The trade-off clinics make to remain cheap


Middle-level private hospitals fail to plan for the skilled health workers they will need as they grow, leading them to make dangerous sacrifices.

Wednesday March 18 2020

For universal health coverage to be achieved, there is need for multiple players to pull together to achieve meaningful health outcomes for Kenyans. To this end, the role of the private health sector cannot be underestimated.
The private health sector has been complementing the public health sector for decades. Most modern medical technology has been made available in the private sector first, enabling patients to access care while the government worked to achieve the same in public health facilities.
Private hospitals and diagnostic centres have enabled patients in public hospitals to get expensive tests done locally to improve their care.
For many years, imaging tests such as magnetic resonance imaging (MRI) and computerised tomography (CT) that are now commonplace, were unavailable in public hospitals.

Patients, even those admitted in the wards, would have to get them done in private hospitals and then return to the public hospital for continued care.

Over time, these services have been made available all over the country, making them part of mainstream care for patients. This couldn’t be better demonstrated than in the availability of an MRI machine at the Garissa County Referral Hospital. This signals positive trends in the public health sector, with ability to provide multiple and advanced treatment options for improved patient outcomes.
It is clear that we do not need to cross borders to benchmark in healthcare and its management. We have our own success stories that we can learn from to make healthcare safe and accessible.
Nevertheless, we ask hard questions when things fall apart in public hospitals like the Kerugoya County Referral Hospital in Kirinyaga County.
We also need to take a hard look at middle-level private health facilities, and the last few weeks, during which the regulators have cracked the whip, have provided us with the opportunity to do so.

As middle-level private health facilities start out, they fail to plan for the skilled workforce necessary for appropriate service delivery. This comes back to bite them as they grow in capacity, expand their scope of services and patient numbers rise and the need for that skilled workforce they failed to plan for stares them in the face.
Skilled workforce comes at a prohibitive cost, which is why most highly qualified specialists in Kenya are found in high-end private health institutions where they can bill for their skill, or in higher level public health facilities, on government payroll.
When privately-owned health institutions procure specialised equipment, there is need for skilled manpower to utilise the equipment effectively for patient care. The higher the level of skill required, the higher the need for support services and the higher the numbers of experienced staff required.
To meet these needs, the cost of healthcare spirals upwards because the required skill is expensive. Balancing the cost of providing health services with the desire to keep the costs within the reach of patients becomes a problem.

In a quest to balance the figures, middle-level private health facilities make sacrifices. Unfortunately, what has been sacrificed, for the most part, has been the cost of a skilled workforce in an effort to remain “affordable”.

This is how we end up with facilities running on unskilled or inexperienced workforce, with a higher likelihood of medical negligence, especially where there is inadequate supervision. It is not necessarily a quest to maximise profits.
It is therefore important to ask yourself two critical questions the next time you walk into a middle-level private health facility with “affordable” costs.
The first is, who is subsidising the cost of your healthcare? The second is: if there is no subsidy, what has been compromised along the care chain?