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Transforming Kenya’s healthcare system: a PPP success story

Monish Patolawala's picture


Photo: Direct Relief, Flicker Creative Commons

The Kenyan government launched its national long-term development plan, Vision 2030, in 2008 with the aim of transforming Kenya into a newly-industrialised, middle-income country providing a high quality of life to all citizens by 2030, in a clean and secure environment.

Constructed around three key pillars – economic, social and political – the blueprint has been designed to address all aspects of the country’s infrastructure and economy, with a key component of the social pillar consisting of ambitious healthcare reforms. Ultimately, the government’s goal is to ensure continuous improvement of health systems and to expand access to quality and affordable healthcare to tackle the high incidence of non-communicable diseases that affect the region.

Rethinking old models

Through the new healthcare plan, the Kenyan Government has embarked on the largest public sector-structured financing package of its kind in Africa. The program is a powerful illustration of the value of adopting new thinking around old established business models such as Public-Private Partnerships (PPPs).

In 2015, the Kenyan Government selected GE Healthcare as one of its main partners to deliver a seven-year Managed Equipment Services Partnership (MES) to provide Kenya’s 46 million strong population with access to teleradiology services across 98 Ministry of Health hospitals in Kenya’s 47 counties. An MES is a form of PPP that enables customers to adopt a ‘pay for service’ expenditure plan and affords a number of financial benefits including funding to cover equipment, maintenance and other project costs such as training.

The model allows the Kenyan government to budget healthcare expenditure over several years by deferring upfront capital outlay. This means the Ministry of Health can assign critical funds to address the country’s most pressing healthcare challenges while also addressing the bigger picture and improving the wider healthcare system. The project represents one of the government’s flagship programs to deliver tangible benefit to people locally by decentralizing specialized healthcare services from national referral hospitals to a county level. The aim of this partnership is to increase access to affordable healthcare for all and enable earlier diagnosis and treatment of various diseases.


Early benefits

In its second year, this program is already delivering tangible benefits for the government and the people of Kenya, including improved access to specialist radiology training for medical staff, increased skillset of healthcare workers, and better workflow efficiency. Local availability of previously non-existent specialized diagnostic devices has led to higher efficiency in the patient continuum and a significant reduction in average scan time from analogue to digital, with the monthly number of digital exams soaring more than tenfold across the first 44 modernized hospitals.

Increased equipment reliability and sustainability is another strength that stems from the MES. This is particularly important in Africa, where most healthcare systems are being negatively affected by the so-called ‘equipment dumping’, whereby manufacturers push equipment sales to make up numbers without a sufficient mechanism for equipment functionality ecosystem, such as training, service or preventive maintenance.

In addition, there are considerably larger numbers of patients visiting hospitals and a rise in the use of different types of radiology services (x-rays, ultrasound and mammograms). For example, the installation of the latest digital mammography has enabled more than 30% of level 5 hospitals (regional centers providing specialized care including intensive care, life support and specialist consultations) to offer in-house mammography exams for the first time, increasing capacity for breast cancer screening, a leading cancer killer in Kenya.

Moreover, patient referrals have fallen due to improved access to radiology services locally, with a 50% improvement in access to radiology services recorded across three pilot hospitals in the first five months after the installation of the new equipment. The cost of scans has also dropped thereby increasing the affordability of specialized healthcare services, and has strengthened the health system.

These early positive project outcomes have already triggered engagement and regional integration with other government ministries in East Africa (Tanzania and Uganda) and other African countries (Namibia, Cote D’Ivoire, Nigeria, Mozambique) for best practices on large-scale healthcare infrastructure development programs.

Clearly our mission to transform Kenya’s healthcare system is still in its infancy within the wider context of the Kenyan government’s transformation plans, but already what it has achieved serves as a powerful illustration of how an established risk sharing procurement model such as a PPP can be adapted to create a new type of partnership to successfully address the healthcare challenges faced by governments and Ministries of Health. 
 
Disclaimer: The content of this blog does not necessarily reflect the views of the World Bank Group, its Board of Executive Directors, staff or the governments it represents. The World Bank Group does not guarantee the accuracy of the data, findings, or analysis in this post.
 

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Kenya’s 3 keys to success: How to create an effective public-private partnership unit
 

Comments

Submitted by Gacuca on

Very encouraging to see systems well executed and performing.

Submitted by Yilji Kumtap Cashmir on

This is great. PPP is certainly the key to revamping the healthcare sector. However, the regulatory frameworks need to be clearly spelt because legal and legislative constraints have hindered the spread of this policy in Nigeria

Submitted by Dr. Mohamed Taher Abdelrazik Hamada,Ph.D on

It is very essential in my humble argument to discuss your presentation about the Kenyan government Long term development plan to be able to provide a well qualified
quality of life to cover all the country apporpriately . It should be presented to cover the economic ,social and political sides that help to promote ambitious healthcare reforms.From your respectable presentation , it can be illustrated that the Kenyan model can affect positively the whole country and also can be transformed to other African countries.
It's benefits have a very fast outcome on the social, economic and political situations.
I used to discuss theseissues in my lectures , while i was a professor,teaching , Health Service Administration at Strayer University in Washington DC campus , Maryland campus, and Alexandria campus in the USA. I asked at that time my students to make presentations about the issues of health that challenges the health care system in the developing countries.
Our discussions in the classrooms at Strayer University in the USA was to clarify and illustrate the recent picture of the health status and how to participate theoritacally to put a framework that can represent the health care system
We also discussed the issue of decentralization of health care services that may help to increase the capacity for quick and fast high quality standard affordable health care.
These decentralized services should include all specializations of medical care at affordable prices for the patients specially urgent cases such as cancer treatment. Health care equipments should be handled to be used efficiently and to the outmost benefit . Radiology services are essential factors to diagnose diseasesin i's early stages
It is much better to stablish a kind of integrity in health care units among African countries and share consulations about health ptoblem specially the critical conditions, through conferences and training
Yours Very Respectfully,
Dr. Mohamed Taher Abdelrazik Hamada, Ph.D
Address
[redacted]

Submitted by Stuart on

So great to hear about this because I am an Ugandan and development in Kenya means a lot to even my home country Uganda due to the fact that Kenya is our closest neighbor so thank u so thank much.
kind regards
Stuart Kimbowa Buzziman
Uganda Wakiso district
Gayaza village

Submitted by Alfred Wanjohi on

Kenya has not managed to keep up with payments for this. Sustainable? No. Additionally, if the US government bothered to look more closely at the meetings a one Esante Muzava was holding with the ministry of medical services and the audit that was authorised as a result of those meetings and before the tender, GE could be taken to task.

Submitted by AHMAD RUFAI MUSTAPHA on

Transforming Kenya's health industries is a process of reaching target beneficiaries at the grass-root level through a good design policy that will be accessible, affordable by the majority of the Kenya's populace for the improvement of their living standard

Submitted by Mulongo on

Due value and transformation of health indeed is a process. The MES attempts at bridging the gap. However, thought must be put into tandem growth of human resource for health.

Having specialized equipment without adequately trained users (health workers such as specialists, biomed engineers etc) falls short of addressing the existing challenges in quality and access.

Sound Procurement and financing systems are key in safeguarding value in view of the cost of corruption as these seem to have been a major concern in the MES project.

Submitted by Dr Thiakunu C K Mwirabua on

I am a Private Medical Practationer in Kenya Rural Set up where the impact of PPP has not been felt much because of the rate of the uptake except in the current ongoing of the equiping of the Government Hospitals in the Counties.
As private Practioner with small Health facility of 20 Bed capacity we usually have problems in raising the capital base because of the High interest Rate for the Commercial banks in the country despite the current capping of the bank rates. However the future is promising because of the Government trying to implement the Universal Health Care with the NHIF becoming a Payer to lower the Out of Pocket mode of paying by the clients which is catastriphict the Family and the entire Kenya Citizenry.
We in private sector in the lower level of the Capital Base we are proving Unbaankable worthy to make it to be able reach the limit of being Financed by the Low Rate World Bank AFFILIATES THE _ AFC because of their Minimum they are ready to offer and we cant be able to consume eg minimum being 3-5 Milioon USD .
How can the PPP Directoraate come out to help the Indigenoous health Providers to be able to gain acces to financial Base capital which would enable us to upsccale our Health Facilities so that we can upscale our service delivery now that the NHIF is a good Payer????I am looking for a Strategic Partner to upscale the facilty to be able to offer the Health services to the needy in Kenya like thePrivate Hospitals in India which are affordable to the Citizenry!

Submitted by Tssar on

The reality isn't as positive as it looks:
Read this
https://www.standardmedia.co.ke/health/article/2001243069/it-s-not-worth-it-says-team-on-sh38b-medical-equipment-project

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