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Best Practice in Treating Kidney Disease



Date: February 5,2015
Submitter’s Name:  Shem Sam

Sector/Committee Name: Health and Biotechnology Committee

 County:  47 counties of Kenya

Brief Description of the Practice: 
Managing Kidney Disease
County governments initiated increased access to Kidney disease treatment services. Initially, all level 3 and 2 and one hospitals did not have dialysis machines. To fill this gap, county governments in partnership with private sector and development partners acquired 51 machines and trained staff on their use.   The objectives were:
1.    To reduce cost of dialyses from KES 13,500 to KES 4,500 for all the required three sessions.
2.    To relieve KNH of referral burden
3.    Make dialysis services available at local levels.

Why the practice was used:
The Ministry of Health  (2012) estimated that one million Kenyans suffer from kidney related diseases and 10,000 cases are diagnosed annually. In addition, the WHO estimates that one in every five men and one in every four women in Kenya aged between 65 and 74 have chronic kidney disease.
Before this intervention, Kenyatta National Hospital (KNH) received 150 referral cases monthly and performed 30 kidney transplants annually at a cost of KES 2,000,000 per operation.  During that period KNH had only one nephrologist (kidney specialist): much lower than required 20 specialists, in line with Vision 2030. In 2012, the country had 200 dialysis machines but only 13 of them were in operation. The cost of dialysis per session was KES13, 000 that was unaffordable for patients. There was need to reduce the cost and increase access.
 Benefits of the practice:

Decline in Referral Cases: As a result of governors’ intervention, KNH has registered decline in numbers of patients seeking kidney dialysis. The decline is attributed to dialysis machines acquired by level 5 and 3 hospitals in the counties. 
Reduced cost of dialysis: Counties have not only acquired the dialysis machines but also subsidized the cost of dialysis by from KES13, 000 to Ksh4, 500. As such the number of kidney patients referred to KNH has reduced by half, that is, from 150 to below 75 cases monthly. Basically, current referral cases require more specialized treatment.
Today counties have a capacity of 944 dialysis sessions per day whereas the KNH and Moi Referral Hospital are capable 72 sessions.

Interesting Fact:  45 % of kidney patients referred to KNH before 2013 come from Nyeri and Kisii Counties.

Challenges associated with the practice:

•    The dialysis machines are expensive given the limited resources associated with each devolved function. To overcome this, counties forged partnership with both private sector and development partners.
•    Technical Staff: Operating dialysis equipment required highly skilled staff who were not available at the level 3 and some level 5 hospitals at the beginning of this initiative. The counties have reached agreement with teaching and referral hospitals to fill this gap.

How the success of the Practice was measured:

The success of the initiative was measured in terms of numbers in relation to:
1.    Access to dialysis and other kidney treatment services
2.    Reduced cost of treatment.
3.    Reduction in referral cases.

The COG Chairman

H E Nanok

His Excellency Josphat Koli Nanok,  Governor Turkana County and the Chairman of the Council of Governors.


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