Why is the medical fields slow to embrace technology like kenya financial sector

[Omollo]

MoonKi

It is one mysteriously ignored fact that the MOH is one of the Most Corrupt Ministries (if not The Most Corrupt). The days when former Health ministers would go around bars begging for beer are gone. Now you have smart millionaires like Anyang Nyong'o, Charity Ngilu, etc. Amukowa Anangwe ran in to trouble with a cartel and got fired over paltry ambulances before he could dip his hand in the real honey. We now have Macharia who wants to rob county governments in broad daylight. Take note of it because it is another Anglo Leasing case in the waiting. GoK has signed a contract which would have to be paid - eventually!

That said, part of the corruption in the hospitals arises because of weak systems. These weak systems can only be corrected by investing in technology. We are not investing in technology so we are bound to remain with weak systems. There you have your vicious cycle.

What you describe is the poor work ethic we are discussing in another thread. Note that there are other factors contributing to the poor work ethic. There is absenteeism caused by illness, bad habits (alcohol), poor transport, bad infrastructure, weather etc. In decent countries the ministry of labor, Health and Transport ensure that this information is thoroughly collected and analysed.

One of the reasons hospitals opt to use technology to clean as opposed to people is exactly that the cleaners become a liability to the very mission of the hospital (no need to expound on it). Machines cover a larger area, reduce the human traffic and improve the quality of cleanliness.

Note that even in the best hospitals on earth one still needs mama or baba kifagio to clean the corners and the patients rooms. But you can't find them in corridors leaning on their brooms and gossipping. 

Russia hospital was ruined by the Kenyatta regime with support from the Brits. It was a state of the art hospital at inception and could easily have rivaled Kenyatta National Hospital.  History and geopolitics aside, it suffers from the same mismanagement that is killing other hospitals.

We need a minister who will be devoted to improving service in hospitals not rent seekers on a mission to build the Campaign War Chest.

[mya88]

This particular angle is not about Kenyan healthcare itself at all.  I am not sure it makes sense anymore if the clinicians are doing the coding themselves though.

I get it now, you had lost me back there....but yes, it would not make any sense since now clinicians are doing it or are at least required to do it.

[RV Pundit]

Omollo,

Why are we not blaming county gov who have taken over health. Health is devolved except for I think KNH. Counties have completely failed. The only exception is Machakos where Mutua has ensured hospitals in there are spotlessly  clean, well stocked and ambulances are on stand up. Not 1 or 12 like in Bomet but 70 ambulances.

We need to focus our energies on holding county gov on this. If they succeed, there will be a case to devolve more sensitive functions in the future; education and security.

Of course Macharia 36B nonsense of equipment is an attempt to undermine counties while stealing tax payers money.

If every governor was half as serious as Mutua has been...some of health issues (like dirty hospitals, absentee nurses, lack of ambulance)..would have long been sorted out.

MoonKi

It is one mysteriously ignored fact that the MOH is one of the Most Corrupt Ministries (if not The Most Corrupt). The days when former Health ministers would go around bars begging for beer are gone. Now you have smart millionaires like Anyang Nyong'o, Charity Ngilu, etc. Amukowa Anangwe ran in to trouble with a cartel and got fired over paltry ambulances before he could dip his hand in the real honey. We now have Macharia who wants to rob county governments in broad daylight. Take note of it because it is another Anglo Leasing case in the waiting. GoK has signed a contract which would have to be paid - eventually!

That said, part of the corruption in the hospitals arises because of weak systems. These weak systems can only be corrected by investing in technology. We are not investing in technology so we are bound to remain with weak systems. There you have your vicious cycle.

What you describe is the poor work ethic we are discussing in another thread. Note that there are other factors contributing to the poor work ethic. There is absenteeism caused by illness, bad habits (alcohol), poor transport, bad infrastructure, weather etc. In decent countries the ministry of labor, Health and Transport ensure that this information is thoroughly collected and analysed.

One of the reasons hospitals opt to use technology to clean as opposed to people is exactly that the cleaners become a liability to the very mission of the hospital (no need to expound on it). Machines cover a larger area, reduce the human traffic and improve the quality of cleanliness.

Note that even in the best hospitals on earth one still needs mama or baba kifagio to clean the corners and the patients rooms. But you can't find them in corridors leaning on their brooms and gossipping. 

Russia hospital was ruined by the Kenyatta regime with support from the Brits. It was a state of the art hospital at inception and could easily have rivaled Kenyatta National Hospital.  History and geopolitics aside, it suffers from the same mismanagement that is killing other hospitals.

We need a minister who will be devoted to improving service in hospitals not rent seekers on a mission to build the Campaign War Chest.

[Omollo]

Omollo,

Why are we not blaming county gov who have taken over health. Health is devolved except for I think KNH. Counties have completely failed. The only exception is Machakos where Mutua has ensured hospitals in there are spotlessly  clean, well stocked and ambulances are on stand up. Not 1 or 12 like in Bomet but 70 ambulances.

We need to focus our energies on holding county gov on this. If they succeed, there will be a case to devolve more sensitive functions in the future; education and security.

Of course Macharia 36B nonsense of equipment is an attempt to undermine counties while stealing tax payers money.

If every governor was half as serious as Mutua has been...some of health issues (like dirty hospitals, absentee nurses, lack of ambulance)..would have long been sorted out.

Pundit

County governments have teething problems. They need plenty of help. I have no idea how it is arranged but I assume the Director of Medical services still calls the shots as concerns quality and service delivery. If this is not the case then we have to amend the law. Get me right, I am all for devolution but not at the expense of quality.

My problem with Mutua is he, like PLO is a born spin doctor. You can never know what is real and what is "Chap Chap". I have treated his every pronouncement with a sack of the best sea salt, since his chap chap road peeled off in his wake as he drove back to town with a sea of journalists.

That said, have you undertaken a brief analysis of the qualifications of our so called governors? How many bought degrees in a hurry to contest? Is it only Joho? Most of these guys were what you can call functionally illiterate. Until there is a proper electoral and campaign finance reform to introduce PR (and avoid the recent UK debacle of re-electing a man you don't want), we shall continue to have this problem.

Education makes a major difference. Take the Police. Those countries that set very high educational admission requirements for their police and proceed to demand a long training period in college also have the most professional police force with limited cases of brutality and corruption. Kenya and the US fall in the same category.

[MOON Ki]

Think in terms of the guy who answers your phone from India asking you if watched the Cubs vs Whitesox game when you call to complain that cable is not working in the first place.

The Kenyans would be working as outsourced resources; as coders.  This particular angle is not about Kenyan healthcare itself at all.  I am not sure it makes sense anymore if the clinicians are doing the coding themselves though.

Tough to imagine; medicine is---and probably right to---a different ball-game.

I imagine most of the work would come from places with reasonably functional health systems and with a lot of work.   That would be the "richer" countries.   But those countries have the most stringent legal regulations, including on privacy and the transfer of medical information. (I recall a long-running skirmish between the EU and the USA on whether medical records could be transferred from the latter to the former unless the USA strengthened its  privacy regulations.)  Just think of Americans' readiness to go for malpractice suits, and you will find all sorts of issues in the "chain".

Going beyond mere data coding, a company such as Nyokabi's would get very little business from a place like the USA, even though there is plenty of such work that needs to be done there.  India tried that market and did not get very far.  From a few years ago:

About fifteen (15) Indian radiologists currently read U.S. images. This number is unlikely to expand much in the near future. When U.S. images are offshored to other countries, the typical reader is a U.S. radiologist living abroad.

And that is because:

To demonstrate competence - to be allowed to legally read images generated in the United States - a radiologist must have completed his/her medical residency in a U.S. program, passed U.S. medical board examinations, be licensed in the state where the image was taken and have privileges in the hospital where the image was taken.

http://dusp.mit.edu/sites/dusp.mit.edu/files/attachments/publications/levy_indian_rad.pdf

[MOON Ki]

Think in terms of the guy who answers your phone from India asking you if watched the Cubs vs Whitesox game when you call to complain that cable is not working in the first place.

The Kenyans would be working as outsourced resources; as coders.  This particular angle is not about Kenyan healthcare itself at all.  I am not sure it makes sense anymore if the clinicians are doing the coding themselves though.

Tough to imagine; medicine is---and probably right to---a different ball-game.

I imagine most of the work would come from places with reasonably functional health systems and with a lot of work.   That would be the "richer" countries.   But those countries have the most stringent legal regulations, including on privacy and the transfer of medical information. (I recall a long-running skirmish between the EU and the USA on whether medical records could be transferred from the latter to the former unless the USA strengthened its  privacy regulations.)  Just think of Americans' readiness to go for lawsuits, and you will find all sorts of issues in the "chain".

Going beyond mere data coding, a company such as Nyokabi's would get very little business from a place like the USA, even though there is plenty of such work that needs to be done there.  India tried that market and did not get very far.  From a few years ago:

About fifteen (15) Indian radiologists currently read U.S. images. This number is unlikely to expand much in the near future. When U.S. images are offshored to other countries, the typical reader is a U.S. radiologist living abroad.

And that is because:

To demonstrate competence - to be allowed to legally read images generated in the United States - a radiologist must have completed his/her medical residency in a U.S. program, passed U.S. medical board examinations, be licensed in the state where the image was taken and have privileges in the hospital where the image was taken.

http://dusp.mit.edu/sites/dusp.mit.edu/files/attachments/publications/levy_indian_rad.pdf

The whole "tele-medicine" business seems to be full of all sorts of legal (and medical) "minefields" that generate much discussion but without any clear resolutions.   In places like Kenya, with the fondness for short-cuts and easy money,  my first worry would be whether the person reading the "outsourced" image was really qualified or whether it would be the boss's nephew holding the image in one hand and a medical textbook in the other.  But, of course, Nyokabi's is an excellent initiative, and one hopes there will be more of that sort

[RV Pundit]

Mutua is working. Whatever he did as Gov Spokesman for me is history. I admire his leadership at Machakos County. Not fools like Isaac Ruto.

Pundit
County governments have teething problems. They need plenty of help. I have no idea how it is arranged but I assume the Director of Medical services still calls the shots as concerns quality and service delivery. If this is not the case then we have to amend the law. Get me right, I am all for devolution but not at the expense of quality.

My problem with Mutua is he, like PLO is a born spin doctor. You can never know what is real and what is "Chap Chap". I have treated his every pronouncement with a sack of the best sea salt, since his chap chap road peeled off in his wake as he drove back to town with a sea of journalists.

That said, have you undertaken a brief analysis of the qualifications of our so called governors? How many bought degrees in a hurry to contest? Is it only Joho? Most of these guys were what you can call functionally illiterate. Until there is a proper electoral and campaign finance reform to introduce PR (and avoid the recent UK debacle of re-electing a man you don't want), we shall continue to have this problem.

Education makes a major difference. Take the Police. Those countries that set very high educational admission requirements for their police and proceed to demand a long training period in college also have the most professional police force with limited cases of brutality and corruption. Kenya and the US fall in the same category.

[MOON Ki]

The counties don't necessarily have it easy.   USAID has been a funding a project to help with some of the issues, and here are some statements from its  January 2015 summary report:

Services and resources were devolved rapidly, but a number of outstanding questions and concerns remain for the Kenyan health system.

Unsurprisingly, significant capacity gaps are common within county political and management structures. When resources were devolved, few counties possessed the administrative capability to absorb the available funding or plan for its use. Although the national government was concerned about these capacity gaps, it had not outlined training and mentoring plans for the counties, as it expected to use the full three-year transition period originally allowed by law.

These issues reflect some of the political and technical challenges associated with devolution. Counties sought to expand the scope of resources transferred from the national government, increase their authority over services, and reduce national government restrictions. However, the national government fought to retain centralized control.

MOH civil servants, seeking to preserve their positions in Nairobi, have tried to limit health worker transfers to CHMTs or health facilities. They fear that certain counties will have poor social services and infrastructure, that they will lose political power outside of Nairobi, and that their work will be subject to greater political interference.

The national MOH has also been slow to restructure. Without adequate political will, it is unlikely that MOH headquarters staff will be reassigned to assist CHMTs or provide health services as originally envisioned.

http://www.healthpolicyproject.com/pubs/719_KenyaDevolutionBrief.pdf

[jakoyo]

Unless we have proper managers and strict accountability and disciplinary process - everything esle is wishful thinking. The greatest hinderance to improved health care in kenya are the doctors and nurses employed by these institutions. Drs in public hospitals in Kenya are a law unto themselves. They are accountable to no one. They abscond work. They are rude. Same with nurses.

Patients are treated as a bother , with alot of dis respect.

Now spare me this BS that medical dstaff work under stress and difficult conditions. Medical staff should reflect on their performance under the circumstances while continually holding the govt to account.

Most radiaology services in public hospital are sabotage by the same Dr and technicians so that patients can be refered where they Drs  earn kick backs.

Drugs are looted from pharmcy so that Dr can write private prescriptions and get kick backs.

Operating theatre are sabotaged so that patients can have their operations in private clinics.

Forensic auditors to investigate these illegal activities and punish the greedy Drs are urgently needed.

But more importantly - Dr and Nurses must be ready to be sincere and work from within to improve the quality of health service.

Drs , managers and nurses who engaged in corrupt activities , abscond duties , neglect patients should be sacked and charged in court if their offences are criminal in nature.

With that in place the health care workers can have the moral grounds to blame the govt of its failures

Enough of my rant. 

[MOON Ki]

That said, part of the corruption in the hospitals arises because of weak systems. These weak systems can only be corrected by investing in technology. We are not investing in technology so we are bound to remain with weak systems. There you have your vicious cycle.

I don't completely buy this argument, which I have also heard in relation to how the national government does some of its business.   Technology of itself will never be a solution to what is, essentially, a fundamental "national character-flaw".     All it will do is make things slightly more difficult and necessitate more creativity in looting.

Look at it this way: at the bottom of whatever technological system one has in place to supposedly prevent theft, there is something as simple as just entering data into some computer system.   As long as the person doing that can be bought, the system is not of much use.

There are way too many people in Kenya who have no problems with public theft.   What's more they know they can get away with it and so have little incentive to stop.   As long as that is the case, the theft will continue.

To my mind, the best way to deal with corruption is Lee Kwan Yew's  Singapore way: no matter how small or how big, punishment is quick and painful---literally when it includes caning.

If, on the other hand, by technology you mean mechanizing more things so that there are fewer people employed who can steal, then the problem still remains: the procurement, servicing, replacement, etc. of the technology will be the vehicles for theft.

The people who do the big-time stealing have the means and opportunity to get around any system.   In fact, it is they who will oversee the setting-up and use of any system that is supposed to stop them from stealing.

Russia hospital was ruined by the Kenyatta regime with support from the Brits. It was a state of the art hospital at inception and could easily have rivaled Kenyatta National Hospital.  History and geopolitics aside, it suffers from the same mismanagement that is killing other hospitals.

That could be so.   I don't know exactly how Kenyatta and the British ruined the hospital; so I can't comment on that.    But I note that both have been long-gone,  and it has been the local management f**king-up for years on end; it is they that I am more concerned about right now.   And knowing that other public hospitals are similarly messed up does not give me much cheer: because of what one might call "historical" or "cultural" reasons, I have "extra" interest in that particular hospital.   

P.S.:  My relative that I mentioned earlier has now moved from "Russia"---but not without a final bit of unpleasantness.   A doctor eventually came to see him, and it went something like this: "Yes, you are seriously ill.  Vey much so.  From this and that.   We need to give you injections of A, B, and C.   That will cost so much, and we require payment before a syringe is even pulled out."   

[jakoyo]

 

Freaking scary stuff. 

you should secretly  record some of these consultations and shame these quacks on FB and twitter. kwani ?

  My relative that I mentioned earlier has now moved from "Russia"---but not without a final bit of unpleasantness.   A doctor eventually came to see him, and it went something like this: "Yes, you are seriously ill.  Vey much so.  From this and that.   We need to give you injections of A, B, and C.   That will cost so much, and we require payment before a syringe is even pulled out."   

[Omollo]

That could be so.   I don't know exactly how Kenyatta and the British ruined the hospital; so I can't comment on that.    But I note that both have been long-gone,  and it has been the local management f**king-up for years on end; it is they that I am more concerned about right now.   And knowing that other public hospitals are similarly messed up does not give me much cheer: because of what one might call "historical" or "cultural" reasons, I have "extra" interest in that particular hospital.   

P.S.:  My relative that I mentioned earlier has now moved from "Russia"---but not without a final bit of unpleasantness.   A doctor eventually came to see him, and it went something like this: "Yes, you are seriously ill.  Vey much so.  From this and that.   We need to give you injections of A, B, and C.   That will cost so much, and we require payment before a syringe is even pulled out."   

[jakoyo]

Two Kitui MCAs have accused Kitui County Referral Hospital staff of demanding bribes from patients.

The county assembly Health Committee chairperson Joyce Mutemi and member Mary Mbandi say some of the staff demand bribes to serve the patients.

Mutemi said she went for an ultrasound scan and a hospital staffer demanded Sh1,000, which he pocketed without giving an official receipt.

She said when she became adamant, the staffer disappeared.

Owino admitted there are cases of staff fleecing patients out of money.

He said the introduction of computers is meant to bring down the vice and discourage thieving staff.

Owino said the cases involving staff and students from Kenya Medical Training Collage Kitui have been discovered and disciplinary action will be taken.

He urged the patients to ask for receipts for any payment at the hospital.

Owino said the county government should give the hospital more money for hiring more staff.

He said the hospital requires at least 175 nurses but has only 105.

 

- See more at: http://www.the-star.co.ke/news/kitui-hospital-staff-ask-bribes-two-mcas#sthash.gtw4G27z.dpuf

[MOON Ki]

I think I missed something.  I'm trying to get a line on how Kenyatta No. 1 and the Brits messed it up and why the local management has since then been f**king up.   

I can't comment on the merits of the British electrical system vs. those of Europe and the rest of the world.   But Kenya, as a consequence of its history, still works on the "British type shiet".   And it doesn't look like it will change any time soon; so common sense would suggest that one be mindful of that.

I know why it's called "Russia", as well as the rabid anti-communism  of the time.  In fact, you'd be probably surprised at how well I know the place.   One significant point I've noted is the growth of myths and tales about the place, its history, and its fortunes---no, I don't mean yours.  But:

* If there are no doctors doing their rounds in the hospitals, then from my personal interactions, I have a good idea---from when I am there on vacation---of which bar or nightclub they are busy in.  And when they wake up, with their hang-overs, the private clinic (serious money) comes first.   

* No drugs at the hospital, even when it should be fully supplied?  I can tell you exactly which "pharma-shack" in Kondele or Manyatta is selling the hospital's supplies.

Moving to the broader picture, jakoyo is on the mark on many things that I may comment on later.  But the essence is this: elitist arrogance in  a corrupt "fuck-all" system is a recipe for disaster in something as important as health-care.

CUBA:

A great to be learned from the place ... for those who care.

[MOON Ki]

Freaking scary stuff. 

you should secretly  record some of these consultations and shame these quacks on FB and twitter. kwani ?

Record?   What for?  Initially I was shocked, but I have since been assured that it's the way things are done there these days.  Standard hospital policy or something.  It appears that free government-provided health-care isn't free, and some of that is not actually corruption---just GoK not providing enough funding (or too much of it getting looted).    He's now at some private clinic in Milimani where the owner works on a slightly better model: the muhindi owner---sorry, veritas---will treat & feed, but the security guard is to make sure that he doesn't even get out for a breath of fresh air unless his daily payments are up-to-date. And if the money keeps coming in, they want the patient to keep staying ...
 

[mya88]

Unless we have proper managers and strict accountability and disciplinary process - everything esle is wishful thinking. The greatest hinderance to improved health care in kenya are the doctors and nurses employed by these institutions. Drs in public hospitals in Kenya are a law unto themselves. They are accountable to no one. They abscond work. They are rude. Same with nurses.

Patients are treated as a bother , with alot of dis respect.

Now spare me this BS that medical dstaff work under stress and difficult conditions. Medical staff should reflect on their performance under the circumstances while continually holding the govt to account.

Most radiaology services in public hospital are sabotage by the same Dr and technicians so that patients can be refered where they Drs  earn kick backs.

Drugs are looted from pharmcy so that Dr can write private prescriptions and get kick backs.

Operating theatre are sabotaged so that patients can have their operations in private clinics.

Forensic auditors to investigate these illegal activities and punish the greedy Drs are urgently needed.

But more importantly - Dr and Nurses must be ready to be sincere and work from within to improve the quality of health service.

Drs , managers and nurses who engaged in corrupt activities , abscond duties , neglect patients should be sacked and charged in court if their offences are criminal in nature.

With that in place the health care workers can have the moral grounds to blame the govt of its failures

Enough of my rant. 

[mya88]

Going beyond mere data coding, a company such as Nyokabi's would get very little business from a place like the USA, even though there is plenty of such work that needs to be done there.  India tried that market and did not get very far.  From a few years ago:

[MOON Ki]

MOONKI

This is incorrect. Actually that is how business is done in the US. Most hospitals do not have Radiologists within the hospitals. They perform x-rays, CT scans and MRIs, then send the images to a radiologists who reads them and sends back the results electronically. So a company like Nyokabis is just catching up with what the US has been doing all along.

Perhaps we are on two different lines here.   Terminator is proposing that folks in Kenya be able to do all sorts of "outsourcy" stuff  for people elsewhere.  I also stated that I did not think Nyokabi could get much (outsourced) business from the USA, not in the USA.

From what I can tell, Nyokabi's  business is in Kenya.   And I'm saying that, as far as I understand American law, her company could not possibly do any/much work for an American hospital/clinic.     The Indian Kings of Outsourcing have not had much success in that regard.

In fact---and please correct me, if I am wrong---even within the USA the legal matter of doctors "practicing across state lines" get very tricky.   Last I looked---I'll have to find the report, which was some legal commentary---only a few states, like Montana (which themselves are already "backward & outsourced" from the rest of the USA) are free-and-easy with the practice of "telemedicine".

Anyway, just to go out on a limb here, I'm going to say that I don't see a US clinic/hospital sending work to Nyokabi in Nairobi.  Not for a long, long, long time.    I'd be keen to know why you disagree.  From where I see it, the legal minefield is simply too huge; but, of course, I could be wrong.

[MOON Ki]

most kids dont make it past age 5 due to lack of these basics. Sometimes I wonder if these people at the top ever get sick? If so, how are they so blind or insensitive to the issue of healthcare....

That's how it is.  And when people come to vote for  who will lead the country, it's all "our man!".  Mission Impossible.  You make your choice: laugh or cry.

[jakoyo]

Only radiologists whose qualifications are recognized by the American Board ( ie Board Certified) and registered to practice in America and have comprehensive medicolegal indemnity can be allowed to give a radiological report of persons recieving treatment in America.

Simply because they believe their standards are safer and superior to ours.

But inversly - most wealthy Kenyans prefer expert opinion from abroad.