By Sharon Atieno
Access to health care is a critical condition for development in all countries including Kenya. For this reason, the government has resorted to looking for other options for financing the health sector in order to cater for the rising health demand in the country. The managed equipment services (MES) or leasing of medical equipment is an initiative that the Kenyan government has taken that is rooted in public private partnership (PPP), whereby the government is partnering with the private sector to scale up investment in health infrastructure.
The health burden in Kenya has been on the rise for instance, there is increase in non-communicable diseases such as cancer, diabetes and heart diseases. Deaths due to cancer infection have risen drastically from 11,995 to 15,762 representing an annual increase of 4.5 percent. The figures for 2016 also imply that out of 100 deaths at least 8 are caused by cancer compared to at least 6 in 2010. The number of injury cases from traffic accidents has also risen with statistics indicating 50 percent of bed occupancy in hospitals and over 40 percent of hospital mortality.
Through MES, the government aims to attain the highest achievable standards that corresponds to the needs of its people. Though this is not the first time the Kenyan government is leasing medical equipment, this time it is different because the health sector is devolved and thus there has to be proper co-ordination between the county government and national government.
The MES project gives health facilities access to modern health infrastructure, equipment and/or services without upfront payment. The facilities have the equipment over an agreed period of time, within which the government makes payment in instalments based on agreed performance indicators.
“The payment is done quarterly subject to reports which are submitted monthly at quarterly reports,” states Edward Mwagore, project manager, Philips –the contracted private company which handles Intensive Care Unit (ICU) equipment at 11 hospitals countrywide. He was speaking at a public forum on emerging health sector financing trends: case of MES, convened by the Institute of Economic Affairs in Nairobi.
The leasing of medical equipment project is estimated to cost 38 billion shillings to the benefit of 98 hospitals nationally. The contractors are required not only to supply, install and train users but also to provide maintenance, repair and replacement services for the specialized medical equipment for the duration of the MES contract.
The equipment to be supplied was divided into seven lots with each lot containing a category of equipment to be supplied ranging from ICU, radiology, renal unit, surgical and theatre among others.
However, a lot of concerns have been raised concerning the MES project with the major challenge being human resource.
“There have been delays in operationalization of equipment because of human resource challenges. The renal unit for Kajiado was commissioned this year yet it was delivered two years ago this is because we had not gotten a renal nurse despite advertising the position,” Esther Somoire, County executive committee member for health, Kajiado County.
She noted that the lack of somebody to fill that position was a clear indication of the shortage throughout the country. It took a year for them to train their own nurse, in addition to that they had to train a physician and other medical officers to be able to manage that unit.
“ICU bed requires six nurses per shift running three shifts per day each allocated to a bed, this results in at least 36 nurses in the ICU unit, yet there are very few nurses who are trained in intensive care,” lamented Mwagore. “Specialization of doctors is a challenge, most doctors are in Nairobi yet they are places that face deficits. In Thika level five hospital, the Cuban doctor is the only one running the ICU,” he added.
Counties decry unfair distribution of MES equipment. Though most counties paid similar amount of money, other counties received more equipment than others. “Some counties received the same equipment as Kajiado but they also have an ICU and city scan among others while other counties received very little,” stated Somoire.
There is a lot of anxiety in the contract terms with county governments not being sure of the future terms of the contract including what happens at the end of the seven years after which the contract is set to end.
Complaints have risen surrounding the full implementation of the memorandum of understanding. “There are parts of the MOU that have not been implemented for example, there was supposed to be interconnectivity between the radiology department but it has not happened yet though we are in the third year of the contract being implemented,” lamented Somoire.
Concern has been raised over extra costs that are being incurred during operation and maintenance. “The radiology department and theatre, x-ray machine fail is very expensive and the cost was never factored in in our 2016/2017 budget when the machines were being delivered. We also have to bear the cost of non-pharmaceuticals supply which is outside the contract,” said Somoire.
She also added that running the renal unit required supplements, hence they had to expand the services in the county laboratory to be able to offer most of the services and test required by renal patients.
There are claims that the cost of MES project has been hiked to 65.8 billion shillings to cater for additional equipment due to increase in demand and technology to network them through a health information system. This means that all the 47 Counties will now have to pay 9.4 billion.
Such risks and hidden costs are making the MES project costly, thus increasing the financial burden of the future taxpayers. The absence of full disclosure of the contract between the ministry of health and the private partners makes it difficult to assess how cost effective or not this project is and whether it is aligned to the priorities of the counties.