WHAT KENYA’S HEALTH SYSTEM NEEDS
By Dr Flavio Mugendi
And it is not the Cubans!
The current national debate is full of corruption rhetoric punctuated by the brief mention of the arrival of Cuban Doctors. It is no longer strange news that the Government of Kenya is importing Cuban Doctors to fill in gaps in healthcare workforce. In a country that has qualified locally trained doctors who are yet to be employed, this move begs one question; Is it the Cubans that we need or a healthcare system akin to the Cuban system?
A properly built system fits the definition that a system is collection of elements or components that are organized for a common purpose. In the healthcare space, the elements are organized towards one common purpose: to deliver quality healthcare. There is no difference in definition for a private and public health care system, a system is as such to deliver a common purpose which is quality healthcare whether the said system is public or private.
In the mention of quality healthcare, many Kenyans especially those seeking the service from public facilities cannot relate with the term quality. What is quality? According to the American Society for Quality, quality is the characteristic of a product or service that bears on its ability to satisfy stated or implied needs. Following this definition, a healthcare system that delivers quality care offers services that satisfy the needs of the patients.
The painted meanings of the terms system or quality have no individual bearings to them. In a properly constituted system, any qualified human being can work and deliver quality services. This is to mean then that there is nothing special with the Cubans, they just happen to work in a proper system that is keen to deliver quality results. I will further state that the Cubans have come and left their properly functioning system in Cuba. They did not board the plane with the system; why? They are not the system. They are just a component of the healthcare system.
A system has inputs and processes that work together to deliver outputs. The checks and balances at the input and process levels determine output. Personnel, infrastructure and consumables are main examples of inputs. Processes basically refer to how we do things, all the steps in execution towards a common goal which is quality healthcare. In achieving quality output there are standards and guidelines that state how each of the two components (inputs and processes) should be. In Medical practice these standards and guidelines are as a result of many years of clinical and epidemiological research, hence evidence-based medicine. In order to standardize the practice of medicine, international bodies such as WHO, publish a set of guidelines that govern the process towards quality healthcare. As stated, most of the guidelines are results of medical research, hence proof of success and quality. So if any nation has to achieve quality healthcare, the inputs and processes have to be congruent with the standards and guidelines as provided by the regulating bodies locally and internationally.
Our Kenyan healthcare system needs to first adhere to local and international standards at the input and processes level before we look elsewhere. The fact that Kenyans can come up and run Private Hospitals that offer quality healthcare and that are leaders in the industry across the region, is a testimony enough that the Public system can work too. It is the same personnel that work in private that work in public hospitals. The difference is just the system. The private healthcare systems have institutional standard operating procedures that are adhered to by professors and sweepers alike. On the other hand few are bothered by the existence or lack of standard operating procedures in the public system.
The challenge in the public healthcare is not the individuals but the system and the corrective measures have to be system dosages. The system output is determined by the inputs and the processes. The input aspect has to be addressed as well as the process so as to come up with quality output.
It is therefore obvious that in addressing a failing system, one would focus on the elements and not try firefighting tactics that do not last. In sorting out inputs, the beginning point is in ensuring that the personnel already available are well trained and equipped then deployed. There remains a gap in terms of shortage of Doctors in Kenya. WHO, the international body that standardizes healthcare, requires that one doctor should serve 1000 people. In Kenya, we have one doctor required to serve up to 16,000 people. In seeking quality as defined by WHO standards, we fall short. The steps to sort out these issues are not hidden in Havana. We know that there are unemployed Kenyan Doctors, general practitioners and specialists. Let us employ these first to reduce the Doctor-patient ratio. The next step is to empower training institutions to train healthcare workers locally. We already have the institutions – the capacity lacks. If we produce a constant number of well trained crème de la crème caliber of healthcare workers, we shall seal the gap that exists in shortage of primary care doctors. In so doing we shall have addressed a key aspect of Input in the healthcare system.
The next vital Input is the infrastructural aspect. We cannot function with infrastructure that was set up in the colonial and post colonial period. As the population expands so should the public facilities. Well trained healthcare workers no matter how passionate are perennially let down by infrastructural inadequacies. The placement and development of infrastructure should match the capability and availability of staff that man them. That is, the personnel and the infrastructure should be in tandem. Yes you can send a doctor to a sub county hospital, but if the theatre has no water the doctor has little options in the event a case that requires surgical intervention presents, no matter the doctor’s passion or qualifications. For sure you can place CT Scans in a facility, but without a radiologist the machine does not contribute in achieving quality.
Processes are all about doing the right thing in the right way as defined by international and local standard operating procedures. This requirement has no nationality limitation. Whether Kenyan, Cuban, Congolese, English or American once in a system, one is required to adhere to well defined standards and guidelines. Routine monitoring and evaluation that check defined indicators, ensures that all players in the system are observing the said standards. Well, corruption and mediocrity at many levels have ensured that we cannot monitor and evaluate with precision and brutality that would lead us to achieving quality. We have to initiate well known checks and balances for us to set up health processes that produce quality service in all public health facilities across the country.
The desire for wellness drives patients to seek healthcare services. The need that the patient has is well known. If the need is satisfied consistently across all seasons then quality is attained. The desire to lessen the burden of disease in fellow human beings drives healthcare workers to deliver services in hospitals. If the healthcare workers deliver the prescribed services across the board according to well set standards and guidelines, then quality is embraced. Both the patient and the healthcare worker need infrastructure and consumables that meet each of them at their respective points of need. In addition, they both need to be governed by well-known standard operating procedures. After each interaction between the patient and healthcare worker, there needs to be monitoring and evaluation measures that will determine if quality was attained. It is therefore not just a simple affair of importing 100 Cuban doctors that will fix our healthcare system, but a system approach that aims to fix all elements with a collective aim of delivering quality healthcare. Such approaches should outlive our generation and that’s a legacy.
Dr. Mugendi is the presenter at WebDoctorKe. www.webdoctor.co.ke