Devolution Issues in Healthcare

The realization of the new constitution had been the dream of every Kenyan in the progress towards reforms and reconstruction of the public sector. One of the proposed restructures was the devolution of various government functions from the central government to the county governments. Health was one of the central government functions that were proposed for devolution. Technically, the move to devolve health functions was welcome, since it is a way of enhancing access to health care services to Kenyans. This move was also aimed to reduce inefficiencies that accompany centralization of services.

Right move or not

The much-anticipated benefits of devolution of healthcare to the counties seem to be a mirage. Devolution of healthcare has shown declining performance of the health systems, bringing in questions on whether the country needed a devolved system or not. The public health sector has been faced with numerous human resource unrests that have led to many deaths and disruptions in service delivery. Matters concerning unfair employee appraisal systems, poor working conditions, inconsistency in remuneration and benefits among other grievances, have triggered these strikes.

Structures for healthcare devolution

All these challenges point towards poor health management structures in counties. The counties lack adequate structures in management of human resources and health finances. These inefficient or non-existent structures have brought about delays and confusions in release of funds for health facilities and workers.

Capacity

Most counties lack health managers who have done health systems/services management. Most of the persons served in the previous centralized health system where they could maneuver around without the requisite skills, since they had fewer responsibilities. Now that healthcare has been devolved, they face greater responsibilities, which they may not handle due to inadequate skills in health services management.

What needs to be done?

Devolution of healthcare is a very beneficial aspect of service delivery, through enhancing access to care and increasing efficiency of health systems. However, these benefits are clearly not achievable since Kenya is inadequately prepared for this. Since this is an issue of law, a referendum is necessary to revert the functions back to the central government until counties are well equipped to handle the health functions. Counties also have to insist on recruitment of persons trained in health services/systems management to handle managerial responsibilities in healthcare.

Innovative Marketing of Health Services for Public Facilities

There has been growing demand for healthcare services in the recent past, and this has contributed to a growth in investments in the health sector. Healthcare services are increasingly being commercialized than it was the case some time back, and therefore an element of competition is becoming a reality in the health sector, just like in the general corporate world. Therefore, every health institution is striving to stand out in the provision of its services in order to maintain and grow its market segments. Public health institutions in Kenya and most other countries lack incentive to market the various services they offer. This can be attributed to their nature of operation as not-for-profit, as influenced by government policies to ensure affordable healthcare to its citizens. The hospitals therefore in most cases have insufficient funds not only to sustain their services, but also to market their services to the level of their private peers. Although successful marketing in any sector comes with a high financial cost, the element of cost is not a hindrance especially in marketing of health services. Public health institutions can still go ahead and compete effectively in the health sector by employing the following strategies at minimal or no cost;

Quality care

This may be seen as an obvious strategy, but public health facilities need to make quality of care and satisfaction of their clients a number one priority since this is really what drives their clients away. Quality is the most valued attribute in the health sector, and therefore it’s an area that needs careful consideration. Quality issues range from the effectiveness of treatment provided (the patient’s role being constant), suitability of materials used, client waiting time, courtesy, adherence to SOPs (Standard Operating Procedures) and the general ambiance of the institution. The institution can set up an active and functional committee to check on quality issues.

Point of convergence for corporate social responsibility

Public facilities play a crucial role in the lives of people in their respective catchment areas due to the high poverty levels especially in third world countries. Therefore, these facilities have a great influence on the local population. The facilities can take this as an advantage in reaching out to the population through other organizations and still gain an edge in marketing. The facilities can achieve this by seeking to carry out joint community health related projects with multinational companies (e.g. Coca-Cola) or other leading national companies. In most cases, the companies will be willing to provide all the resources for the outreach, while the hospital can provide expertise, site space and access to the population. As the company seeks to market its activities and products to the local population and beyond, the public hospital will also gain limelight as a contributor/partner to the success of the outreach. These outreaches may combine the efforts of several organizations, or they may be bilateral between the hospital and a company depending on the practicality, economic viability and willingness of the companies involved.

Specialization while ensuring diversification

Successful companies like Samsung, initially had specialized in making cell phones and was ranked lower than Nokia. On diversification to other household electronics (like televisions, refrigerators etc.), Samsung gained higher ranks than Nokia and became a market leader in 2012. There is need for health facilities in the public sector to identify their strengths in service delivery and put a keen focus on these in order to gain much authority in those categories, just the way Samsung focused initially on cellphones. On identification of this area of specialty (guided by feasibility of implementation and demand for the service), the hospital should also diversify its services to widen its market. For example, Mathari Level 5 Hospital has specialized in mental health which has made it gain popularity in Kenya and beyond, although it still offers other services like dental care and thus serving a wider market.

Collaborations with institutions of learning

Most hospitals miss out on the marketing opportunities that come along with collaborations with medical training schools. These collaborations are usually seen in an abstract manner without deeper insights on possible opportunities for marketing. Hospitals can gain a lot through joint researches with medical training institutions usually at no cost. In most cases, the hospitals usually provide access to the subjects but at the end of the day, the name of the hospital dominates the research work. Isn’t this marketing without a sweat that?

Publicity

In the year 2012, Webuye Level 4 Hospital was awarded as the best maternity services provider among all the public health facilities in Kenya. Hospitals should strive to seek positive publicity in various ways, outstanding performance being one of them. Public hospitals can also take part in celebrations like the World AIDS Day and do these in unique ways that elicit media/public admiration and interest.

In conclusion:

It is now quite clear that public health institutions need to be at par with the reality of commercialization of healthcare, and thereby strive to stand out against competition that is increasing with time. This calls for innovative marketing strategies since these institutions are faced with financial constraints.

Future Challenges for Health Systems Management

Healthcare/system management is one of the professional practices that are rapidly changing with time. This dynamic practice therefore has experienced various uncertainties and challenges with changing times in the past. Some of the future challenges healthcare managers are likely to face, are analyzed in the following sections.

Escalating healthcare costs

Health care management will be faced with the challenge of minimizing healthcare expenditure which has been brought about by the trend of rising health care costs annually (Walshe & Smith, 2011). Research has shown that, for example, in the year 2001, the United States of America (U.S.A) had 14.1% of its Gross Domestic Product (G.D.P.) committed to covering health care costs. Going by the upward trend, this expenditure had been predicted to rise to 17.7% of G.D.P.in the year 2012 and continued increase in the subsequent years. This poses a great challenge to healthcare management professionals on how to contain these rising costs and increase efficiency in health care delivery.

Social disparities/inequities in health

One of the goals in health care management is to increase the access to quality health care in a fair way. Health care management is faced with the challenge of enhancing fairness and access in healthcare provision, due to the rising pressure on the public to pay for the healthcare services as a cost containment measure. This has limited the financial access of the poor to quality health care services, thus creating disparities in health status on the basis of income/social status. These disparities are likely to increase in the future as long as the cost of care is still being passed on to the consumers.

New healthcare technologies

Development of new drugs and technologies has been instrumental in improving the health of the population, although, it has also had its share of challenges in the health care industry. Many of these new technologies are expensive and may receive partial insurance coverage (Geisler, Krabbendam, & Schuring, 2003). Insured persons are thus quite often required to cover the high costs of these new technologies and prescription drugs. As the number of new technologies increase with time, healthcare managers are likely to be faced in the future by a conflict of interest between the benefits of new technologies to the society, and the need to minimize coverage of such new technologies in a bid to reduce healthcare expenditure

Emergence and re-emergence of diseases

The increasing burden of disease is another challenge that is currently facing healthcare management and is likely to be worse in the future. This will put a lot of pressure on healthcare managers to continuously review their healthcare priorities for the population. Emerging and re-emerging of conditions is proving a challenge in relation to frequent diversion of attention and action, which is likely to negatively influence overall health outcomes. An initial focus on infectious diseases in the 1960s was diverted to an increased focus on non-communicable diseases in the 1990s. A rise of the number of drug-resistant bacterial infections has been experienced in the past, and the trend is set to continue in the future. Health care management is thus faced with an additional challenge of investing more in research under its already constrained budget.

Complex client-provider relationship

The increasing complexity of the relationship between patients/clients with providers of healthcare will present a great challenge in the future. This relationship has been shifting from patient-provider to customer-provider, where patients/clients are insisting on their choice of treatment/care, confidentiality of information and informed consent. This continued empowerment of clients on health matters may result in increased risks of litigation against providers. Health care management will therefore be faced with the challenge of enhancing ethical practices among its providers in order to minimize ligation costs, and enhance patient/client satisfaction.

In conclusion;

Health care management being a dynamic field, is likely to be faced with various challenges ranging from rising expenditure, increased disparities in access to care, introduction of new technologies, increased burden of disease, to developing complexities in patient-provider relationships. These challenges need careful strategic planning to achieve the desired health care outcomes in the future.