Private hospitals struggle as patients stay at home

Clinical staff attend to a Covid-19 mock patient at Aga Khan University Hospital, Nairobi.

The private healthcare sector has found itself in a precarious position with workers in the sector teetering on the edge of unemployment due to the impact of Covid-19.

Top private hospitals including MP Shah, Aga Khan and Mater Hospitals have already effected pay cuts for their staff while some smaller facilities have laid off workers in a bid to stay afloat.

A memo from MP Shah Hospital board chairman Manoj Shah to staff said the pay cut would be effected from May 2020, and would be reviewed after three months.

Mater Hospital's CEO Dominic Mwenja also said staff would take a pay cut between June to September in a graduated scale according to pay. The memo also said some staff would be going on unpaid leave, but would be cushioned with 50 per cent of the newly graduated salary.

At St Mary’s Mumias Mission Hospital in Kakamega county, 40 employees were a week ago sent on unpaid leave as effects of the pandemic bite.

The facility’s administration said operations had been affected by the virus, making it unrealistic to keep the workers.

Father Columban Odhiambo, who is in charge of the hospital, said the number of patients seeking treatment at the facility had drastically dropped and management was struggling to pay salaries of  its over 200 employees.

Painful choices

“We have been forced to send some clinical officers, nurses and workers in other cadres on unpaid leave until further notice,” said Father Odhiambo.

The hospital, he said, was struggling to buy medical supplies and had been compelled to shut down one ward for lack of patients.

Despite retaining its 700 employees, Port Florence Hospital in Kisumu county has had to implement a 15 to 40 per cent salary deduction depending on the carders of staff.

It has also recorded a 50 per cent reduction in the number of patients. According to Director Dr Joshua Oron, this has in turn affected their revenue stream.

“The struggle is real. As a hospital, our revenue is directly proportional to the number of patients we handle, and when the number goes down, we face a huge deficit hence cannot pay our bills,” he said.

There has been speculation that many people have kept off hospital over coronavirus fears.

Dr Amit Thakkar, Chairman of the Kenya Healthcare Federation (KHF) says patients have mostly been afraid of visiting hospitals due to the virus, only showing up when it is absolutely necessary or for emergencies.

Worryingly, reports show that there has been a rise in maternal deaths due to mothers delivering at home, while others are keeping off the facilities and missing out on crucial child immunization programmes.

 “One of our big worries is that people are only going to hospital when their chronic condition has become an emergency. Many of the doctors in private hospitals are dealing with increased cases of hypertension and diabetes that are not being controlled well because of missed appointments,” said Dr Amit.

Revenues have also been affected heavily.

“Because of the pandemic, we have seen a 40 per cent decline in the revenue across all hospitals. Some have been affected more severely than others. The ones that rely a lot on surgical patients were the first to get affected because all the elective surgeries (non-emergencies and conditions that can wait for a while like growths, small swellings, fibroids) were discontinued by the government in Mid-March,” said Dr Amit.

The Government last week lifted the restriction on elective surgeries, which Dr Amit says might increase the flow of patients waiting to have their operations done in private hospitals.

Meanwhile, the medical staff continue to feel the heat of the pandemic.

A nurse at a  private hospital in Nakuru talks of the pain of getting a termination letter on June 1.

Her contract was to expire in September, but lean times forced her employer to take drastic measures sooner.

 "I do not know if the management will pay my dues. I was ordered to hand over my roles and hospital property this week. I am devastated," said the nurse.

At least 15 health workers among them nurses and clinical officers at Nakuru Nursing Home have also been sent on unpaid leave.

Miriam Wairimu, the facility matron told The Standard that low patient numbers has affected its revenue streams.

"We are left with half of the employees, with the rest given unpaid leave, until the situation improves," said Wairimu.

Currently, the facility serves about 10 patients a day, a number that has dropped from 100. Deliveries at the facility, feted best in maternal service provision Nakuru by Population Services Internation (PSI), in 2018, has also reduced.

Normally, about 10 women deliver at the hospital. This number has reduced to one or two, raising concerns that women might be delivering in hands of unskilled personnel.

The pandemic has also come with other challenges.

Debt from the National Health Insurance Fund for other diseases has ballooned and hospitals in rural areas that rely on NHIF are in dire need.

Speaking at a webinar on job security in the private sector earlier in the week, Dr Brian Lishenga, Chairman of The Rural Private Hospitals Association of Kenya (RUPHA), said private hospitals in rural and urban underserved populations like Kangemi, Kayole and Kisauni were in dire need.

“The reason is that most of them are doing service provision with NHIF,” said Dr Lishenga.

“This has also coincided with certain reforms happening at NHIF and with people working from home, processing of claims and approval of procedures has slowed down,” he said.

During the webinar, Dr Lishenga said the current situation had exposed the underbelly of the private health sector calling for more public–private partnerships (PPPs).

“We need to move away from the private sector –public sector dichotomy and move to a single payer system. We can regulate prices and level the playing field. Let the public and private sector compete on efficiency only,” he said.

[Jacqueline Mahugu, Mercy Kahenda , Mactilda Mbenywe, John Shilitsa]