Currently the Kenyan public hospitals that seem to be doing well financially and in service delivery owe their success to a large part to the private wings of the public hospitals that were also known as AMENITY WINGS. Amenity wings within public hospitals were a Kenyan-born solution to many challenges faced by the curative health system.
CHALLENGES IN THE KENYAN CURATIVE HEALTH SYSTEM
- Public health CANNOT (or is unwilling) pay health workers and especially doctors and specifically specialists what they are worth
- As a result of this inability (or unwillingness) of public health to pay its doctors public doctors were forced to ‘moonlight’ in private hospitals to make ends meet. This leads to a perception of ‘absenteeism’.
- Public hospitals CANNOT (or monies are diverted elsewhere) get enough funds to run all their services to the highest possible quality of care.
Amenity wings sorted out these basic drawbacks of curative health service provision. Addressing these challenges public hospitals came up with PRIVATE WINGS or so called AMENITY wards. This was a brilliant move as it killed 6 birds with one stone.
HOW AMENITY WINGS IMPROVED PUBLIC HOSPITALS
- Amenities increased funds collected by the public hospital. Clients who could pay for amenity services within the public hospital did so and at a slightly higher premium than the normal public fees. This significantly boosted the overall hospital kitty.
- The monies thus raised were used to improve THE WHOLE HOSPITAL and not the amenity wards only. Infrastructure and services of the whole hospital improved
- Doctors began admitting their private clients into the amenities. This served to increase the presence of the doctors in the public hospitals. Services indeed improved partly due to this increased availability of doctors.
- Doctors reduced their ‘moonlighting’ by increasingly admitting their private clients to the amenity wards. This reduced the number of hospitals one had to run to so as to make ends meet.
- The Hospital Management Teams approved monies to be paid to doctors as a result of their bringing their private clients to utilize the amenities. This was perfectly legit.
- The hospitals that encouraged amenities grew in leaps and bounds. They boasted of higher revenues, improved infrastructure and increased doctor presence and especially the specialists.
- Doctors were happy as they had solved the 3 problems that commonly face doctors in eking out a living – too hectic a schedule moonlighting, additional earnings to supplement the meager government salaries and increased job satisfaction as they had some control over the quality of care.
AFYA HOUSE ORDERS DOCTORS TO PAY UP AMENITY MONIES
Then BOOOOOM! AFYA HOUSE LANDED
Afya house accused doctors of earning double salaries. They claimed that it was illegal for a public servant to earn two salaries. This was in the backdrop that Afya House had done little to improve doctors salaries. Afya house conveniently forgot that amenities had led to massive improvements in hospital infrastructure, improvements in hospital revenues and and ultimately improvements in service. It forgot conveniently to note that doctors were more present (both physically and mentally).
Afya house ordered doctors to pay back all the monies they had earned in amenities. Afya house conveniently forgot these were private patients who had come to see these doctors. Afya house went ahead and charged doctors for improving public health facilities. This was as a result of Afya House listening to administrators and ‘numbers’ instead of listening to the health workers.
DECLINE OF PUBLIC HEALTH FACILITIES AFTER COLLAPSE OF AMENITIES
As a result of these Afya House move doctors and especially specialists withdrew their services and clients from amenities. They returned to the private hospitals. They were dejected and annoyed for being cheated off their monies they worked hard for. The amenities died. The hospital funds diminished. The specialist presence reduced and the situation returned to where it was pre-amenity. After some time Afya House noted the decline in the revenues in the public hospitals. They tried to woo back the doctors to amenities but the damage had been done. Even in trying to woo back doctors they drafted ridiculous regulations on the amenity monies literally rewarding those who had not worked for it.
This is the story of Kenyan Hospital system. Doctors solve a major problem with public health system and the authorities reverse the gains made by quoting some vague laws while conveniently ignoring the gains. You cannot have your cake and eat it.
BRING BACK AMENITIES TO IMPROVE UHC
I put it that any hospital or county that successfully returns the amenity system will take off in hospital improvements. Amenities kill many birds with one stone. This will help in the movement towards universal health care.