In February 2021, a team from the Kenya Medical Practitioners and Dentists Council (KMPDC) together with its associates conducted an inspection exercise of College of Surgeons of East & Central Africa (COSECSA) training institutions in Kenya, as part of KMPDC’s monitoring and evaluation framework.

The inspections, which took place between the 22^nd and the 26^th of February 2021, marked the second such exercise conducted by KMPDC, and was in line with the Council’s mandate to regulate the training of all medical and dental practitioners and community oral health officers (COHOs).

The team, appointed by the Council’s Chief Executive Officer Mr. Daniel Yumbya, also visited existing and proposed COSECSA training sites in order to ascertain whether or not they meet the minimum requirements to train residents in general surgery.

The week-long exercise targeted 24 sites and was aimed at advancing education, training, standards, research and practice in surgical care in the country. This will in turn, help increase the number of surgeons in Kenya which still remains very low.  

According to our data, there are only 581 licensed surgeons in the country. The COSECSA program therefore aims to bridge this gap through a unique in-service training, where the surgeons are taught within their countries of origin and in their respective counties. This not only reduces costs incurred by trainees if they were to study abroad, but also helps in surgeon retention post qualification at the place of study.

With most surgeons based in urban areas, this unique training program also aids in the distribution of the specialists across the country as most surgeons are retained in the specific counties where they studied.

Some of the COSECSA training sites that were inspected include the Kenyatta National Hospital, Moi Teaching and Referral Hospital, PCEA Kikuyu Hospital, AIC Kijabe Mission Hospital among others.

One of my favorite philosophers Mahatma Gandhi once said “It is health which is real wealth, and not pieces of gold and silver”.

His sentiments ring true to this day and might explain why patients are always seeking better health services and if they can afford, are willing to spend millions by traveling abroad to seek treatment if promised favorable outcomes when their health is on the line

This could be one of the reasons why medical tourism is a multi-billion industry.

The Ministry of Health (MoH) estimates that Kenyans spend $15 million on medical expenses abroad.

In any given year, hundreds of Kenyans troop to hospitals abroad in search of treatment. Between January and December 2019, more than 400 patients were cleared by the Ministry of Health and the Kenya Medical Practitioners and Dentists Council (KMPDC) to travel abroad for treatment. The numbers recorded in 2020 are slightly lower due to the lockdown imposed to mitigate the spread of Covid-19.

The few patients who seek clearance from KMPDC are those who need the National Health Insurance Fund (NHIF) to help with their medical bills abroad. Hundreds of other people, especially those with private insurance, go directly without authorization from the Council.

According to our data, the most common referrals are those to do with oncology, heart disease and organ transplants. Although some, if not all of these services are available in health facilities in Kenya, a number of patients genuinely travel for services unavailable in the country.

While going abroad for treatment is no guarantee for better health care, it has been sold as the ultimate option for medical care. This is not always true.

Whereas the treatment expenses overseas in some cases may appear pocket friendlier than the costs in Kenyan hospitals, many patients travel oblivious of a myriad of added costs resulting from travel. Besides the hospital fees, patients pay for accommodation, air ticket and food as separate bills. In most cases, family members accompany the patients adding onto the costs.

Such costs make treatment abroad extremely expensive and many patients, unable to meet these expenses, end up detained in foreign hospitals for unpaid medical bills. This only adds more suffering to families already strained by medical bills and anxiety over the health of their members.

A patient also needs to plan for any needed aftercare upon returning home. One must talk to their doctor to plan for medication and other post-operative needs that may arise from treatment to ensure that the treatment received is indeed working well. It would be quite difficult for a practitioner abroad to physically follow up on a patient who sought treatment from them.

For reasons elucidated above and several others, the Kenya Medical Practitioners and Dentists Council in 2017 developed rules for referral of patients abroad. Under these rules, a medical or dental practitioner may refer a patient for medical or dental management abroad where; there is evidence of inadequate expertise or medical facilities to handle the condition locally; when referral is the most cost-effective option available for the patient; and when the patient opts to pay for medical intervention abroad.

The rules determine the procedure for referrals and eliminate sporadic or unwarranted referrals that fleece Kenyans. This means that Kenyans who want to seek treatment abroad must inform the Ministry of Health and KMPDC about their intent.

This is important because it will help reduce unnecessary referrals when the services can be received in the country at a lower cost and, in the unfortunate event a patient loses their life while receiving treatment abroad, the Kenyan Embassy at the country which one is seeking treatment is in the know of such an eventuality, making it easier to help in the transfer of a body from a foreign country.

In recognition of fissures in the current regulations, the National Assembly is seeking to amend the Health Act by introducing a new section in the law that will establish policy guidelines in the regulation of oversees medical referrals.

Sponsored by Kesses MP Dr. Swarup Mishra, the amendments make the referral of a patient abroad a multi-agency affair. KMPDC, NHIF, Association of Private Health Institutions, Kenyan Embassies and consulates will play a part in vetting the referrals.

The rules, as proposed, stand to benefit the people but nobody should mistake them for a panacea to the menace. KMPDC is committed to ensure that Kenyans get quality healthcare available in the country and in the event that they are referred abroad, their safety and healthcare concerns are well taken care of.

Patients must however commit to play their part and seek advice from the Ministry of Health and the Kenya Medical Practitioners and Dentists Council before travel. The forms and other requirements are on KMPDC’s website www.kmpdc.go.ke.

The editorial has been written by Daniel M. Yumbya, MBS, the Chief Executive Officer of the Kenya Medical Practitioners and Dentists Council and Management Committee Member, International Association of Medical Regulatory Authorities (IAMRA)

When the first case of Covid-19 was reported in the country on the 12th of March last year, many Kenyans were terrified. The dreaded coronavirus that had killed people in thousands in developed countries that had the latest medical technologies and infected hundreds of thousands, was now in Kenya.

Following the discovery of the first case, the president would then issue a number of directives including travel bans to and from countries with confirmed Covid-19 cases,14 days of quarantine for all incoming passengers and an immediate suspension of learning and encouraged people to work from home. A 6am to 7pm curfew was further effected.

People’s lives were inevitably affected, socially, economically and psychologically. And for the first time in the history of this country, the luxury of traveling to other countries for leisure, escape or to seek treatment, was no longer there.

There was a period of doom and gloom for thousands of Kenyans, and for a moment, many never thought we could get through it. But as the proverbial phrase goes, every cloud has a silver lining; and rising like a phoenix from the ashes, we slowly, but ably proved that we could make it as a people in a pandemic.

Analyzing how the country has performed in the past ten months since the coronavirus was first reported in Kenya shows a lot of improvement, especially in healthcare. For instance, with the travel bans, no one could seek treatment abroad and all focus shifted towards strengthening the country’s healthcare system. The president instructed each county to have at least 300 isolation beds to address the increasing demand, in preparation for a surge in Covid-19 positive numbers. As a result, the national and county governments supported our hospitals and institutions to the point of enabling them deal with the virus at their levels. County governments were able to equip their respective health facilities to ensure that should there be a peak, the facilities would not be overwhelmed.

Another key activity undertaken by the government was an assessment of the availability and reliable supply of high-quality oxygen whether by gas cylinders, liquid oxygen tanks through central oxygen piping system, concentrators or liquid oxygen plants. The findings necessitated the formation of a task force to formulate policy and strategic mechanisms to enhance adequate availability and reliable supply of oxygen, a critical PANDEMIC has been a blessing in disguise component in the treatment of pandemic cases. Post the pandemic, these will still be used for patients who come with other communicable/non-communicable diseases.

Healthcare has also shifted towards telemedicine following fears of contracting the virus in health facilities. The Kenya Medical Practitioners and Dentists Council has been approving Electronic Health certificates which have helped health professionals engage their patients virtually, allowing diagnosis, treatment and prescription of drugs online, without having to physically go to a hospital.

Alongside other state agencies, the Council has also been providing technical assistance to strengthen the county capacity to handle pandemic situations. Some of our key findings reflected high level of county awareness and efforts to contain the pandemic, albeit constrained by resources and infrastructure.

Another improvement witnessed in the past 10 or so months is the critical role played by doctors, community health workers, nurses, clinical officers and other cadre of health workers who are critical in Primary Health Care (PHC) at the community/grass roots level.

Through them, communities learnt about the importance of hygiene and social distancing. In many counties, more than 1,000 Community Health Volunteers were trained to handle the pandemic to support the health care worker efforts. These efforts went a long way in not only reducing the number of Covid-19 infections, but also infectious diseases like colds and flus, diarrhea, cholera among others. Looking forward and noting the critical role health workers play in any society, the government should look into boosting its support for this group in all cadres and implementing Universal Health Coverage to ensure that we are ready and capable to deal with any future pandemic. This can be done through the training of more specialist doctors, investing in specialized treatment and capitalizing in primary/preventive healthcare at levels 2 and 3. There is also need to enhance partnerships with Faith Based Organizations and private sector in health, seeing the critical role the private sector played in the pandemic.

The most important lesson that none of us should forget after this pandemic is that health is not domiciled in the Ministry of Health; it is everyone’s responsibility. We should all continue to be involved as players to enhance positive impact on health outcomes.

On March 12th 2020, Kenya confirmed its first case of coronavirus triggering the country into a response and preparedness mode. In its regulatory and advisory capacity, KMPDC was mobilized through the Ministry of health to assist in national coordination, compilation of action and implementation plans to curb the deadly virus as the government continued to review and implement more measures to curtail the pandemic nationally.

Evidenced by the spreading pandemic in the counties, the Cabinet Secretary Ministry of Health, Sen. Mutahi Kagwe, rapidly constituted a national team of experts under the leadership of KMPDC Chair, Dr Eva Njenga in July 2020, to provide technical assistance to all 47 counties with a view to enhance the county governments’ pandemic preparedness and response mechanisms. The Council’s Chief Executive Officer, Daniel Yumbya, was the Secretariat Head., where KMPDC was a key player in supporting the COVID National Task force and providing vital technical information to inform the government COVID-19 response strategies.

In collaboration with the County Health Management Teams, the technical experts’ team conducted a countrywide exercise of health facilities in each county, to establish the counties’ capacities to effectively manage the coronavirus cases when presented. Data based evidence indicated that the outbreaks in the various counties were through inter/intra county importation of the virus, it was acknowledged that some counties were stretched to adequately cope with the public- health emergency due to various limitations in health physical, financial and health resourcing, and technical and expertise knowledge of the novel virus.

The exercise identified key challenges such as limited health infrastructure, delayed laboratory test results, and inadequate supply of testing kits. In fact, the lack of fully equipped lab services, timely testing and reliable transportation, including long turnaround times for sample collection and results was seen as a weak link in management of the pandemic It also cited infections among health workers and extreme understaffing in the public health sector as major challenges in Kenya’s ability to tackle COVID-19.

One of the key activities of the exercise was an assessment of the availability and reliable supply of high-quality oxygen whether by gas cylinders, liquid oxygen tanks through central oxygen piping system, concentrators or liquid oxygen plants. The findings necessitated the formation of a task force to formulate policy and strategic mechanisms to enhance adequate availability and reliable supply of oxygen, a critical component in the treatment of pandemic cases.

The team embarked on capacity building on rapid response, multi-agency team mobilization, management and supplies of essential medicines, communication and publicity, monitoring and evaluation, and risk management. Scientific evidence available demonstrated that quarantine, social distancing, and isolation of infected populations help in containing the epidemic, the team assessed 290 facilities in 47 counties. The team found out that about 47 percent of the assessed facilities needed significant upgrading to effectively handle the pandemic.

The team also trained health workers on referral system to health facilities when the need arises, criteria for determining recovery and discharge of patients. Anticipating a surge in COVID-19 cases, the team also disseminated and supported the roll out of Home-Based Isolation and Care guidelines to provide an alternative solution in the management of the increasing numbers of asymptomatic or mildly symptomatic patients which will serve to decongest health facilities in the country.

The Council opines that the pandemic hastened upgrading of healthcare facilities across the counties adding that the response by the government has greatly improved health systems that will be useful post-COVID-19.

The country also improved its ICU beds to 826 as at 30 th 0f October 2020 an improvement from 153 that existed in March before the onset of Covid-19. Over 15,600 isolation beds have so far been identified nationally and 272 facilities licensed by KMPDC as infectious Disease.

Treatment Centers. Kenya has so far experienced better epidemiological outcomes than many countries outside the African continent, an evidence that could be cited to government’s stringent response; which Mathenge says, was science based. “The government commissioned several studies that have informed policy and response. The data collected will serve to inform many other decisions in the future.

This approach has also ushered in an enhanced era of data driven policy and strategy formulation. I think we are headed into the right direction,” she notes with optimism. KMPDC’s role in COVID-19 mitigation measures cannot be gainsaid. As the regulator in medical and dental practice, KMPDC lived up to its mantra and stepped up activities in a bid to guarantee delivery of quality health services.

The COVID-19 pandemic has brought about a lot of changes in several sectors not only in Kenya, but the world at large. It is no longer business as usual and the health sector has not been left behind.

When the first case of COVID-19 was reported in Kenya, the number of people going to health facilities to seek treatment dropped as Kenyans shunned hospitals due to fears of contracting the virus from the said institutions.

In line with KMPDC’s mandate of regulating the practice and licensing of medicine & dentistry and healthcare institutions in the country, the Council moved swiftly to respond to this growing concern by looking into ways of ensuring patients still got quality healthcare from their healthcare providers despite the prevailing circumstances.

To enable patients consult with their doctors virtually KMPDC commenced the issuance of provisional approvals for various registered and licensed health institutions to offer virtual medical services. So far, about 20 health facilities have received approvals from KMPDC to offer telemedicine services in the country.

The approvals only granted permission for the health facilities to offer virtual consultation health services. These approvals were subject to review every three months from date of issue. 

“The move by the Council to approve the facilities to offer telemedicine is a response to a growing need for the services due to physical distancing rules imposed by the government to curb the spread of COVID-19,” said KMPDC Ag. Corporation Secretary, Michael Onyango.

The Council has now taken it up not just as a COVID-19 mitigation measure but as a way of increasing access to healthcare in an effort to promote Universal Health Coverage and is now issuing annual licenses to health facilities to offer virtual consultation health services. Facilities receive licenses after satisfying the Council that telemedicine services offered are aligned to data protection and medical records regulations.

Even though Kenya currently is yet to enact laws regulating telemedicine, the Council developed e-Health guidelines back in 2019, and shared the same with the relevant government authorities for approval and subsequent gazettement.

“The rules will offer a base for the full roll out of telemedicine services in Kenya,” Onyango says.

According to the Centre for Disease Control (CDC), “telemedicine is the use of electronic information and telecommunication technology to get the health care you need while practicing social distancing.  All you need is a phone or device with the internet to continue your medical care while protecting yourself and your healthcare provider from COVID-19.”

Onyango however says only existing health facilities received approvals to offer the services.

“The facilities receive approvals after satisfying the Council that telemedicine services offered are aligned to data protection and medical records regulations,” he says.

Onyango adds that telemedicine services are “here to stay” after COVID-19 accelerated the adoption of technology in healthcare.

According to the Telemedicine Services Market Global Report 2020-30: COVID-19 Growth and Change “the global telemedicine services market is expected grow from $39.3 billion in 2019 to $48.3 billion in 2020 at a compound annual growth rate (CAGR) of 23.0%. The growth is mainly due to the lockdown across countries owing to the COVID-19 outbreak and the preference for contactless medical services. The market is then expected to stabilize and reach $78.3 billion in 2023 at CAGR of 17.4%.”

In line with the anticipated growth, KMPDC has set up a regulatory framework for E-health in Kenya. Already, the Council has plans to review the Code of Conduct for medical and dental practitioners in a bid to align it to technology driven health services.

That is not without concerns. First, ensuring patient data security is a challenge due to the vast and boundless nature of the Internet, Onyango says. “But we are in the early stages of telemedicine. People may be skeptical but the regulator is ready for the shift in medical services.”

“Regulating the Internet is very difficult,” Onyango adds.

The proposed e-Health regulations, drafted in 2019, bar health service providers from hosting the platforms outside Kenya.

The draft regulations cover areas of virtual medicine, use of artificial intelligence in health and e-Learning including training of medical personnel and online based continuous professional development (CPD) points.

Further, the regulations address establishment of virtual medical facilities prescribing disciplinary measures for any form of misconduct.

After years of red registration and licensing of foreign doctors to practice in Kenya, KMPDC has announced new and ‘friendlier” procedures in enlisting foreigners to practice in the country.

This comes at a time when the regulator moves to improve oversight in the sector as Kenya intensifies efforts to achieve Universal Health Coverage by 2022.

In an interview with The Practitioner, KMPDC Licensing Manager John Kariuki said the Council has started issuing temporary registration certificates to foreign doctors. He says once they acquire the certificate, the doctors are then able to apply for a temporary license that can be used for up to one year, unlike in previous years.

According to Kariuki, if given the temporary licenses, the doctors will be subjected to same regulations and code of conduct that guide the practice of medicine and dentistry in the country. This includes garnering 50 continuing professional development (CPD) points yearly, before they are able to renew their practicing licenses online.

Kariuki however maintains that despite this, Kenyan doctors still get preferential treatment and are entitled to work anywhere in the country and in several health institutions, unlike foreigners who are only allowed to provide medical and or dental services in only one health facility in Kenya.

“It is important that our stakeholders understand that the practicing licenses issued to foreign doctors limit them to only one hospital. Only Kenyans are able to practice anywhere in the country subject to license renewal,” said Kariuki, “We do not just register and license foreign doctors. Kenya has a rich pool of qualified and competent doctors and dentists offering medical services. We have no intentions to replace Kenyans with foreigners.”

According to the Council, any practitioner not registered in the Republic but who, having valid qualifications from a different country outside the East African Community, and who is desirous of giving medical or dental services in the course of any humanitarian or other valid cause, shall be required to obtain a license upon payment of the prescribed fees.

To acquire temporary registration, foreign doctors must submit copies of curriculum vitae; proof of proficiency in English; a certified copy of a valid registration certificate issued in the country of qualification; a certified copy of a certificate of good standing; passport photos; and national identification documents. After submission of these documents, the practitioner is then subjected to peer review or Council exams (Internship Qualifying or Pre Registration Exams). The doctor further has to submit an employment letter.

 Kariuki says the temporary registration of foreign doctors will help the Council provide more oversight in medical practice. “With digitization of our processes, KMPDC is currently able to provide real time data on the numbers of foreign doctors in the country and where they are working,” he explained.

KMPDC keeps a separate register of foreign doctors, Kariuki pointed out adding, “Only a few foreign doctors are permanently registered to practice in Kenya.”

This is because before 2014, the Council had a provision for permanent registration of foreign doctors, but after changes in regulations, KMPDC did not revoke permanent registration of already enrolled foreign doctors.

Kariuki says the move by the Council to issue foreigners with temporary registration certificates is a step towards improved healthcare.

“Health facilities can identify shortages in their workforce and hire foreigners to fill the gaps. Our work is to enable health facilities, medical and dental practitioners deliver quality health services,” Kariuki noted.

The Kenya Medical Practitioners and Dentists Council (KMPDC) has redesigned its organizational structure, in a renewed effort to ensure better service provision and delivery of its mandate.

This is also aimed at aligning the Council to the requirements of State Corporations Advisory Committee (SCAC), following the categorization of the Council as regulatory agency PC6A, March, 2020.

According to KMPDC Council member and Chair of the Training, Assessment, Registration and Human Resource Committee Dr. Jacqueline Kitulu, the new structure sets forth the principles and rules which govern the administration of Human Resource and defnes the terms and conditions of service of all staff under the employment of the Council.

“The new structure couldn’t have come at a better time. The changes that come with it will ensure facilitation of the Council’s objectives through proper coordination, enhance synergy between directorates and eliminate duplication of work,” she said.

In the policy, the Council proposes reorganization into six departments and 4 stand-alone divisions, and staff establishment of 228 officers.

The departments will be: Training and Quality Assurance, Registration and Licensing, Compliance, Regulatory Affairs, Human Resource and Administration as well as Finance.

However, the Council’s Human Resource Manager, John Mburu notes that a review of its organizational structure will have financial implications occasioned by the proposed optimal staffing numbers.

“To enable the Council contain the resultant expenditure on personnel emoluments, we have recommended that the optimal staffing levels be implemented in a phased out manner,” said Mburu.

KMPDC draws its legal existence from the Medical Practitioners and Dentists Act (CAP 253) Laws of Kenya, with a mandate to regulate training, practice and licensing of medicine and dentistry and healthcare institutions that include private and mission hospitals, medical, dental centers and clinics, nursing and maternity homes and standalone funeral homes.

The training mandate, according to the new structure, will he handled by the Education, Training and Quality Assurance Department, to be headed by a Director.

“The functions of the department will entail establishing and maintaining uniform norms and standards of the learning of medicine and dentistry in Kenya. This also includes approving and registering medical and dental schools, maintain a record of medical and dental students, conducting internship qualifying exams as well as accrediting new and existing institutions for medical and dental internship,” said Dr Kitulu.

Headed by a Director, the Compliance Department will carry out regular inspections, carry out pre-registration and participate in the development of minimum requirements on infrastructure, personnel and service provision.

It is recommended that the department be organized into two divisions; accreditation and inspectorate, each headed by a Deputy Director.

The Regulatory Affairs Department will be tasked with determining and setting a framework for professional practice of medical and dental practitioners. The functions also include regulating health institutions and taking disciplinary action for any form of misconduct by a health institution.

It is recommended that the department headed by a Director and organized into two subdivision, standards and complaints handling, each headed by a deputy director.

The Human Resource and Administration Department will be responsible for providing strategic leadership and coordination of human resource while the Finance and Planning Department will ensure effective financial management.

Four standalone divisions; Corporate Communication, Supply Chain Management, Corporate Secretary and Internal Audit, will offer support services.

Mburu says the reorganization of the Council structure aims at improving service delivery and will go a long way in ensuring proper guidelines for grading of staff and their career progression. This focuses mainly on promotions and re-designations.

KMPDC PRESS RELEASE ON SHALOM HOSPITAL MACHAKOS COUNTY, SAT. 27th JUNE, 2020

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