Staff shortage hampers medical project

A Sh38 billion government project to equip and maintain county and national hospitals with machines for renal, critical care, maternity and imaging is off to a bumpy but encouraging start.

The project, launched last year targeting 98 county and two national hospitals, was at inception criticised by governors and senior doctors as “putting the cart before the horse” since there were many basic infrastructure and human resource needs that needed to be addressed first.

Faced with staffing and management inadequacies, it now seems that criticism was not far-fetched, at least in some regions.

So far, the Ministry of Health indicates 87 theatres of the targeted 151 countrywide are working, while six out of the 11 intensive care units are complete.

Thirty-nine of the 49 hospitals targeted for renal equipment are using them, while all the 96 hospitals have imaging and sterilisation systems.

However, adequate utilisation of the equipment remains a mirage in some counties due to poor management of the health sector at the county level.

In Lamu, for instance, a lack of medical personnel presents a huge challenge to the success of the project.

The county’s largest hospital — King Fahad — where the ICU, radiology and rental departments will be hosted, operates with less than four medical officers.

The facility serves more than 130,000 people and sees about 1,700 patients a day, according to Dr Mbwana Kombo, the executive for health in Lamu County.

For now, says Dr Kombo, patients with kidney disease need at least Sh11,000 for transportation alone to make the two trips a week from Lamu to Mombasa — on boat and bus — for dialysis.

King Fahad’s medical superintendent, Dr Swaleh Nyae, says while the diagnosis of chronic or acute kidney problems is not rampant in Lamu, the best the hospital can do is refer the few patients to Mombasa.

Dr Kombo says they expect the hospital will start offering dialysis services under the government programme in February next year.

For now, and despite the urgency of the matter, patients will have to rely on Mombasa for care.

The entire Lamu County has only three hospitals — King Fahad, Faza and one in Mpeketoni — 41 primary health care centres, and only one specialist, a gynaecologist, who is based at King Fahad.

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Apart from Sh200m worth of equipment and infrastructural upgrade that the county will receive from the Managed Equipment Service, the Ministry of Health will spend an additional Sh550 million to increase maternity facilities and install water distillation systems that will allow the hospitals to use the salty water from the ocean.

For a region where health care workers have, since time immemorial, been used to improvising, the equipment come with a lot of worker motivation.

Mr Robert Kitonga, a radiographer at King Fahad, says he now attends to, on average, 40 patients a day who require X-ray services, as opposed to only 15 before the equipment arrived.

Governor Issa Timamy believes the services could be even better, and is therefore appealing to the Ministry of Health for more specialists, even though he understands well health is a devolved function.

“These equipment will be of great help to our people, but we may never be able to utilise them adequately if there are no qualified people to operate them,” says Mr Timamy

Principal Secretary for Health Nicholas Muraguri says the national government will use a “multi-pronged” approach to solve the issue of specialists and the general lack of health care workers in the coastal region.

While Dr Muraguri has not committed to a specific date, he says the Ministry of Health will send interns to King Fahad to buffer the work force.

He also says the national government will pay specialists to work in Lamu and other counties with acute specialist shortage.

After years of neglect by the government, the logistics of providing health care in the Lamu archipelago is proving to be costly than the county government had anticipated, given the geographical challenges.