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The Kenyatta National Hospital, one of the largest referral institutions in the East Africa region, is on the verge of transforming itself into a self-sustaining, profit-making outfit.Acting Chief Executive Officer, Dr. Charles Kabetu outlines a raft of measures the hospital’s top organ, the Board of Management, has recommended and started implementing to achieve the long cherished and desired goals.This will be a major brake from the hospital's historical dilemma of being underfunded by the government, yet still remaining the largest referral hospital in the country and region, catering for some 500,000 outpatients annually.
KNH, as it is popularly known, turned a century old in 2001 and boasts a rich history and pedigree, including being the first facility where Siamese twins underwent surgery in 1977 to have them separated, though one of them died shortly after the surgery.DEA photo Editor, Yahya Mohammed recalls the event with a mixture of pride and regret, (one of the twins died) and says the surgery went on from 6.00am to 6.00pm, conducted by a team of neuro, bone, heart, skin and other experts in an epoch-making operastion.
KNH, which handles patients from as far as Uganda, Rwanda, Tanzania, and Burundi started off as a 40-bed facility, then called Native Civil Hospital but was renamed King George Hospital in 1952.Come Kenya’s Independence and its name changed once again to reflect the new circumstances. it became the Kenyatta National Hospital, named after founding President, Jomo Kenyatta.
With over 50 wards offering specialised care and over 70,000 in patients admitted each year, KNH is easily one of the busiest hospitals in the continent, coupled with its twin mandate of providing a special environment for medical research. The latter is done jointly with the Kenya Medical Training College, Kenya Medical Research Institute and the National Laboratory Service of the Ministry of Health.
Dr. Kabetu says that the challenge of providing health and medical care is immense, making it impossible for the government to single-handedly achieve it.
“It is impossible for the government to be the sole provider of health. But other sectors could chip, like, say the Education ministry, which gets almost five times what the ministries of Public Health and Sanitation and Medical Services are aallocated in the national budget. At Sh 30 billion, he laments, this figure is a far cry from the recommended 16 per cent of the national budget as it constitutes less than 8 per cent.
He sees the way forward as using part of the Education budget to promote health, say through handwashing campaigns to reduce germ intake and such initiatives, which boost health in the short and long run.
Dr Kabetu, an anaesthetist by profession, says other sectors also have the potential to aid the health endeavour “long before we go development partners for assistance” and cites the social services and water sectors as examples.
In 1987, KNH got a fresh mandate to treat referral cases, both from Kenya and beyond, with specific reference to specialised care. It was also to assist in training medical students for the University of Nairobi, the MTC, research activities as well as for paramedics. Its' expanded mandate meant that the institution was to provide leadership for policy-making in health provision.
Presently, the government provides funding for human resource requirements for up to Sh 3.5 billion, leaving KNH to generate its own money for operations and maintenance. The latter is aided by the concept of cost-sharing by patients.
Dr Kabetu says this concept is not foolproof as only 30 per cent of patients are able to pay. “The rest are students, the unemployed or those with no means of paying.” This poses a huge financial burden.
But he has spearheaded a remedy, which started in earnest last month. And it starts with the revitalisation of an organised referral system, which collapsed several years ago. Its collapse meant that at the moment, up to 98 per cent of patients are walk-in cases, which makes it near-impossible to plan for them, especially in specialised care. “It is a big challenge,” he says.
Planning is further thrown into a spin when one considers that KNH provides renal (kidney), cardiac, cancer, neuro-surgery, paediatric surgery, orthopaedic, obstetrics and gyanaecology, psychiatry, comprehensive care in HIV/AIDS and tuberculosis, palliative care (counseling and pain management), general and specialised surgery, a 21-bed critical care unit and 23 operating rooms.
Further, it is the only public critical care unit that is functioning, thus the choice of many in the country when faced with the choice of where to take patients in need of such care. Among the raft of changes envisaged by the management, Dr Kabetu says a 4,600 strong workforce poses certain challenges, including finding funds to offset the Sh 600 million budget.
To smoothen operations in this regard, computerisation of records and operations has already began, with the manpower in place and raring to go even as computers are being bought piecemeal. Records in the finance departments have started this journey and the progress is impressive.
In April, heads of departments, senior and middle level managers and staff held a brainstorming session and agreed to come up with some 250 innovative ways of raising money in addition to plugging loopholes which serve as conduit for losses.
It was also noted that another method of achieving effectiveness and efficiency was to out-source certain services, such as security, debt collection and catering, so as to reduce core staff and its resultant supervision as well as emoluments.
Another challenge faced by the KNH is retaining specialists, especially when fully employed and the way out is being seen as allowing them to do consultancies even as they perform specific duties at the hospital. This method is in line with the concept of devolved services, in which specialists will be allowed to work as consultants, freeing even more cash. it also allows the institution to generate cash to even pay its core staff in the long and short run.
In the bigger picture, Dr Kabetu says, the way forward would be to devolve specialised care to other hospitals across the country. “Let us have other Kenyattas in the regions. That is because KNH is not funded as a national facility. That would ease congestion and allow us to do highly specialised work. Indeed, that kind of scenario would allow us to engage in medical tourism,” he says.
If medical tourism takes shape and gets running, says Dr Kabetu, more patients from the region would actually come to KNH and enable the institution to make more money, which is crucial in the journey towards self-sustenance and profit-making. “We are working towards this direction,” says he. The Hospital is fortunate that it has not been affected by brain drain, which has hit other sectors hard, with trained personnel migrating to other countries for greener pastures.
Indeed, says the CEO, there is great interest among medical staff in working at KNH. For instance, during a recent recruitment exercise, there were 15 positions for nurses to be filled but thousands of applications were received.
Even as the journey towards self-sustenance gets rolling, KNH is yet to achieve its full mandate as a referral facility and would actually need 20 times its current numbers of medical personnel to attain Vision 2030, a government blueprint for making Kenya a middle-income economy by then. Even aspects such as training are overstretched, what with the parallel degree and other programmes which outstrip resources and facilities.
“Facilities are overcrowded. We are trying to decentralise as a teaching hospital because we are overwhelmed. We have not met our referral hospital mandate,” says Dr Kabetu. Staff welfare is another area targeted for improvement so that employees, say through a savings scheme, can identify with the institution and feel that there is something for them. “We are trying to improve the general attitude of our workers. It can be done.”
Additionally, the private wing of the hospital, the Amenity Wing, which hosts some 206 beds, is being refurbished. “Ideally, it was meant to make profits but now it shares lots of amenities with the public wing. We are trying to devolve it from the rest of the hospital. If it can sustain itself and declare profits, the better for us”, says Dr Kabetu.
The route to Vision 2030, though clear, faces daunting tasks, not least the revival of filter clinics, which would enable medical personnel to sort out the everyday stuff from emergency cases as well as channel clinic cases to specific areas. That would mean that a diabetic, for instance, does not have to travel across the city to KNH to attend clinic as his case can be handled at
The hospital plans to review charges, especially bed charges which as the current rates of Sh 400 per day are quite low. These may be reviewed to Sh 800 per day, still reasonable by any standards.
But plugging what he terms as “leakages” is the biggest challenge at the moment. If losses from these can be curbed, income could double or even triple.Are cases of cancer on the rise? , Dr Kabetu says the perception of a rise in numbers is prompted by the fact that there is more awareness, which leads to more diagnoses.
He says lifestyle is another strong factor that may influence growth in numbers and cites as an example, feeding on western-styled foods, strong in processed fats and preservatives, a sedentary lifestyle and alcohol and tobacco consumption from an early age. The leading incidences of cancer are cervical, breast, oesophagus (throat) and prostrate, in that order. Over and above that, the commonest diseases handled at KNH are pneumonia and cancer.
He says KNH has adequate capacity to diagnose and treat kidney ailments, buttressed by the myriad physicians who handle renal dialysis. The unit has 15 machines, all fully operational, including three that were delivered towards the end of April. Another five are in the process of being acquired, with an extra three pledged by well-wishers. The capacity is to have 35 such machines fully running.
When we visited the Renal Unit, a medical physicist, Ejidio Ngigi and other staff were in the process of calibrating one such machine and the station was a buzz of activity. It was clear the machines will be busy.
In addition, the renal transplant programme was refurbished three years ago and will greatly boost local capacity to perform such transplants. “We are telling our patients that they really do not have to go to India for kidney transplants,” says Dr Kabetu. He blames the rising cases of TB and malaria drugs resistance on the use of sub-optimal medicines. Further, drugs dispensed over the counter, especially antibiotics, without the benefit of records or patient history, have also contributed to the problem.
He sees a greater collaboration between industry players, such as pharmaceutical companies to enforce guidelines and rules as a way out in the short term
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