Brand new equipment, same old problems

The recently launched Sh38 billion medical equipment project has placed Kenya’s health-care system on the global platform.

Kenya will become the first country in Sub-Saharan Africa to use the Managed Equipment Model (MES) model to procure and manage equipment.

The equipment would offer more advanced technological  healthcare solutions to patients in a country that is grappling with an escalating number of non-communicable diseases.

The equipment, fitted with an internet interface, is not only a testimony of Uhuru Kenyatta’s vow to push the Information Systems and Technology (IST) agenda, but also an indication of Kenya’s healthcare taking ambitious steps towards a higher standards of service delivery in the medical field.

PROBLEMS ARISING

However, there are several  issues that  medics say must be addressed. While appreciating the government’s initiative Dr Elly Nyaim, Kenya Medical Association’s chair said that the ministry of health is ‘climbing the tree from the top’.

“We have state of the art billion shillings equipment but meanwhile the same healthcare workers expected to work with the equipment are threatening to strike for not being paid their peanut salaries,” says Dr Nyaim

“Why won’t we sort the foundational needs that doctors have been crying out for first, because good healthcare is not achieved by dealing with needs in isolation?” he asks.

 “It is like buying a car, keeping it in the house so that you can go learn how to drive it.”

Since its devolution, the health docket has faced numerous  challenges.

Workers have been threatening to strike over delay of salaries and in 2014 a study dubbed Health Community Scorecard revealed poor emergency response in all health facilities surveyed with none of the sampled hospitals offering ambulance services in their catchment areas.

There have also been cases of acute drug shortages that have resulted  in patients having to bear the cost of sourcing higher priced drugs from private hospitals.

Dr Nyaim says that some of the newly acquired machines such as the renal equipment, need a team of at least one nurse and a  trained medic. Unfortunately, these are the same medical personnel that the government has trained but failed to retain.

LACK OF DOCTORS

The deplorable working conditions of healthcare workers, and other factors, have also  contributed to the immigration of medics from public practice to private practice

While their migration to developed countries has reduced somewhat, there is still a marked shortage of experienced medical personnel in many parts of Kenya.

Data from the Health Management Information System indicate that as at 2013, there were only 8,682 registered doctors, a mere two doctors for every 10,000 people.

The Nursing council records show there are only 1,873 nurses with an undergraduate degree translating to only four nurses to 100,000 people and a total of 37,907 registered nurses some with diplomas.

Even though Kenya has been dubbed the silicone savannah thanks to its rapid growth in technology advancement and usage, Dr Nyaim remains uncertain about the technical know-how of healthcare workers when it comes to operating the new equipment.

“Doctors’ organisations are just as awestruck as the public … we were not even aware they were being bought, and we are probably going to be in awe when they are installed as the patients will be expecting us to attend to them using the new equipment.”

However, while talking to Jobs, a Health Cabinet Secretary John Macharia, stated that the manufacturers will be tasked with training doctors and nurses on operation. The companies will also bear the costs of maintenance.

“It was deliberate to have only the original manufacturers supply the equipment so that they will maintain the equipment should there be a breakdown, they will train Kenyan medical personnel on the use,” he says.

 “We did not take chances on this because we are aware that for cancer or any other chronic illness a delay or a fault is a matter of life and death… literally.”

COMPETENCY LEVELS

Dr Nyaim’s fear of workers’ competence to handle the technology is not isolated.

A solution to Dr Nyaim’s fear can be drawn from Didier Bonnet’s article titled Convincing Employees to Use New Technology that appeared in the Harvard  Business Review on September 9, last year.

If new work practices and the culture of organisation are adopted to accommodate the equipment, there will indeed be positive returns for health care service providers as well as the government.  

By all human resources management standards, the Ministry of Health should have at least identified   ‘committed technology champions’ early, medics with a rapport with the rest of the medical fraternity so as to create the much needed horizontal influence to help implement behaviour change across the board.

If this had been adopted initially, perhaps local doctors would have been the first people to rally the public against the ‘enemies’ of the new project, such as governors.

However, as written in Bonnet’s article, CS Macharia can be forgiven for a lack of foresight on the matter because when executives are faced with limited budgets, priority is given to the most tangible part first — deploying the technology.

Adoption is left for later.

However, should ‘later’ never come, Bonnet predicts a destructive chain of response:  failure of overall adoption—including filling the aforementioned cracks in healthcare — will breed negativism that can spread through the healthcare workers.

The equipment may also bear  the brunt of the blame if there is failure in the system, especially in cases of malpractice.

At that point cynicism will set in for both healthcare workers and the public and in the future, every additional health investment will be negatively scrutinised and rejected.

Still, better equipment in public hospitals has a ripple effect across the medical service sector.

In an earlier interview, Nairobi University’s lecturer and dental surgeon, Dr Hudson Alumera, gave an example of how dentistry in Kitale changed when equipment was installed in the regions’ district hospital thus pushing the private hospitals to also update their facilities.