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KENYA: Report lays bare mess in country’s referral hospitals

May 2019 theStar. Referral hospitals in crisis. They are, suffering from ineffective patient-nurse ratio, lack of critical supplies and equipment, dilapidated structures, unsafe overcrowding and inadequate sanitation, among many other problems.

A parliamentary Health committee report says there’s an almost total lack of plant and equipment maintenance and replacement at these critical facilities, including at the giant Kenyatta National Hospital.

The report says KNH faces “a near crisis” shortfall of 1, 456 medical workers that has greatly undermined services.

These details emerged days after a separate audit report revealed that 80 babies die every week at the New Born Unit (NBU) of KNH.

The new report by the National Assembly’s Health Committee revealed that four of the country’s referral hospitals have been incapacitated by acute understaffing and perennial underfunding, among other problems.

They are overcrowded, the buildings are old and dilapidated, with cracks in the walls and roofs that leak.

Critical facilities such as enough toilets, bathroom sinks and ventilation are lacking in most of the hospitals.

The report focuses on national government-managed referral hospitals such as KNH, Moi Teaching and Referral Hospital (MTRH), the National Spinal Injury Hospital (NSIH) and Mathari National Teaching and Referral Hospital (MNTRH).

The committee chaired by Muranga’ woman representative Sabina Chege said KNH is “severely constrained” due to underfunding and overcrowding.

“This has seen a lack of plant and equipment maintenance and replacement,” the committee report says.

The nursing report says the nursing cadre is the worst hit in the staffing shortfall. At times one nurse is forced to take care of as many as 50 patients.

“The nursing cadre was the most understaffed with an average nurse to patient ration being 1:20. In certain wards, this could go as high as 1:50,” read the report.

KNH provides treats an average of 2,093 inpatients daily and 2,500 outpatients daily.

The hospital has a bed capacity of 1,800.

“The hospital is overcrowded due to broken referral systems. The hospital also closed its outpatient clinic that had been previously used to de-congest the main hospital,” Chege’s committee reported.

According to the report, the situation is dire at the Mathari Teaching and Referral Hospital.

The facility, the only mental hospital in the country, falls far short of international standards due to its sorry state and wanting services.

The hospital has an acute staff shortage in all cadres. The available staff does not meet the international ratio. There are only 386 staff against a recommended 1,077.

The hospital operates with only 164 nurses against the required 500 nurses, 11 psychiatrists against a required 20 and only five clinical officers against a required 10.

“Currently, the budgetary allocation for salaries or compensation to employees is Sh615 million. However, the hospital does not utilise the allocated amount fully as a result of non-exchequer releases,” the report read.

It states that Mathare’s buildings are old and dilapidated. Roofs are leaking, walls are cracked and crumbling. The sewage system is virtually destroyed, resulting in constant blockages.

The reports say that the water pipes are old and the drainage system leaks. Water supply is erratic, huge volumes are lost and water bills are high.

It says that the maximum security unit of the hospital, where patients are referred from the police custody and the judiciary, is overcrowded and fces security problems.

The committee reported that Mathare has a serious funding problem after its budget was slashed from Sh114 million to Sh92 million. This was worsened by the failure of NHIF to reimburse the hospital Sh105 million.

“One of the major causes of MNTRH’s financial challenges is a result of it serving patients referred by the Judiciary and police service for mental assessment for suitability to take the plea. Such patients do not pay the facility, nor do referring agencies make compensation,” it says.

“As a result of the budgetary constraints, the current hospital infrastructure is dilapidated, run down and does not meet the norms and standards of a referral and teaching facility,”  the report reads.

The Moi Teaching and Referral Hospital was found to be the most overstretched of all the countries referral facilities.

The Eldoret-based hospital serves about 25 million people living in 21 counties in the Western region and beyond.

“Despite a bed capacity of 900, the facility experiences a daily patient workload of 1,500 outpatients and 1,200 inpatients and a bed occupancy of 110 per cent. This is because of high patient numbers occasioned by the dual function of the hospital as a referral and as primary healthcare centre,” it says.

The committee says MTRH is facing a serious cash flow problem caused by waivers and bad debts that stood at Sh828.3 million on January 31 this year.

According to the report, the hospital management had recommended writing off Sh500 billion in collectable debt secured on identity cards and commitment letters since it opened in the year 2000.

So far, Sh1 billion had been waived as at June 2018, the amount the committee wants the government to reimburse the facility.

Waivers and bad debts hurt cash flow and services.

In the current financial year, the hospital has a budget deficit of Sh1.2 billion that was meant to fully implement the new basic pay structure and pay medical staff allowances as approved in the Collective Bargaining Agreement.

During the year, the hospital received Sh30 million, representing only five per cent of the amount required for the development.

The National Spinal Injury Referral Hospital is overstretched as it serves patients from East and Central Africa.   

It has a bed capacity of 35 and at any given time, the beds are always. This delays admission for waiting patients.

“The hospital is in an appalling situation with dilapidated buildings with no significant expansion since Independence,” it says.

The facility also has an acute shortage of staff in all cadres coupled with stagnation of staff due for promotion. This hurts morale. the hospital is owedSh6 million by NHIF.

Most of the equipment is donated by well-wishers but is not operating and lack of service contracts makes it hard and expensive for the hospital to repair them itself.

The committee also faulted the Kenya Urban Roads Authority and the National Land Commission for hiving off seven acres of the facility’s land worth Sh4.2 billion to build a road without compensation. It was meant for expansion of the hospital.

The hospital has several incomplete projects due to inadequate Exchequer release. 

“Lack of a complete ICT system has affected efficiency and effectiveness at the hospital,” the report reads.

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