As I pen this article I wish to quote one of my favourite artistes, Lady Gaga, who sang: “There ain’t no reason you and me should be alone tonight, yeah, baby….” because, indeed, patients and doctors have been at loggerheads for more than one month.
The collective bargaining agreement, which their union wants implemented, has several items, a majority of which will necessitate some form of expenditure by the government. The current impasse is because the CBA dwells extensively on spending but does not mention revenue generation.
The problems bedevilling the health sector are broad-based and include shortage of doctors and insufficient doctor hours in the public service, reduced staffing, lack of equipment and medicines and most importantly, a functional system that links all the above together to provide clinical service.
The doctor remains an integral part of the healthcare system and is the driver to its downstream function and the overall operation. An appropriate analysis of the public healthcare burden calls for investment in methods that provide data on what it would cost to keep mwananchi in optimal health. The technocrats at the Ministry of Health, the World Bank and the World Health Organization have figures that shed light on what is required to provide comprehensive healthcare.
There is a glaring increase in the number of Kenyans seeking healthcare in the private sector as seen in the mushrooming of private hospitals, while government hospitals remain static, with the last one probably opened in the 1980s.
The government should quickly form a new health sector financing and management platform through which public healthcare will be delivered. Doctors should take charge of the public health system through an outsourced system and insist on tendering for all the healthcare in counties.
The ministry, WHO and World Bank should provide the baseline data for budgeting. The doctors will then determine what it will cost them to provide comprehensive healthcare, starting from the community, the county and referral hospitals to the tertiary centres. The doctors will tender for the entire process of patient care, from disease identification, treatment, and rehabilitation to prevention. They will use the money to employ nurses, pharmacists, buy and repair beds and everything that is necessary to run the hospital.
The ability to manage the country’s health budget will provide the doctors with an opportunity to develop models that optimise care. The savings made in this model will enable the doctors to control their earnings, and cater for their medical cover and pension. But savings will arise only from serious consideration of innovations in healthcare delivery. Doctors will compete to provide healthcare to the county governments. The models may differ in the way ancillary and support staff such as nurses are hired and the ability to subcontract services. The counties will be happy to have to look at only one entity and not a group of rioting doctors or nurses and the doctors won’t blame the county for underpaying them as they will manage the cash.
The regulation of these doctors’ conglomerates may be tasked to a special body created by the national government. They will lay down the rules of engagement, size of doctors’ conglomerates, composition, and the ability to manage multiple hospitals, including private ones. The same body will license independent agencies to audit healthcare delivery and advise the national and county governments.
The current government budget remains insufficient to finance healthcare as the doctors want it.
Therefore, more avenues need to be opened to ensure competitive financing. Institutions such as the NHIF should be provided with competition so that people can submit the monthly subscriptions to the better manager of their monies.
Doctors’ health conglomerates could also compete for the current donors that work with the government. The financial burden of the Kenyan healthcare sector is vastly unknown. Diseases are poorly characterised, mainly due to absence of appropriate medical records.
Doctors must be willing to work with lawyers and health economists to realise this model. It is high time the doctors and government found the rhythm and moved away from salaries and job groups to instead think of an outsourced health delivery system where the State’s involvement is minimal.
So the best of luck to the tenderpreneur and thanks Lady Gaga for reminding us that we have to push the limits of engagement to realise what we want.
Dr Leonard Ngunga Mzee is a cardiologist in private practice in Nairobi. The views expressed in this article are his own and not his employer’s.