ISSUE: 30 October–5 November 2004 A public-health article in this week's issue of THE LANCET highlights how national policy initiatives to strengthen district hospitals are required to compliment efforts to provide essential primary care if child survival benefits are to be maximised in Kenya.
Mike English (KEMRI Centre for Geographic Medicine Research, Kenya) and colleagues surveyed 14 first-referral level hospitals from seven of Kenya's eight provinces and obtained data for workload, outcome of admission, infrastructure, resources, and the views of hospital staff and caretakers of admitted children. They report how paediatric admission rates varied almost ten-fold among the hospitals studied; furthermore, while basic anti-infective drugs, clinical supplies, and laboratory tests were available in at least 12 hospitals, other essential resources--more sophisticated antibiotics, appropriate treatment for malnutrition, newborn feeds, and measurement of jaundice--were rarely or never available in the majority of hospitals studied.
Among hospital staff surveyed by the investigators, a strong sense of commitment, support for the work of the hospital, and a desire for improvement were expressed. Caretakers' views were generally positive, although dissatisfaction with the physical environment in which care took place was common.
Dr English comments: "This project arose in part as a result of a meeting organised and hosted by the Kenyan Ministry of Health in November 2001 to promote efforts to deliver 'Quality Healthcare for Kenyans', part of an ongoing government initiative. Results of the collaborative project make it clear that in combination with improved primary care the capacity of the district hospital in Kenya needs strengthening if simple hospital-based interventions and services are to contribute to achieving the Millennium Development Goal for child survival".
An accompanying commentary (p 1560) by Elizabeth Molyneux (College of Medicine, Blantyre, Malawi) and Martin W Weber (WHO) compares the situation in Kenya with that of Malawi. Dr Molyneux comments: "In Malawi, trainees in paediatric medicine from the medical school have adopted eight district hospitals. Together with designated hospital staff, the trainees have identified both good and bad practices. They identified emergency care as an area that needs improvement in all the hospitals. A simple course in emergency triage assessment and treatment was taught on-site at all the hospitals, and trainees are now visiting the hospitals regularly to continue to monitor progress and help with care of inpatients. She concludes: "It is too easy for staff and carers to lose pride in their institution. Persistence and determination are required from everyone at all levels to regain it. We need to do more than debate the problem; we need to act, and act soon, or it will become increasingly difficult to turn the situation around."
Contact: Dr Mike English, KEMRI, Centre for Geographic Medicine Research Coast, PO Box 43640 00100 GP, Nairobi, Kenya;
T) 254 20 271 0672;
menglish@wtnairobi.mimcom.net
Professor Elizabeth Molyneux, Department of Paediatrics, College of Medicine, Blantyre 3, Malawi;
T) 265-677-245;
emolyneux@malawi.net
Journal
The Lancet