Medical practitioners are proposing that teaching and referral hospitals remain under the national government.
The Kenya Medical Association (KMA) now wants the Government to take charge of the hospitals, accusing the counties of failing to manage the hospitals well.
Former Director of Medical Services Richard Muga said this cadre of hospitals has not been able to fit well in devolved governance of health systems.
“There is a group of hospitals that used to be called provincial hospitals. In the new dispensation, they have not been defined. Only Kenyatta National Hospital and the Moi Teaching and Referral Hospitals have been classified by an Act of Parliament. The others have been left hanging, without proper indication of where they fall and how they should be financed in the devolved health systems,” Dr Mugo said.
Examples of teaching and referral hospitals include: Jaramogi Oginga Odinga, Mt Kenya, Coast, Kakamega, Nakuru, Embu and Garissa.
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“Counties are running to invest many millions to make these hospitals meet the state-of-the-art criteria but still they are overwhelmed, owing to inadequate resources,” Muga said.
Big challenge
He cited Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), which serves almost 10 counties with an overall population of about 10 million yet it is only financed by the county government.
“JOOTRH serves Kisumu, Vihiga, Homa Bay, Migori, Siaya, Kisii, Busia, Nyamira and Kericho. They all take their patients there. So if you call them county hospitals and make one governor to be in charge, then our health system is in trouble. It is a challenge to have regional hospitals accountable to one county, which clearly indicates a mismatch” he said.
He said the workforce at the regional hospitals, which currently stands at between 800 and 1,000 inclusive of health professionals and non-medics, cannot meet the demands of the population and are thus always overstretched.
“We should look at how to empower the teaching and referral hospitals, and how we can remove them from one county and make it the responsibility of all the counties in the catchment areas within which the facilities are located,” he said adding: “We must also give it an empowered board with a budget line to cater for its needs. The Chief Executive Officers should also be elevated to a level where they can command, budget and mobilise resources to give quality care.”
Poor families
The Government, he said, must now rethink of a mechanism to address the challenges that are detrimental to the achievement of universal healthcare.
He said the out-of-pocket payment of health insurance denies many poor families access to health care as they are unable to meet it most of the times.
“As it is currently, Kenyans are financing their health on a premium basis through the National Health Insurance Fund. The Government needs to lower the burden to the poor household by paying for their health insurance through taxes,” he said.
Consultant Urologist George Magoha said Kenyans are not getting effective healthcare as they thought under the devolved health systems.
