KNH’s problems can be fixed in three easy steps

Misfortunes never come singly, and no one knows this better than Kenyatta National Referral Hospital, which has gotten its fair share of bad press this year.

From accusations of rape of mothers with babies at the newborn unit, to the stealing of a baby from a mother in its premises, and most recently, brain surgery on the wrong patient, the woes seem never-ending.

As a result, the hospital has fallen out of favour with the public, with a serious battering on both mainstream media and social media.

Top management has been sent on leave and the board of management has made terse statements. Doctors who tried to explain what goes on behind closed doors, were seen as trying to cover for their own. They decided to withdraw their services until the systemic issues are addressed.

So what ails Kenyatta which is praised and criticised in the same breath?

To understand, we must begin at the very beginning. The 117-year-old hospital opened its doors in 1901 as the Native Civil Hospital, to treat Kenyans during the colonial era. Across the street was the European Hospital (the current Nairobi Hospital), the white equivalent providing service to white settlers.

The Native Civil Hospital metamorphosised into the King George VI Hospital in 1952 and then Kenyatta National Hospital after independence. During this time, it grew from 40 beds to become a 1,800-bed specialty hospital with multiple departments.

TEACHING HOSPITAL

It serves as a teaching hospital for the University of Nairobi’s College of Health Services, as well as the The Kenya Medical Training College, and several other newer institutions that have come on board over the last few decades. It is also a centre for medical research and innovation. Its core function is to provide medical care to over 40 million Kenyans who come for treatment for simple and complex ailments alike.

Like most other public institutions, Kenyatta has been forced to meet the needs of an expanding population without requisite proper planning to ensure that resources expand to meet growing demand

The main hospital infrastructure was well-designed, but over the years, the number of patients requiring care at the hospital has far outweighed resources and infrastructure which have not grown in tandem. In response, many practices have been entrenched in the running of the institution without questioning their validity or effectiveness.

For instance, not many understand that a 1,800-bed hospital that is usually forced to carry twice its capacity is grossly understaffed. What then happens is that a lot of clinical work is left to medical students, thus disguising the fact that the hospital has a human resource problem. The bitter turth is that students cannot replace the much-needed human resource.

The human resource problem can only be solved by the Ministry of Health, which is directly responsible for the management of payroll at the hospital. If the ministry does not think that it is important to employ more clinical staff, the hospital cannot change that.

UNDERFUNDING

Chronic underfunding coupled with corruption which bites into a huge chunk of the meagre budgetary allocation, is the other major challenge that leaves the hospital on its belly. It is impossible to procure equipment in a timely fashion to sustain the pressure to keep up with the need to improve services. Without funding, it is also impossible to train staff to keep up with new technologies in a timely fashion.

Leadership and governance has also been a long-standing problem. For years, the top leadership of the hospital has  been viewed as a political reward. For this reason, most of the people at the helm of KNH have their hands tied when it comes to trying to streamline the institution and root out the rampant corruption entrenched in various levels. Some have bullets lodged in the spine for their efforts.

Clinical management is a core function in ensuring patient safety and must be completely delinked from politics. The professionals who provide medical care are the ones who understand their job, how to regulate themselves, set up standard operating procedures and develop protocols on patient safety. They must be free to do this within a setting where there is no fear, intimidation or interference. The team leaders must be answerable to their patients first!

However, when politics comes in to cause knee-jerk reactions that intimidate office holders, the result is an institution with weak leadership because those best qualified to lead prefer to avoid the political drama. Let us clean up the mess that’s glaring at us and restore this institution to its former glory!