Healthcare provision in the counties over the last 10 years has come under sharp focus. Since devolution of Kenya’s health, there have been many industrial actions in the various counties against poor health care management. Majority of the strikes have been as a result of mistreatment of the human resources for health.
To balance out though there have also been positivie mentions about various aspects of the pillars of a health system of several counties . Makueni County comes top of mind. But remember Makueni county had issues in its initial stages. A stalemate between the first governor and the county assembly required the intervention of the president to resolve. Some counties were also praised for maintaining their Facility Improvement Fund autonomy like Nakuru County. Others have trained many specialists like Kiambu County and ASAL counties.
Lately, Murang’a county is emerging as as the county to watch. The current governor, Irungu Kang’ata started off well by identifying the needs of the health system and systematically attempting to address each of the pillars of the healthcare system. Here is an overview.
In health governance, he appointed Dr Frederick Mbugua as the County Executive Council Member (CECM) of Health of Murang’a County. Dr. Mbugua at the time of appointment had served as the gynecologist of Murang’a county for 22 years. He is a mentor to many and overall the internship program as it started in Murang’a county. He also served in the DMSO team supervising health facilities in Murang’a county in the years 2007-2013. He was also at one time the medical superintendent at Murang’a County Referral Hospital. The county Director of medical services role was given to Dr Mburu, a seasoned psychiatrst, who in the past often doubled up as the medical superintendent of Murang’a county hospital prior to the demolition of health. The governor started health governance on a sound note by ensuring that those he appointed had the prerequisite academic and professional qualifications, known credentials and a track record to lead their dockets to occupy the governance space. In running a health system getting governance right is key.
In the human resources for health pillar Murang’a county has tried to get a good compliment of health workforce within its limited fiscal space. HRH currently takes up a large chunk of the health budgetary allocations. Despite that there is still a shortage of their health workforce but the attitude of health workforce in Murang’a is excellent. The county has benefited from the previous regime’s efforts of sending health personnel for specialization. Murang’a was the first county to train a renal team and initiate dialysis. Murang’a County boasts of having a neurosurgeon, there being a very small compliment of this kind of specialists in the whole country. Continuous development of HRH is key to any county health development plan.
In health infrastructure ongoing facilities that were incomplete are being completed. Kigumo SubCounty Hospital has a beautiful facility awaiting operationalization following completion of the construction. Once operationalized it should serve as an internship centre and decrease the load from Maragual and Murang’a County Hospitals. In maternity Kigumo has noticed an increase in clients who previously went to the two large hospitals opting to use the health services nearer their homes.
In the health products space the county has automated its procurement systems and monitor its performance. The fill-rate for pharmaceutical products is being monitored & hopefully will be used to improve identification of missing medication for future improvement.
In the use of a health management information system Murang’a County is way ahead of all other counties. Working in collaboration with the Ministry of Health of Kenya, Murang’a County uses AfyaKE, an intergrated health information system. Health facilities in Murang’a counties all tbe way down to the dispensary use the system that makes it an information super high. I have used several EMR systems. I particularly like this one for its simplicity. The three big issues with the use of the system are power outages, system, outages, and Internet outages. Overall though it is a big improvement from the paper-based system, as it allows patient information portability, and makes referral easier and we eventually make research easier.
On Health care financin the county recently celebrated the milestone of Kenya shilling 1 billion own-source collection. Hopefully this will translate to an increase in health care financing. On the maternity side the Kanag’atacare program allows, expectant mothers who are unable to afford skilled birth delivery, deliver safely in a health facility as long as they get registered. The program solves two health related problems in one go. Data is collected on the numbers of indigens who may be expectant and may not afford skilled bath delivery. These mothers, who in the past may have opted for a home delivery are given a chance to have a safe delivery in the health facilities with skilled personnel.
Finally, in the health service delivery pillar, all the factors outlined above, have a common pathway towards improving healthcare services across the county. Health facilities have noted an increase in the number of patients seeking health services. Patients have also noted an improvement in the availability of essential medication. Indeed, when there are stockouts, the patients will be informed and may needs to buy for themselves out of pocket.
All in all Murang’a county continues to embark on continue improvement in the health sector. Shoil the other counties need a place to benchmark in, the Maranga county is the county as a yardstick.
Dr Simon Kigondu is an Obstetrician Gynaecologist and a commentator on matters of healthcare