an egg, well within reach of a majority of Kenya families.

But it is in how to ensure that everyone in the population is covered with the services they need, when they need them, where deeper controversial issues reside. 

What is the right balance of investments in preventive and promotive health vs curative? 

How can we claim scarcity of human resources when staff absenteeism rates are at 52 per cent?

Artificial limits

And why are commodities (med and non-med) two to three times more expensive in Kenya in comparison to India?

The traditional, conventional thinking, now prevalent in the Ministry of Health and many health departments at county level (health is a devolved function) focuses on high cost, curative services.

As a result, everyone tries to upgrade Level 2 facilities to Level 3, or the new Health ministry's invention Level 3a. All counties want to upgrade Level 4 facilities to Level 5s and so on. 

But what if we turned this thinking on its head and did something innovative? 

Remove the idea of levels, because it sets artificial limits to the services that a particular facility can or should provide.

In its place, have sample referral, networked pharmacy and telemedicine. Impossible you say. Well, we have done just that in the Laikipia Health Service (LHS). Here is how.

Sample referral. When you enter any of our 87 LHS outlets you can expect the full service, with minor exceptions.

If we need some bloodwork that is not available in the facility where you have sought service, it is upon us to pick your sample and get it done in any of our other labs.

We no longer refer you to another facility for laboratory work. Rather we refer to your sample.

And if by chance there is a medication that the clinician wants to prescribe and it is not in her store, it is our back office to sort it out.

As our client, what you expect are medicines. It is our responsibility to sort out the backend to meet your expectation.

Networked pharmacy means that a dispensing pharmacist can tell which medicines are available throughout the 87 facilities and main stores. 

They then use the same process as sample referral to get the medicines to the client at the point of service, greatly reducing incidences where we are unable to fill a prescription. 

And clinicians consult their specialist colleagues using technology. 

On our part, LHS urges you to have health insurance, NHIF being the minimum package.

That traditional and conventional thinking has birthed a current, bitter controversy.

Raging behind closed doors, it pits Ministry of Health heavies and the contractors of the controversial managed equipment lease on the one hand, and liberal, assertive governors, on the other.

Basically, the ministry and the contractors want to extend the now expiring MES contracts for three more years. And get this, at the cost of roughly Sh100 million per year per county!

Both the ministry and the contractors of the managed equipment lease have been making concerted efforts to get an extension.

Obsolete technology

At the end of seven years, most of the final payments are due this April. The MES contracts were in several lots. 

In all lots except one, the equipment should transfer to the counties leasing, for peppercorn at the end of the seven years.

This, no doubt because lots of technology is considered obsolete after seven years.  In one lot, the transfer should happen at the residual value.

The proponents of extension have been making various arguments. I examine them briefly.

They have claimed that many hospitals do not have specialised repair tools to repair MES equipment.

Therefore, if the extension is not done, equipment will not be repaired and will not be available to provide required services.

Those opposed to the extension have responded that what is required are maintenance contracts, not an extension of the lease contracts themselves. 

In any case, these so-called specialised tools must exist somewhere in this universe and counties or the maintenance contractors can get them.

The proponents of extension have also claimed that the spare parts are not available locally and therefore the breakdown of any equipment will result in equipment not being repaired due to lack of spares which will mean required services will not be available. 

Those opposed have again responded that the maintenance contracts will take care of that.

Better option

The contractors have made the self-defeating argument that there is equipment that requires replacement after seven years and therefore if the extension is not provided, these will not be replaced and consequently, no service will be available.

Well, the reason the lease contracts were for seven years is that after that the equipment is considered obsolete!

Why should we extend contracts for another three years to cover obsolete technology?

A further argument is that if the extension is not provided and equipment fails, patients will have to travel to Kenyatta National Hospital (KNH) for the services.

All are rather pedestrian arguments. 

Auto crave machines used for sterilisation are, for example, rather standard equipment.

Ministry seniors have chimed in that the renewal makes business sense.

Business sense for whom they don’t say.

Frankly, I am struggling to see how paying Sh100 million per year for three years is a better option for counties, than paying the US$ 1 peppercorn that the contracts call for. 

It might be good for the bottom-line of the contractors, but to claim that extension is in the best interest of UHC is to think we are dimwits.

Both the ministry and contractors have alleged that counties don’t have the biomedical engineers necessary to repair and maintain the equipment.

Two basic questions arise from this allegation. Where has the ministry been for seven years that the contracts were running? 

How will they remedy the situation with the three-year extension that they are seeking?

In any case, what were the hospitals doing before the managed equipment lease?

As I have argued in this column before, UHC is achievable.

But it will be through innovation, not lining the pockets of health sector contractors.