KENYA: We need quality care, not more hospitals

February 2014 Elesban Kihuba; Reports about medical malpractice are a common item in our media. The much-touted fatal unassisted births in public hospitals are just pointers to the suffering of patients and the poor quality of health services in Kenyan hospitals.

A look beneath the surface raises a number of pertinent questions. Does the country have the right policies to drive quality hospital care and innovation? Has the country taken the right stance on the quality of care improvement? How many patients did hospitals hurt last year?

Past government efforts to address the quality problem have mainly resonated around the access question: How do we increase the number of hospitals and beds in the country? Most counties have rushed to put up new hospital buildings and buy mega machines, a popular political solution which mainly results in cosmetic change.


For instance, a hospital that was recently in the news because a baby died during delivery had been ranked the best a number of times in the past. This indicates that the fundamental question — do hospitals provide safe and timely care to Kenyans who need it? — has been systematically ignored.

One of the contributing factors to this state of affairs is the lack of a comprehensive policy on the governance of quality of care.

This begs the questions: How do you query hospital care in the absence of defined principles and standards? Can public hospitals be faulted for something they have decided not to do or have no plan to do? Should we continue to assume that quality concerns are the reserve of professional associations?

Another key aspect of the quality of care improvement process is that it is hungry for information. We may be in the era of information, but our health sector lacks accurate “big data”. Nowhere is the data problem more clearly illustrated than in our inability to answer questions like: Which hospitals have good outcomes for patients? How many patients were mistreated and hurt in our hospitals? How many patients were readmitted?

Lack of such information compromises the ability of hospitals and their staff to provide quality care. More importantly, it erodes patients’ power and role.


What is the role of patients in the process? If a broad definition of the quality of care improvement process is applied, then the patients are the nexus. In a fundamental sense, patients should improve or change their taste for services so that hospital care can improve.

It is a wake-up call for patients and citizens if the social contract on quality of care is to change. The call for patient participation in quality improvement is not a chimera. Indeed, countries that care about patients’ dignity invest to improve their powers and role.

So, how do we move forward? As affirmed in our Constitution, transparency and accountability are the cornerstones of our social fabric. Our governments (both county and national) should embrace these principles in the management of health care.

Given the sensitivity and attention that health services attract, the right to information on the quality of health services should be spearheaded by an independent organisation, as is best practice across the globe.Parliament should consider making these provisions in the Health Bill that is expected to be tabled soon.


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