Letters

Tap PPPs to grow local healthcare industry

health

A health worker attending to a patient. FILE PHOTO | NMG

In his second term, President Uhuru Kenyatta has put forward the “Big Four” agenda as his key focus. The “Big Four” agenda includes; ensuring food security, provision of affordable housing, expansion of manufacturing and provision of affordable healthcare.

In the provision of affordable healthcare, the population that had no access to healthcare due to unaffordability will now be able to access medical services once they have been enrolled on the National Hospital Insurance Fund (NHIF).

This will result in an increase in demand for health services with health facilities receiving more clients. It is on record that the Linda Mama programme, which provides free delivery services to women, has led to more hospital deliveries than previously recorded.

In the promulgation of the Constitution in 2010, healthcare was devolved to the counties. The increased pressure on health facilities will require that county governments upgrade existing facilities or build new facilities. This will require funds for both construction and equipping of these facilities. Further, more human resources will need to be hired to work in these facilities.

Counties have taken over management of all hospitals at Level 5 and below with the national government managing Level 6 hospitals. In this change of responsibility, most of the former district hospitals were assigned the role of county referral hospitals. These hospitals were ill prepared for this role and therefore require heavy investment in infrastructure, equipment and human resources.

The universal healthcare programme and the devolution of healthcare has clearly created a huge need for investment in healthcare. National or county governments will not be able to bridge the infrastructure gap and there is therefore a need to look at the private sector funding in bridging this gap. The Public Private Partnerships (PPP) Act (2013) is currently under review to allow counties to engage directly with private sector in the financing of infrastructure projects in the counties.

PPPs in healthcare have been used around the world in the provision of healthcare with some level of success. There are examples of hospital PPP projects in South Africa and the UK where positive health outcomes have resulted in private sector managing healthcare facilities. The point to note in healthcare PPPs is that the contracting authority (county or national government) should be very clear of what they expect out of the PPP arrangement and put that out to the private sector at the onset as Key Performance Indicators (KPIs). These should be part of the contract between the contracting authority and private sector.

Further, there should be a mechanism to ensure that patient numbers remain within agreed parameters. One way to ensure this happens is to have a referral system that works. It is not uncommon for patients with common illnesses to visit Kenyatta National Hospital (KNH) whereas there are many lower level hospitals that could treat such ailments.

An influx of patients to a hospital run on PPP basis could lead to the contracting authority paying for the extra patient numbers beyond the agreed cap. This is not the desired result of a PPP arrangement.

In the design of PPP projects in healthcare, consideration should be made on community needs in healthcare. There is a tendency of the private sector to focus on hospitals in urban areas where the population can afford services but the greatest healthcare need is at the primary healthcare level.

The mother in Isiolo County who has to walk for six hours to take her child for immunization needs a health facility that is more accessible. The question then remains on how private sector can provide access to healthcare at this level.

India has made efforts in getting private sector in the provision of primary healthcare. Private sector provide technology innovation like telemedicine where patients in rural areas can interact with doctors in urban areas by having their data captured at rural clinics and doctors in city hospitals providing offsite diagnostic services.

Further, private sector are involved in the provision of mobile clinics that serve remote areas and receive compensation from state governments. This has led to huge improvement in health outcomes. In conclusion, there is need for the national and county government to engage seriously with private sector and identify gaps that private sector can fill in the provision of healthcare to ensure the universal healthcare agenda is a success.

Patrick Gichimu Macharia, senior manager with PwC Kenya advisory deals team