Every few weeks a news headline pops up that one of the referral hospitals in Kenya is reeling with patients. Little wonder that the recent Daily Nation report on the congestion at Kiambu Level 5 Hospital caused merely minor ripples in the form of public outrage.
Even with the Treasury recently allocating Sh2 billion to free primary healthcare, more patients still prefer referral hospitals to their local clinics and health centres.
Earlier this year, Health Cabinet Secretary Sicily Kariuki pointed out that Kenyatta National Hospital and Moi Teaching and Referral Hospital at Eldoret were more than 180 per cent congested. It is common for patients to share beds, contract infections from the unhygienic conditions or even die before getting the doctor’s attention.
On paper, patients are encouraged to visit the health centre nearest to their homes as their primary point of contact. The World Health Organisation (WHO) defines primary healthcare (PHC) as the first point of contact for individuals within a healthcare system, noting that it should “provide comprehensive, accessible, community-based care that meets the health needs of individuals throughout their life”.
It further notes that PHC ranges from health promotion to palliative care that can meet 80-90 per cent of an individual’s health needs over the course of their life. Ideally, referral hospitals should handle patients referred by lower hospitals that cannot offer the needed specialised care. But it is common to see people travel hundreds of kilometres to a referral hospital to get treatment for a condition that could have been addressed a walking distance from home.
KNH data shows about 46 per cent of their patients come from Nairobi County. Patients from Kiambu make up, 13 per cent, Machakos, 6.3 per cent, Kajiado 5.6 per cent and Murang’a 4.3 per cent. Many of them do not have a referral from their local hospitals.
Indeed, this bypassing of primary care centres is often justified, especially in cases that are more serious. Furthermore, many Kenyans understandably go straight for the referral hospitals because their previous experience with primary care facilities was less than satisfactory.
The local health centres are often understaffed and under-equipped. Repeated efforts by government to equip them have revealed that more work still needs to be done to change the attitude of patients. After decades of bad experience at local health centres — absent doctors or the lack of necessary equipment and medicine — many Kenyans now simply bypass even those primary care centres that are actually equipped to help them.
This calls for more deliberate change-of-attitude campaigns among policymakers and those managing primary care facilities. For instance, health facilities should begin promoting themselves by highlighting the services that they provide rather than simply carrying the title of a “hospital” or “health centre”. This will prompt patients to stop and think before defaulting to the referral hospitals.
Since referral hospitals cannot, by law, turn away patients, the government should give incentives for the primary care option, especially in areas where the centres are equipped to handle the numbers and the ailments. This may include discounted cost of consultation and care.
This year’s budgetary allocation of Sh2.5 billion for the roll-out of universal health coverage (UHC) to four counties on a pilot basis is a step in the right direction.
Local care centres should also carry out health drives in the surrounding communities, to cultivate an ethos for primary care. By integrating primary healthcare into other aspects of local community and social engagement, it will be easier for the residents to think of these centres as their first point of contact.
Still, these psychological and sociological tactics can never replace the fact that, in order to work, primary care centres need to be well equipped and adequately staffed. An ethos for prioritising primary care is not a medical diagnostic tool.
LESS THAN IDEAL
Goodwill can never replace antibiotics. These lower-level hospitals must be refurbished. The number of specialists there should be increased and modern equipment installed.
The Kenya Medical Practitioners and Dentists Board says that 80 per cent of doctors in Kenya are based in Nairobi and Mombasa — many of them by choice. Many of these doctors cite the lack of medical equipment at the primary care facilities, which further complicates their work and makes them liable to offering less-than-ideal patient care.
While a change of attitude is necessary, however, it is secondary to the capacity challenges that stand in the way of healthcare delivery.