The last three weeks have seen images of new hospitals coming up in Kakamega and Nakuru Counties. Everyone has been quick to congratulate the respective governors for their splendid work.
I will go out on a limb and say I have not been fascinated by these developments. If the answer is a 6 billion new hospital, as some quotes would have it for Kakamega, what then was the question?
Some months back, Bungoma County was in the news for having patients share beds at the peak of the Coronavirus period. When asked why this was the case, County officials pointed out rightly that the county hospital had been built in the precolonial period and the bed capacity had not been increased since then.
What those officials failed to tell the watching public was how many surgeons were under the employment of the county and how many operations they did weekly. What they hide from the media is how many specialists they have employed for the fifth largest county by population.
What were the capabilities of their laboratories and how efficient these labs were. How many nurses were in employment in the county referral hospital. What was the turn around time of a patient admitted in the hospital and was that slow turn around time affected by poor staffing norms and failure to provide basic services?
To prove that they care, they ended by saying they were in the process of constructing a maternity hospital to ease congestion. If they have been unable to sufficiently manage a smaller hospital how will expanding the size change service delivery?
BUNGOMA GOVERNOR MOVES TO BOOST MATERNAL HEALTH WITH NEW 300-BED CAPACITY MATERNITY COMPLEX
— BungomaDigital (@BungomaDigital) July 18, 2019
You can build the largest maternity hospital in Sub-Saharan Africa but when you have employed only two obstetricians to serve 1.67 million people you are bound to be in trouble.
When the underfire Nairobi Governor Mike Mbuvi ‘Sonko’ was told about the problems at Pumwani Hospital, his solution was not to make the hospital more efficient, rather, his solution was to come up with a 20-floor master plan for a new Pumwani. Bollocks!
Hospitals are not hotels. Solution for lack of bed spaces is not building bigger hospitals, the solution is increasing the efficiency in these facilities. These two governors are setting up bigger, fancier hospitals but I doubt this was the best way to utilize the money at their disposal.
Referral hospitals will always be bigger but if the level I, II and III Hospitals are not upto scratch, then there will always be demand for even bigger hospitals.
IGNORE PRIMARY HEALTH CARE
In Kenya we continue to ignore Primary Health Care and little resources are put to level I and II facilities. As someone who has worked in Level V hospitals, trained in level 6 hospitals, I can say without fear of contradiction that our solution to health care issues is ensuring our dispensaries and health centers are upto scratch.
Most of these severely-ill patients present to referral hospitals after failure in treatment of basic ailments at the lower level hospitals. Most patients will walk to the nearest clinic/dispensary where their minor ailment is misdiagnosed or mistreated. They later show up at a bigger referral hospital when their disease has complicated making their prognosis worse.
This extra admission would have been avoided by having a more competent individual at the lower level of care. they could have either treated the patient or referred early in the course of the treatment. This eventually improves outcomes and reduces length of hospital stay.
Away with the champagnes for these two counties. Could these governors improve the services and efficiency in these hospitals without multi-million shilling investments? Would it have been easier to add a theater and extend the lab, rather than build a completely new hospital?
LESSONS FROM MTRH
For reference, look at Moi Teaching and Referral Hospital (MTRH) that is progressively increased the scope of services offered without building a new hospital. This was a former District Hospital that has still retained the wards that it had for ages and the investment have improved on what was there initially.
If the grassroots are not improved, enough staff are hired, range of services not improved, then we will continue to build these monuments in the name of hospitals. If the answer is a 6 billion new hospital, what was the question?