Scarce funding cripples service delivery in Kenyan hospital

Monday June 3 2019

St Luke’s Mission Nursing Home in Kilifi.

St Luke’s Mission Nursing Home in Kilifi, in southeastern Kenya. PHOTO | KEVIN ODIT 

VERAH OKEYO
By VERAH OKEYO
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It is hard to believe that the now rusty iron hospital beds, dirty wards and the costly but run down equipment in the theatre as well as the intensive care unit were once the hallmark of St Luke’s Mission Nursing Home in Kilifi on Kenya's Coast.

The Kenya Medical Practitioners and Dentists Board closed the facility in April 2016 due to "lack of registration," a decision that interrupted learning at the hospital’s nursing school, which had more than 100 students, and rendered their tutors jobless while the management was left in a fix.

But those who were most affected by the closure were the residents. The hospital had unburdened them of hours of walking to seek healthcare, with the nearest affordable facility being some 20km away — the Mariakani Sub-County Hospital.  

St Luke’s Mission Nursing Home was established in 1927 by the Church Mission Society, but later changed hands, being taken over by the Anglican Church of Kenya.

Covering the larger disadvantaged parts of Kilifi, the facility began with missionary health workers. It grew steadily and at the time of its closure, it housed a theatre, three wards and a paediatric unit.

LIMITED SERVICES

Philip Mbaji, who grew up in Kaloleni, has enduring memories of the facility.

“I remember in the 1990s when my uncle who had scrotal elephantiasis was admitted to St Luke’s. The doctors operated on him and he became a champion for the disease, which locally was associated with witchcraft,” Mr Mbaji said.

While the Mariakani Sub-County Hospital is the next affordable option for area residents, it is overstretched and the specialised care is a far cry from what St Luke's offered.

The other alternative is the Coast Provincial General Hospital, the largest public facility in the region, which is three hours’ drive away, and where there are long queues and challenges of devolution such as stock-outs.

However, a public outcry forced the Kilifi County government to invest Ksh11 million in St Luke’s and it was reopened in February 2017, but with a skeleton staff of 19 out of the 106 at the time of the closure.

The mobile clinic at St Luke's Mission Nursing Home in Kilifi, in Kenya's coast.

The mobile clinic at St Luke's Mission Nursing Home in Kilifi, in Kenya's coast. PHOTO | KEVIN ODIT

Only the outpatient section and maternity wing (which handles normal deliveries) are operational currently.

The five nurses and three clinical officers attend to just about five expectant women at the Linda Mama programme (Kiswahili for protect mother), which is run by the state insurer, the National Hospital Insurance Fund.

However, with the limited services offered at the facility and given the minimal amount that mission hospitals charge, St Luke’s has been unable to sustain itself over the past two years, a nurse said.

"The majority of health workers have left, disgruntled over unpaid salaries,” the nurse said.

Jerusha Dullu, the facility’s acting human resource director said they also lack drugs.

CHALLENGES

The fate of the hospital remains uncertain, as a series of meetings with government officials have failed to bear fruit.

Retired ACK Mombasa bishop Julius Kalu directed The EastAfrican to the current Bishop Alphonse Mwaro Baya who did not answer calls.

Several visits to the NHIF did not bear any fruit.

The Tabaka Mission Hospital in Kisii County in southwestern Kenya has resigned itself to its fate, offering free services facilitated by a meagre Ksh2 million ($20,000) annual funding from Italy as well as patient charges.

Fr Elphas Kolia, the hospital’s director, said a number of the mothers who visit the facility are not registered under the NHIF, forcing it to write off their debts.

The 250-bed hospital serves patients from three counties — Kisii, Migori and Homa Bay — supporting the public Kisii Teaching and Referral Hospital.

Though the 42-year-old hospital has a number of departments including outpatient, inpatient and the comprehensive care centre, maternal and child health services is their specialty.

John Bosco Bicumu Makuba, an obstetric gynaecologist at the facility, said they perform at least 120 deliveries each month, 45 of which are Caesarean sections.

“Our main challenge is that this hospital is located in a rural area and we end up receiving referrals from smaller facilities around. At times we are overwhelmed, but we try our best,” said Dr Makuba.

For example, after 31-year-old Susan Ogaga, a resident of Rongo in Migori County, delivered her third born, heavy bleeding saw her referred to Tabaka, which is three hours’ drive away. It does not help that the facility was recently elevated a rank higher from a Level Four hospital, placing more responsibility on it but without the requisite support.

Additional reporting by Ruth Mbula and Winnie Atieno.