UHC is only achievable through innovation and modernization

Governor of Laikipia Ndiritu Muriithi. [Elvis Ogina, Standard]

I applaud the launch this week of CSU. Universal health care is a cornerstone of development.

It is not possible to have a high quality of life with poor health.

This is why the mission of the Laikipia Health Service is quality health care for all.

Around the world, all nations are striving to achieve UHC.

Achieving UHC requires that all members of the population are covered by the services they need, when they need them and at the lowest cost.

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

Many families and friends gather at restaurants in towns and villages across Kenya to hold harambees to pay medical bills.

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

Social insurance, such as the National Hospital Insurance Fund (NHIF) is recognized worldwide as protection against financial ruin.

This is why it is essential that all families are registered. And although the needy need support, the daily Sh17 bounty is about the price of an egg, well within reach of a majority of Kenyan families.

But it is in how to ensure that every member of the population is covered by the services they need, when they need them, that deeper contentious issues lie.

What is the right balance between investments in preventive and promotional health and curative health?

How can we say that there is a shortage of human resources when the staff absenteeism rate is 52%?

Artificial limits

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

Traditional and conventional thinking, which now prevails in the Ministry of Health and in many county-level health departments (health is a decentralized function), focuses on high-cost curative services.

As a result, everyone is trying to upgrade facilities from Level 2 to Level 3, or the new Level 3a coined by the Ministry of Health. All counties want to upgrade Tier 4 facilities to Tier 5 and so on.

But what if we turned that thought upside down and did something innovative?

Delete the idea of ​​tiers, as it sets artificial limits on the services a particular facility can or should provide.

In its place are sample referral, network pharmacy and telemedicine. Impossible you say. Well, that is exactly what we have done at Laikipia Health Service (LHS). Here’s how.

Sample reference. When you walk into any of our 87 LHS outlets, you can expect full service, with a few exceptions.

If we need blood work that is not available at the facility where you requested service, it is our responsibility to collect your sample and have it done at one of our other laboratories.

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

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

As a customer, what you expect is medication. It is our responsibility to sort out the backend to meet your expectations.

The network pharmacy means that a dispensing pharmacist can find out which drugs are available in the 87 main establishments and stores.

They then use the same process as the sample referral to get the medications to the customer at the point of care, which greatly reduces the instances where we are unable to fill a prescription.

And clinicians consult with their specialist colleagues using technology.

On our side, LHS strongly advises you to have health insurance, NHIF being the minimum package.

This traditional and conventional thinking has given rise to a current and bitter controversy.

Raging behind closed doors, it pits Health Department heavyweights and controversial managed equipment leasing contractors against liberal and assertive governors on the other.

Basically, the ministry and the contractors want to extend expiring MES contracts for three years. And get this, at the price of about 100 million shillings per year per county!

The ministry and the managed equipment lease contractors made a concerted effort to secure an extension.

Obsolete technology

After seven years, most final payments are due in April. The MES contracts were in several batches.

In all but one batch, the equipment is to be transferred to county leasing, for pepper at the end of seven years.

This, no doubt because many technologies are considered obsolete after seven years. In a batch, the transfer must be made at the residual value.

Proponents of the extension have made various arguments. I examine them briefly.

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

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

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

In any case, these so-called specialized tools must exist somewhere in this universe and counties or maintenance providers can obtain them.

Proponents of the extension have also claimed that spare parts are not locally available and therefore failure of any equipment will result in the equipment not being repaired due to lack of spare parts, which means that the requested services will not be available.

Opponents again replied that maintenance contracts will take care of it.

Best option

The contractors made the counterproductive argument that there is equipment that needs to be replaced after seven years and therefore if the extension is not provided it will not be replaced and therefore no service will not be available.

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

Why should we extend contracts for an additional three years to cover obsolete technologies?

Another argument is that if the extension is not provided and the equipment breaks down, patients will have to go to Kenyatta National Hospital (KNH) for services.

All are rather pedestrian arguments.

Autocrave machines used for sterilization are, for example, rather standard equipment.

Senior ministry officials said the renewal made good business sense.

Business sense for which nothing is said.

Frankly, I find it hard to see how paying 100 million shillings a year for three years is a better option for counties, than paying the US$1 in peppercorns the contracts demand.

That might be good for entrepreneurs’ bottom lines, but to pretend that the extension is in CSU’s best interest is to think we’re fools.

The department and the contractors alleged that the counties lacked the biomedical engineers needed to repair and maintain the equipment.

Two fundamental questions arise from this allegation. Where was the department for seven years that the contracts were in progress?

How are they going to remedy the situation with the three-year extension they are asking for?

Anyway, what were hospitals doing before managed equipment rentals?

As I have already explained in this column, UHC is achievable.

But it will be through innovation, not out of the pockets of healthcare contractors.

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