Improving access to surgical care in Kenya

Universal access to good-quality surgical care is a critical tool for fighting poverty and Kenya/African countries should make provisions for surgery while developing programmes for communicable diseases, non-communicable diseases and injuries.

Key speakers stressed this point during the 2017 international conference on global surgery at the African Union Commission in Addis Ababa, from 1st to 4th February.

Further, the case for surgical system investment in Africa is strong: over 70 percent of the population has no access to surgical care and anaesthesia; that up to 15 percent of all deaths are due to surgically preventable conditions like HIV, maternal deaths, cancers, amputations and birth defects; and that surgical procedures are some of the most cost effective health interventions currently available including circumcision, caesarian delivery, cancer surgery, treatment for fractures, correction of birth defects and cataract surgery.

Kenya has a similar outlook. First, our people are increasingly surviving childhood diseases such as pneumonia, diarrhea and malaria only for them to get exposed to the unmitigated wrath of surgical diseases in their teens, adult life and old age.A recent study found out that injuries and maternal complications accounts for over 65pc of mortalities due to non-communicable diseases among adolescents and young adults. Indeed, surgical diseases recorded the largest increase in prevalence between 1990 and 2012 with injuries now accounting for over 10pc of the country’s total disease burden and projected.

Second, public awareness of surgery is extremely low. The consequence of this is that surgical health systems have attracted the lowest level of investment in the health sector. For example of the 608 county and sub-county hospitals, only 130 (21pc) have capacity to provide surgery. This is one of the biggest driver of inefficiency as patients with surgical conditions are more likely to be seen at the wrong level of care.On human resources, the country faces a critical shortage of surgical workforce and it’s bound to get worse. We currently have 800 practicing specialist surgery workforce (obstetrician, anesthetist and obstetrician) and by 2020 (estimated population of 55 million) we will need between 5,500 and 11,000 specialist surgical workforce!

Lastly, many Kenyans struggle to purchase surgery care. The surgical health system is experiencing runaway costs inflations and those delaying care are on the increase. While NHIF has rolled out a comprehensive surgery cover, the participation of public health facilities which owns more than a half of hospitals is unclear, thus limiting their capacity to contain the costs of surgery. Further, most of the surgeries are done on an inpatient basis which tends to be inefficient due to lack of appropriate technology.

On the last day of the conference, attendees worked together to design methods that would strengthen surgical health system. Among the suggestions presented is that governments should write a letter to world health organisation (WHO) and bilateral partners to prioritize surgery. Another is for the ministry of health to develop a costed policy framework for investment, scaling up of surgery and strengthening of the surgical health system.

The policy should include details regarding infrastructure, trained workforce, financing, service delivery and information management. Another suggestion was to strengthen research and knowledge management as a tool for promoting stakeholders cohesion and informing approach to building an efficient surgical system. Investing in Surgery will improve health, decrease unemployment, alleviate poverty and grow our GDP, as has been shown recently.

(By Prof Pankaj Jani, President College of surgeons of east, central and southern Africa & Dr Elesban Kihuba, Health services researcher)

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