It isn’t every day that public hospital facilities are in the news for a good reason. Last week’s celebration by the Bungoma County Health team as their laboratory was awarded ISO certification was one such day however.
Bungoma County Referral Hospital now boasts of being just the second facility to achieve that particular quality standard. This is a major milestone in devolved healthcare and for rural health services.
This was the first time in over 50 years of healthcare that a rural public hospital has attained that mark. A few other laboratories may have similar certification, but these institutions are usually supported by donor funds or are research centres based in medical schools.
As more and more emphasis is now being placed on the diagnostic arm of the medical process, quality assurance becomes an integral part.
When a laboratory says it is cancer or tuberculosis it needs to be so. This certainty offers both patients and clinicians confidence in the management of their diseases and the diagnosis we give as clinicians.
By virtue of their pricing, public hospitals serve the base of the pyramid clients and tend to have high numbers of poor patients. Many of their clients are unable to afford the fees charged by the private sector for some laboratory investigations. In terms of price discrepancy, the variations sometimes lock them out.
The attainment of this standard is important for two reasons. First of all because referral hospital laboratories serve satellite regional health centres, they are convergence points for many hospital samples.
As such they handle a huge amount of workload specimen wise. With this, error margins are high unless protocols are observed such as those ISO standards set.
Secondly the award sets precedence and challenges other counties to also seek similar or higher certification standards for their laboratories. At present many rural counties have to ship samples to Nairobi or Mombasa for some tests.
Hopefully Bungoma County will commit more investments and allocation of resources to their other health diagnostics units because the requisite ingredients in maintaining the certification are personnel and equipment both of which demand adequate funds.
Amidst the celebrations though, the county health administrators need to strategise on how to get and maintain such certifications.
Revelations by the Moi Teaching and Referral hospital CEO that the hospital was owed Sh180 million by former patients points to the problem. No doubt many other public hospitals are owed more money by clients.
One public hospital’s billing department sometimes ago indicated up to 27 per cent of its bills were waived especially for patients admitted as emergencies and those admitted for a long time. From a business perspective this is obviously untenable.
Interestingly though, poverty levels within the counties may be mirrored by the number of patients whose hospital bills are waived.
The main casualty of hospital waivers is a decline in revenues and a gradual deterioration in budgetary allocations to ongoing quality improvement projects.
For this reason it would be prudent for Bungoma and other counties to work towards increasing the number of people with access to health insurance.
As a strategy this is the only sure way to achieve and maintain quality standards not just for laboratories but across all hospital departments. Like many meritocratic awards getting there is the easy part, staying there is the hard part.
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