One cold evening last year as John Mchicha, a long-distance truck driver drove out of Nairobi on his way to Busia in western Kenya, his journey was cut short when he was involved in an accident at Kimende, just over 50km from the city.
Good Samaritans rushed Mr Mchicha, who had suffered extensive injuries, to the nearest health facility from the accident scene—the AIC Kijabe Referral Hospital, one of Kenya’s largest mission health centres.
He would end up staying at the hospital for eight months, oscillating between the intensive care unit, operation tables and the ward, and incurring a bill of more than Ksh3 million ($30,000).
His health insurance provider paid the hospital Ksh500,000 ($5,000) while friends and family raised some Ksh200,000 ($2,000). Mr Mchicha still owes the hospital Ksh2.4 million ($24,000).
"I am helpless," he told The EastAfrican at his Kayole home in Nairobi's Eastlands area. "I cannot walk nor provide for my family. I depend on people to perform even the most private tasks," he said.
Apart from the outstanding bill, Mr Mchicha also needs knee replacement surgery.
Kijabe offers restorative and rehabilitative care for road accident victims like Mr Mchicha.
However, the facility is losing millions of shillings through non-payment by patients who lack medical cover and are too poor to pay for the services out of their own pockets.
For example, in January alone, the facility incurred a Ksh10.9 million ($109,000) debt — nearly four times the amount that patients paid in that month, according to hospital records seen by The EastAfrican. Its debts have risen by nearly 40 per cent since last year.
Kijabe is not alone in this predicament. Other faith-based hospitals including the PCEA Kikuyu Hospital — some 30km from the Nairobi Central Business District and owned by the Presbyterian Church of East Africa, and Tenwek Hospital in the Rift Valley are in the same predicament.
Founded more than a century ago by Christian missionaries, these facilities have filled a crucial gap in a public health system battling poor funding and inadequate human resources.
World Bank figures show that these hospitals provide about 30 per cent of healthcare in Kenya and up to 60 per cent in rural areas.
During the protracted industrial actions that paralysed healthcare in public hospitals in 2017, they were the go to facilities among patients who could not afford private healthcare.
The government ranks faith-based facilities as private and as such, they do not receive funding from the Treasury. They rely on donors, well-wishers and the user fees charged to patients, which are barely enough to run the facilities.
Kijabe’s director of finance Sam Mwaura now says the facility, which was recently accorded referral status, is almost on its knees.
“The fundraising is not sustainable due to the general decline in donor funding,” he said, adding that since faith-based facilities were founded on compassion, making it impossible to send patients away or discontinue care, their mounting debts will soon render them unable to serve Kenyans.
Universal Health Coverage
Health economists now question Kenya’s plan to realise its ambitious Universal Health Coverage drive launched last year, when a large portion of the health system is not integrated into the sector’s financing plan.
Dr Samuel Mwenda Rukungu, the general secretary of the Christian Health Association of Kenya, the umbrella organisation for Protestant churches, is perplexed that the government did not include faith-based facilities in the UHC pilot even though they take care of nearly half of Kenyans.
Faith-based hospitals are bearing the brunt of systemic collapse in health and development in general.
The World Health Organisation notes that road traffic accidents claim 1.2 million lives annually across the globe, 90 per cent of them in sub-Saharan Africa.
This has baffled experts because Africa has two per cent of the world’s vehicles but the deaths on roads are 24 per 100,000 compared with 10 per 100,000 in Europe.
Dr Benjamin Wachira, an emergency medicine specialist, attributes this to a number of issues including roads without sidewalks and a broken emergency response system in hospitals.
Until 2016, Kenya did not have a trained emergency medicine specialist, and there was no course in medical schools for it until hospitals started training their own staff and extending the training to healthcare workers outside of their staff.
Kijabe, which handles about 10,000 surgeries annually and caters for more than 600 inpatients, has also invested money in training its clinical officers in emergency response.
Once patients are stabilised, they need care. It is this care that bleeds the facilities, especially when the patient goes into intensive care.
When we visited the hospital, orthopaedic surgeon Chege Mwangi had just come from a surgery on a patient whose injuries read like a constitution.
“Fractured spine, broken limbs, trauma in the head…”, a statement that he expands with medical names of bones and concludes, “He will stay with us for a while.”
After surgery, he will need nails inserted into the broken bones, accompanied with external fixators while undergoing therapy.
The cost of each nail ranges from Ksh25,000 ($250) to Ksh40,000 ($400). The number of nails a patient needs depends on how many bones have been broken.
The fixators have bars that help to realign the bone.
According to Dr Chege, sometimes the facility is forced to conduct corrective surgery on patients who are referred to Kijabe from public hospitals that have run out of the materials needed for the operation, with exposed bones that sometimes begin to rot from infections due to poor handling.
“When they come here, they may have lost portions of the bone that must be grown back, 1mm each day,” said Dr Chege.
During treatment, the improperly healed bone may be broken afresh forcing doctors to begin the therapy again, services for which Kijabe and other mission hospitals say they are not compensated despite the patients originating from public facilities.
The most traumatic cases he has received are motorbike riders, or boda boda in Kenyan slang.
Boda bodas are a cheap and popular means of transport. But because the majority of riders and/or their passengers do not wear helmets, they sustain extensive injuries if they survive an accident.
Mr Mwaura acknowledges that the government sent a few health workers to Kijabe, unburdening them of salaries, but this was hardly enough to sustain the operations of the hospital.
He said that it does not help that many Kenyans are not insured. The Kenya National Bureau of Statistics records show that only a quarter of Kenyans (27 per cent) have health insurance cover.
However, even when insured, the tedious reimbursement process from the National Health Insurance Fund leaves the facilities in debt.
Jecinta Mutegi, the national executive secretary of the Catholic Health Commission of Kenya, said that the national insurer owes the 500 hospitals the Catholic church runs about Ksh1.3 billion ($13 million).
“When we plead and push, we are given say Ksh10 million then there are also delays,” said Ms Mutegi.
Both the NHIF and the Ministry of Health had not responded to their claims by the time of going to press.
—Additional Reporting by Ruth Mbula and Winnie Atieno.