Managed Equipment Services: The Kenyan Story

In 2015, the Kenyan government launched an ambitious program to upgrade hospitals by providing what they termed “specialized, modern, and state-of-the-art medical equipment” through a managed equipment services scheme. They claimed that the program’s goal was to increase access to specialized health services countrywide, consequently improving the quality of health care as well as decongesting the main referral hospitals. The reality, though, was slightly different. Much of the equipment that arrived – surgical instruments, trolleys and radiology equipment – was pretty basic, and many medical professionals failed to recognize the promise of “state-of-the-art”. With a seven-year lease period, many asked, “Are these tools really worth it?”

As it stands, this equipment is yet to be used as it was envisioned. Although some facilities earmarked for this equipment have made the effort to install and use it, many devices remain undelivered due to various challenges including the actual infrastructure to house them and the personnel to operate them. Getting information from the Kenyan Ministry of Health on the evaluated status of the equipment is akin to pulling teeth.

The government committed US$450 million of taxpayers’ money to the project, touted as a flagship of the then-new administration. In addition to operating theater equipment, other tools on the scheme included sterilization stations, dialysis devices, intensive care machines, and radiology equipment – all under a public-private partnership model with various suppliers. Two hospitals in each of Kenya’s 47 counties were selected to benefit from the program, as well as four of the country’s national referral hospitals.

Theoretically, the project should have helped a developing country with an ailing healthcare system claw their way out of a possible collapse. In practice, though, the flaws in the scheme outweighed its benefits.

At the time, Kenya had just started implementing a new constitution in which the 47 counties existed as devolved governments responsible for the bulk of Kenyan healthcare. Unfortunately, the counties were not consulted nor their needs analyzed prior to procuring the equipment. Instead, a one-size-fits-all approach was used in designing and implementing the scheme. But even though the counties were not asked for opinions, the county governments were still expected to fund the scheme – to the tune of approximately US$1 million per county, per year. And the funding was expected to begin in the 2015/2016 financial year – before there was even any sign that the counties had the capacity to support the program!

Worse still, the criteria for selecting the facilities to be supplied with equipment were shrouded in mystery. One particularly egregious example is a county whose facility was only partially constructed when the scheme was proposed – and, although the facility was still incomplete at the end of 2017, taxpayers had already begun paying heavily for equipment that couldn’t even be provided.

Kenya’s physician-to-population ratio is about 1:4,000, and the nurse-to-population ratio is even worse. The introduction of the new scheme, without accounting for the personnel needed to support it, meant that the equipment was bound to lie idle in facilities. The government also hasn’t factored in the time it takes to fully train healthcare personnel – we cannot rush through training in the timeframe the government has promised and then be expected to offer the quality our patients need and deserve.

Herein lies the third flaw: misinformation. Many Kenyans were led to believe that the equipment supplied is the answer to all their health problems, including cancer treatment. Cancer, to many Kenyans, is either a death sentence or a guarantee of perpetual poverty. It’s understandable, then, that the new equipment scheme raised people’s hopes – but the truth is that there was never any form of cancer treatment in the package. The closest thing included in the program is a mammogram (part of the radiology package) – but what use is a mammogram with no radiologists, pathologists, oncologists, breast surgeons, or support staff? Who’s going to make the diagnosis or treat the patient?

Although the government’s intentions in procuring such equipment to help ease the burden of care may have been right, my opinion is that the high cost and lack of planning make the scheme a poor investment of taxpayers’ money.

This should be taken as a serious “what not to do” lesson in the healthcare sector for any country, particularly other developing countries struggling to provide essential services to their citizens. The Kenyan example should demonstrate the importance of planning and doing a needs assessment prior to any “mega-project,” tenets that should not be rocket science for any serious government.