At Iten County Referral Hospital in Elgeyo Marakwet, peasant farmer Christopher Suter is undergoing dialysis at a newly established renal unit. Dialysis is a new medical service at the county’s biggest health facility.
Suter suffered kidney failure two years ago. Before January, he had to endure agonising, biweekly trips to Moi Teaching and Referral Hospital, 80km away. Though frail, he can now afford a smile.
“I used to travel all the way from Marakwet to Eldoret. The transport costs were huge. And if I failed to get dialysis services due to the high number of patients at MTRH, I was often forced to pay for accommodation in town,” Suter says.
The national government began leasing Sh38 billion medical equipment to 94 county hospitals in 2015. These include dialysis machine, mammogram, radiology machine and X-ray machine. They were delivered through the Managed Equipment Services programme to improve services. ICRH got Sh1 billion worth of equipment.
Suter is among four other end-stage renal disease patients receiving dialysis at the Iten hospital. He says he is lucky the dialysis machine was brought to the hospital. Many kidney failure patients in remote villages gave up and succumbed to the ailment. They could not afford the high cost of travel and treatment.
“I get dialysis services here at Iten for free, thanks to NHIF medical cover. I pay absolutely nothing to access the services,” Suter says.
DOCTORS, NURSES TRAINED
Former Health PS Julius Korir says the MES programme has fostered training of health workers, as the state strives to build capacity.
The health workers, mainly doctors and nurses, have been trained at the country’s referral hospitals — Kenyatta National Hospital and MTRH — to handle and manage the new equipment.
“The medical equipment will be delivered to county referral hospitals in all 47 counties. We are now finalising implementation,” Korir says.
The former PS says the equipment also includes Intensive Care Unit machines. Korir says the cost to treat kidney has significantly reduced after NHIF super cover covered dialysis.
“In the past, the referral hospitals were burdened because they were the only dialysis centres. Now with one centre in every county, KNH and MTRH can handle very complicated cases and strengthen kidney transplant,” he says.
At a recent tour of MTRH, newly appointed Health CS Sicily Kariuki praised the strengthening of county and subcounty health facilities. She said it puts the country on the path to achieving universal health coverage.
Kariuki said most county and subcounty hospitals will be equipped to offer level five services to decongest referral facilities.
“It is unfortunate that MTRH and KNH still offer primary healthcare services. We want to allow them to focus only on specialised services,” she said.
MTRH CEO Wilson Aruasa says the hospital receives 15,000 patients daily, 2,000 of whom get admitted.
“We are happy that patients don’t have to be taken to Eldoret and can be dialysed here,” he says. “At MTRH, we will now focus on the specialised and complicated dialysis services, plus kidney transplants and open heart surgeries, which we will be doing regularly.”
The CEO says the Eldoret-based referral hospital will mentor county hospital staff to ensure the medical equipment is utilised.
He says MTRH hired 24 specialised renal nurses and distributed them across the country to help establish the new services resulting from the equipment.
Some of the equipment has been deployed to Chebiemit and Kamwosor subcounty hospitals to decongest ICRH.
DIAGNOSTIC MACHINES NEEDED
Elgeyo Marakwet Health executive Kiprono Chepkok says getting to Eldoret for dialysis was previously a burden. Some patients made four-hour travels from far-flung areas of Markwet, including Tot and Liter.
He calls on the state to include diagnostic machines in the medical supply deal.
“Non-communicable diseases, particularly cancer, are on the rise, and we need early diagnosis so life-saving interventions can be made,” Chepkok says.
He adds: “We are able to do some diagnostics at our county, but we still need a lot of help.”
In preparation for the MES programme, the county took 18 doctors to various universities and tens of nurses to KNH for training. It also constructed buildings in readiness for delivery of the machines.
“With all the training and availability of machines, we will be a real referral hospital. As it is, we are not in the league of referral hospitals, but we are closer to attaining that status,” he says.
To further decongest the county referral facility, the county is upgrading five subcounty hospitals, including Kocholwo, Kamwosor, Kaptarakwa, Chebiemit and Tot.
Chebiemit and Kamwosor subcounty hospitals will receive theatre machines before April, while Tot will receive a similar machine in June, bringing advanced medical services closer to locals.
ICRH medical superintendent Castro Mukala says the renal unit will not only benefit locals.
“Patients from Elgeyo Marakwet and those from neighbouring counties can come for renal replacement therapy and management of renal failure,” he says.
Mukala says some patients travel from remote villages in Marakwet, 130km from Eldoret, for dialysis.
WHY GOVERNORS FOUGHT IT
Governors, led by then Bomet leader Isaac Rutto, opposed the medical equipment deal, citing lack of proper consultations with the county bosses.
Rutto, who was the Council of Governors chairman, said in June 2015 the contract was a scheme by senior state officials to create loopholes for corruption through the MES deal.
“As governors, we must be involved in this project. We should be given a clear picture surrounding the equipment,” Rutto said.
He accused the government of forcing the governors to sign a deal whose procurement process was unclear to the county chiefs.
But the governors later bowed to pressure from the national government to sign the deal.
Rutto’s successor Peter Munya said the governors were set up to seem like they were against access to world-class health care.
Munya said there were pending issues regarding the project, noting the counties will iron out the issues with the national government individually.
“As a sign of goodwill, we will allow governors who have not signed the MOU to be at liberty to sign,” the former Meru governor said.
The Canadian government, through the World Vision Kenya, has augmented the national government’s efforts. It has provided Sh26 million medical equipment for at least 111 health centres across the county. The programme aims to reduce mortality and malnutrition among mothers and children.
MALNUTRITION EMERGENCY
The drought that ravaged most counties in Kenya last year, World Vision reports, occasioned a malnutrition emergency among children.
The drought did not cause a food emergency as most people thought, says François Batalingaya, country director of World Vision Kenya. It caused malnutrition due to lack food diversification, he says.
This is what compelled the Canadian government to work with county governments to fund programmes that help reduce malnutrition.
World Vision conducted a baseline survey that indicated that the raving drought resulted in malnutrition, particularly in children between zero and two years.
“Last year, this country faced a major drought. During that period, the malnutrition rate reached the emergency threshold,” Batalingaya says.
He says the baseline survey was done in Elgeyo Marakwet county and showed the county had some of the most malnourished children.
Batalingaya spoke on Tuesday in Kapchelal, Keiyo North, during commissioning of Sh26.4 million nutrition and health supplies funded by the Canadian government. These include delivery beds, infant warmers and digital blood pressure machines.
“World Vision will continue to work with the community, county government and key partners in ensuring children enjoy good health and thrive in all aspects of their lives,” Batalingaya says.
Canadian High Commissioner Sara Hradecky says the medical equipment will be supplied to 111 health facilities in Elgeyo Marakwet county.
She says the Canadian government, in partnership with World Vision, is funding production of bio-fortified crops, including orange-fleshed sweet potato and iron rich beans, to reduce malnutrition.
“We have already established demo farms of the nutritious crops,” Hradecky says.
The project targets to reach 68 per cent of the county’s total population as direct beneficiaries, which includes 74,347 children below the age of five years, 104,397 pregnant women and lactating mothers.
Elgeyo Marakwet Governor Alex Tolgos says the county will supplement efforts by NGOs to boost reduce malnutrition.
Tolgos urges heath workers to ensure the medical supplies are well utilised and maintained.