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The 'other truth' about leased medical equipment.

figure By NZIOKA WAITA The raging debate about the cost-effectiveness of the countrywide programme to equip public hospitals with modern equipment is a healthy discourse that should be encouraged.But the discussions around the Managed Equipment Scheme (MES) should nevertheless be nourished by facts and immunised from distortions and obfuscation of truth.

Launched in 2015, the MES programme, a joint venture between the national and county governments, targets the equipping of select public hospitals with modern equipment. These include cutting-edge machines for dialysis, intensive care units, theatre and X-rays, and other imaging facilities.

Under the programme, two hospitals in each county will benefit from an equipment upgrade. It is the onus of county governments to select the respective beneficiary institutions.

By end of last year, 96 hospitals had received surgical and radiology equipment, 39 had dialysis machines, while nine had brand new ICU facilities.EFFICIENCYCritics of MES claim the programme fails to acknowledge the diversity of medical priorities and needs of each county.

Others accuse the national government of forcing on county administrations equipment that they either do not need or were ill-prepared for.What such arguments ignore are the statistics pointing to a shared burden of the specific diseases that MES seeks to alleviate.

Research reveals that cancer, diabetes, high blood pressure and other life-threatening diseases are on an upward trajectory in virtually every corner of the country.Before the introduction of MES, many county hospitals that are the first port of call for majority of Kenyans were reduced to lettering referrals for many of their patients.

Often, patients were directed to Kenyatta and Moi referral hospitals. The long patients' queues and even longer waiting lists for urgently needed medical attention at the two institutions were a continuous reminder of an unhealthy crisis.

PRODUCTIVITYAnother argument against MES is that health is a devolved function and, therefore, the national government has no business prescribing interventions for the sector. Granted, the Constitution vests in the counties the management of the sector.

But the national government is expected to midwife the relevant infrastructure to nurture a healthy citizenry.The importance of health to the well-being of a nation cannot be gainsaid.

The ill-health afflicting an individual mutates to a national headache in so far as the pressure on public-funded medical facilities and diminished social-economic productivity is concerned. A nation can seldom prosper when its citizens are overrun by disease.

The significance of efficient health services underpins President Uhuru Kenyatta's government focus on the sector. The Universal Health Coverage, which is among the Big Four legacy projects of his administration, and MES are among the key interventions intended to boost the sector.

Kitting public hospitals with modern medical equipment is an expensive undertaking, even to advanced economies.Besides incubating economic growth to free more internally generated revenue to the public health budget, governments around the world resort to ingenious public-private sector partnerships to fund the sector.

The MES should be seen in this light. By negotiating leasing contracts with leading global medical firms, the Government has struck a win-win deal that provides, on fast-tracked terms, much-needed facilities to public hospitals.

Furthermore, tying the suppliers to routine maintenance and software upgrades also mitigates the risk of equipment obsolescence, and thereby guarantees optimum utilisation of leased services.The key successes of MES are self-evident.

For instance, the number of public hospitals that are now offering dialysis has shot to 49 from five in three years. ICU and high dependency units (HDU) beds in public hospitals have increased to 116 and 63, up from 50 and 30, respectively, in the corresponding period.

The same healthy increase has been witnessed in a rage of X-ray services and theatre facilities. But the numbers only tell half of the success story.

A stronger narrative rests in the relief MES is quietly administering to hundreds of patients across the country.Most services offered under MES are subsidised, meaning they cost below prevailing market rates.

In a country where virtually everybody has received appeals for medical aid for friends or relatives, cheaper health services are a much-needed respite.A good example is the dialysis machines.

Before MES, many diabetic patients had to travel to either KNH in Nairobi or MTRH in Eldoret for dialysis. Often, patients would be forced to queue for unknown days for the service, at the risk of aggravating their health conditions.

It is common for patients to travel in the company of a relative or a friend. The multiplier cost on transport and other attendant expenses inadvertently heightened private financial burdens.

The same applied to patients in need of cancer screening and other imaging services.With these services now available at county hospitals, this burden has mercifully been reduced and so are the hours expended in pursuit of medical attention.

The resultant savings can now be channelled to more productive ventures for the gain of the individual and the nation.Another important consequence of MES is in the skills transfer.

Over 750 Kenyan medical professionals have undergone extensive training in the running of the equipment. This acquired expertise will outlive the programme to gift the country a critical mass of professionals who can be relied on to apprentice others.

This is not to deny that there may be a few operational challenges in MES. But beyond the din of criticism, many are the Kenyans who have found medical succour in the programme.

Mr Waita is the President's Chief of Staff and head of the Presidential Delivery Unit.
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Publication:Daily Nation, Kenya (Nairobi, Kenya)
Date:Dec 12, 2018
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