One of the weaknesses of having a health system operating on basic level is that ingenuity is forced on managers to handle the numerous needs of their patients using the limited resources at their disposal. In the process a lot of shortcuts are taken sometimes leading to poor outcomes.
Health systems in most developing nations have referral systems not seen in developed ones. In the current context a patient navigating our treacherous system is wont to spend as much as a third of the actual cost of care on the road.
Moving from a dispensary to a health centre upwards to a sub-county and finally the referral hospital may take as much as a year especially for conditions requiring specialised care. Often times in the West the referral reason is available at the first point of care.
In our setup even after this lengthy process, arrival at the referral hospitals is not a guarantee that your problems will be addressed. A mix of both paucity of specialists and equipment means missed appointments are a norm. At one of the referral facilities, a patient was given a four-month waiting period appointment after traversing such a system. What they would be doing until then was a question the relatives had.
A visit to either of the two referral hospital’s specialist units details the plight patients’ face and last week’s Daily Nation article on the same topic was spot on.
As health system managers there are some questions we must start asking ourselves beginning with why referrals are increasing. Secondly what the total cost of meeting a referral is, then finally what the outcomes of our referrals are.
In some instances referrals taking 10 hours from call of referral to arrival at destination. In conditions where time is critical such endeavours are often sadly fruitless consumption of patients’ and health system’s scarce resources and time.
Until we start evaluating the economic costs of our referral system’s bottlenecks, we cannot address its shortcomings. Presently the basing of referral hospitals along county administrative boundaries as opposed to spatial and demographic population basis is a weak link.
For instance from Oloitokitok, Taveta, Makindu and Emali, one has only the choice of Kenyatta Hospital as a referral point. An equidistant facility near these four administrative units could well better serve patient’s needs.
Another suggested way is synergistic collaborations between various counties. By themselves, each is not capable of building, equipping or staffing a full referral facility. More so for those close to each other and with poor populations. A proposal would be to have hospital B to do cardiology specialisation and Hospital X orthopaedic specialisation while C could venture in another field and all then refer patients within themselves.
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