The country needs a quality (of care) commission to spearhead regulation of health care


Reports about medical malpractice are now a common item in our media.  The much touted fatal unassisted child births in public hospitals are just pointers to suffering being experienced by other patients which suggest that the quality of health services in hospitals is sick. A quick look beneath the surface raises a number of real questions; does the country have the right policies to drive quality hospital care and innovation?  Has the country taken the right stance on quality of care improvement? How many patients did hospitals hurt last year?

Past government efforts to address the quality problem has mainly resonated around the access question: how do we increase the number of hospitals and beds in the country. Even in the newly elected administrations, most of the counties have rushed to put up new hospital buildings and buying of mega machines.  A politically popular solution which mainly results in a change that is purely cosmetic.  For instance, the hospital in which a baby died on delivery sometime last month had been ranked the best hospital a number of times in the past. This indicates that the fundamental question of care which has bedeviled the country for long- ‘do hospitals provide safe and timely care to Kenyans who need it’ has been systematically ignored and marginalized. One of the contributory factors is the lack of a comprehensive policy on governance of quality of care. Begging the questions: How do you query hospital care without any publicly defined principles and standards? Can public hospitals be faulted on something they decided not to do or have no plan to do? Should we continue to assume that quality improvement is the reserve of the professional associations? This is the paradox of our time in health care.

Another key aspect of quality of care improvement process is that it’s hungry for information. One might say that we are in the era of information, but the truth is that the health sector in our set up lacks accurate ‘big data’.  Nowhere is the data problem clearly illustrated than in our inability to answer the following questions: which hospitals have good outcomes for patients? How many patients were mistreated and hurt in our hospitals?  How many patients were readmitted? As noted by a scholar ‘knowledge will forever govern ignorance’.  Lack of this information tends to compromise the ability of hospitals and their staff to provide quality care to those who need it. More importantly it erodes patients’ powers and role playing.

What’s the role of patients in the process? If a broad definition of quality of care improvement process is applied, then the patients are the nexus for improvement. In a fundamental sense, patients should improve or change their taste for services so that hospital care can improve. Its wake up time for patients and citizens in general if the social contract on quality of care is to change.  The call for patient participation in quality improvement is not a chimera. In deed countries that care about patients’ dignity invest heavily to improve patient powers and roles.

So, what do we do to move forward? As affirmed in our constitution, transparency and accountability is the cornerstone of our social fabric. Our governments (counties and national) should embrace these principles in the management of quality of care. Given the sensitivity and attention that health services attract, the right to information on quality of health services should be spear headed by an independent organization that works outside government. This is a move that is consistent with best practice across the globe. The second session of parliament should consider making these provisions in the health bill that is soon going to be tabled.

By Dr Elesban Kihuba, Is a Health Systems Researcher with SIRCLE.