Senior doctors at Kenyatta National Hospital are spending more quality time with well-paying patients in their private clinics, where they make triple what they earn on government salary, a situation that has left poor patients coming through the public at a loss.

Those holding the hospital together and doing much of the work in attending to patients are the nurses, medical interns and students, medical officers and registrars.

Interviews with several doctors revealed that they are earning triple or four-times of what they get as government doctors. A doctor at KNH, for instance, a doctor in Job Group 4 earns a basic salary of between Sh 60,000 and Sh. 80,000 without allowances, while in his or her clinic; the same doctors rakes-in upto Sh 400,000 in the same period.

A few others are making over one million shillings a month in their private work. Doctors say the salary structure is punitive and does not acknowledge value of their skills.

Majority of the doctors are said to be living lifestyles and investing in property that cannot be sustained by the government salary. Hence they have turned to the handsome pay by patients in private clinics or hospitals to oil their projects and lifestyles.

Besides KNH, some of them have between two to three clinics and offer services in leading private hospitals. Failure to be at KNH as they attend to these private entities is now creating discontent among the nurses and other few doctors, who think they are handling the workload while their colleagues are busy making a fortune.

The current scenario is having a negative impact on the efficiency and quality of services delivered by the hospital.

“If a doctor runs a clinic in a private hospital, how do you expect the same doctor to be available at KNH to offer similar services with commitment and passion,” one doctor wondered.

The issue is so sensitive that no doctor or health provider wants to be quoted for fear of reprisal from the top management and colleagues.

But the hospital administration has vigorously denied this is happening arguing that contrarily to perceptions by the public and patients, doctors at the hospitals, who are employed as consultants, are giving back to the facility much of their expertise and time.

“There is this wrong perception that doctors are not giving Kenyatta National Hospital the quality time it deserves. Yet they are trying their level best to do just that,” says Dr Reuben Lubanga, the Acting Deputy Director-Clinical Services.

“The absence of a doctor in the ward does not mean patients are not being taken care of. We have a mechanism in place that addresses these issues adequately,” he adds.

According to Dr Lubanga, between March 2007 and March 2008, the hospital conducted over 19,000 surgeries. “Who did this if the doctors were not putting much time here,” he posed.

He however admits that there are other challenges that are impacting negatively on the hospital’s service delivery, other than the doctors’ issue. Increased work load at the hospital caused by the collapse of district and health centres, is one of those cited.

Dr Lubanga argues that since the collapse of these health facilities, the hospital has ceased to function as a referral centre dealing only with specialized cases.

Patients with minor injuries and ailments who would have been managed easily at the district or divisional health facilities are pouring into KNH, overstretching the doctors.

All patients with infectious diseases are now being transferred to the hospital after the government transformed Mbagathi hospital, which was the main infectious facility, into one that offers general medical services.

So are the trauma patients who otherwise would have been treated at Kabete were it not that the facility was taken over by the military.

This entire lot of the people knocks at KNH, with the massive numbers making medics to spend little quality time with patients as they rush to clear the backlog and save sometime for their own private clinics.

One doctor, for instance, is expected to handle over 30 patients in a half day, resulting in less time being allocated to each sick person. Ideally, a doctor should spend at least 15 to 20 minutes with one patient.

But KNH being a teaching hospital, notes Dr Lubanga, doctors and nurses may spend over one hour on single process as they teach the students. This defines how many patient can be seen within a given time-frame.

Poor salaries doctors get is said to be another reason why they are not motivated to put much time in the public service. Doctors want to earn triple what they are earning presently if they have to give much of their time to public service.

In the wards, another backlog is created as patients who have recovered and been discharged continue to occupy beds because they cannot meet the fees required for their stay and treatment.

For instance, by 2nd June, 2008, the hospital had 340 patients- almost a third of its bed capacity-who had been discharged, but were still staying at the hospital occupying beds that could be used by new patients.   

Lack of specialized equipments or blood is also resulting in many patients waiting for long before treatment can commence. The most affected areas are orthopaedic, neurology, Intensive Care Unit, Cardiology, and blood transfusion departments.

While other doctors agree these challenges exist, they still think some of their colleagues are not giving the hospital as much attention as they do to their private work.

“It is the same salary we earn, why are some of us putting more hours than them,” one doctor wondered.

A doctor who works in orthopaedic department and another in the gyneacology complained of how their colleagues make technical appearances at the hospital. Much of their time is spend in the private practice as cases allocated to them at the hospital go pending for many days.

Take the Hospital’s Doctors Plaza. The long winding queue of patients at the Plaza is not only indicative of an ailing nation, but also of how doctor’s pockets will be fat at the end of the month.

Secretaries who usher patients into the doctor’s rooms and who collect the consultation fees admit there is good business at the plaza. On average, doctors who does well collects over Sh 20,000 a day. This translates to Sh 600,000 a month.

Patients interviewed said they find it easier to access the same doctors at the Plaza or in their other private clinics than at KNH where they are put on waiting lists or have to queue for long hours before being attended to. And when they are seen, they do not have quality time with the doctor as is the case in his or her private clinic.

This scenario has created a huge demand for doctors in their private capacity, eating into the valuable time they are supposed to be offering public service at the hospital.

A number of doctors are now proposing that the hospital signs annual contracts with each doctor, detailing how much time he or she will be at KNH every week, with pay reflecting the amount of work done.

This will cut down on allowances paid for doctors who do not show-up or put little time in their work. Contracts for those who contravene this should be terminated. Similar practices exist in private hospitals where doctors earn for their efficiency and quality of work.

But this is what many doctors at the Hospital do not want to hear. Speaking on condition of anonymity, three senior doctors threatened to charge the hospital per hour or for every surgery done if they are forced to signs contracts defining the number of hours they have to work.

One theatre operation in the private sector they charge a minimum of Sh 200,000, when at KNH what they get is a salary, no matter how many such surgeries they undertake, they argue.

“Our contribution to the hospital should be commended and not condemned, because even the people we treat in private hospitals or our clinics are Kenyans. So we are contributing to the wellbeing of the country,” one of the doctors said.

Dr Lubanga cautioned against putting specific times for doctors within contracts, terming such a move as dangerous and not in the best interest of the hospital. “If we delink from these consultants, we shall loose control of them and they will give less attention to our patients and students.”

He says instead of barring doctors from private practice or making their life difficult, the hospital is appealing to them to give more priority to KNH patients and students.

Although the hospital runs an audit system that monitors the amount of time a doctor puts in ward rounds, surgery and other clinical work, witty doctors are able to bypass this.

Besides the contracts, doctors have also refused to acknowledge calls for them to quit and be fully employed in the private sector instead of earning for lip service to the public. A section of those who spoke to The Horizon said such a move would be suicidal to them.

“At KNH you are able to access patients with complicated cases, impact knowledge to students, grow as a professional, and leave a legacy of your work,” one of them said.

A suggestion by World Bank to decentralize its services and create institutes, each headed by a director has not received support either.

Under this arrangement, departments dealing with specialized issues like the orthopaedics, cardiology, neurology and plastic surgery, among others, would be transformed into Institutes with their own management. Such a model has been tried and works well in developed countries.

Doctors at the hospital say the current centralized system at KNH creates a lot of bureaucracy and bogs down decision making processes that affect the efficiency and quality of service delivery to the public.