For equity in health, Treasury must fund referral hospitals

Some months ago at the height of the stalemate on revenue allocation formula, a National Assembly had a session. Suba MP Millie Odhiambo from the gist of her argument, sought to propose a shift aimed at ensuring equitable health resources distribution: particularly targeting referral hospitals.

Her argument was that the National government should have a deeper and active financial role in running referral hospitals across the country. Rightfully so, given the costs of operating such facilities. So far, county hospitals are struggling to sustain their running.

The national government’s involvement in healthcare in the devolved context, is mostly policy making and training. Apart from this, the Ministry of Health also administers special programmes such as HIV, Malaria, Tuberculosis, Immunisation, family planning and some diseases of interest. Indirectly, through her parastatal hospitals, the other role is running some few critical institutions.

So far, these include Kenyatta National Hospital, Mathari Mental Hospital, Spinal Injury Hospital, Moi Teaching and Referral Hospitals etcetra. Two such recently added facilities are the Kenyatta University Teaching Research and Referral Hospital and the Othaya Level 5 Referral Hospital.

Odhiambo’s sentiments during the debate, were aligned towards seeing each region have one of these facilities to ensure equitable support from the national government. So far, this has not happened. Patients from some regions spend enormous resources and time accessing specialised care at level 6 facilities.

Counties, envisaged to handle healthcare, are unable to optimally operate such facilities since the cost of running one is pretty high. Some counties may also struggle with attracting, equipping and retaining talent given the relatively low devolved funding.

Since referral hospitals serve patients from multiple counties, recommendations by some health experts include the national government taking up their running. Presently, budgeting and cost apportionment of what each county should allocate for “her” patient is hard, in shared hospitals. Secondly, operating them is gobbling up much of the meagre devolved resources at the expense of primary healthcare.

A few such facilities have been taken up by the national government. The Othaya Level 5 Hospital, is presently being managed by Kenyatta National Hospital, a parastatal. In the interest of equity in resource distribution, the Kenyatta National Hospital should also take up the other five mooted regional referral hospitals.

As it stands, only three former provinces have these special parastatal-status run hospitals.

Under this proposal, modelled along the former provinces’ administration, referral hospitals like the Jaramogi Oginga Odinga Teaching and Referral Hospital could be a parastatal under Kenyatta National Hospital. Similarly, the Coast region would also get a parastatal level six hospital and the Northern Frontier Districts’ region would also benefit from such an arrangement.

We would see proximity of specialised services devoid of hiccups experienced when remittance of funds to counties happens.