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September 23, 2019
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Nursing Experience on Universal Health Coverage at Moi Teaching & Referral Hospital (MTRH) Eldoret

Universal Health Coverage (UHC) aims to ensure communities get effective promotive, preventive, curative, rehabilitative and palliative care of sufficient quality with no financial harm in the course of the process. The path towards UHC implies addressing the gaps in healthcare provider competency, quality of care provided, motivation of health workers, optimal productivity and performance of the Human Resources for Health (HRH).

Nurses constitute the majority of the HRH; hence play a major role towards realization of UHC and achievement of good patient outcomes. The nurse to patient ratio in the population varies from 9.7 nurses in urban areas to 0.1 nurses in arid areas per 10,000 citizens in Kenya. Equally the recommended WHO nurse to patient ratio has not been attained in most health facilities.

MTRH Directorate of Nursing is organized to ensure round the clock provision of care by the Director Nursing Services during the day and the Night Superintendents at night. 

MTRH has empowered Nurses through interdisciplinary, multi-professional teams and a strong leadership, which empowers the nurses by having clear role clarification, job descriptions and professional recognition. The Hospital is continually aiming at improving nursing workforce and patient outcomes by encouraging specialization and implementing a positive work environment for motivation and retention of nurses.

The varied disease conditions managed at MTRH has necessitated nurse specialization training in cancer nursing, renal nursing, theatre nursing, and intensive care nursing among others at the MTRH College of Health Sciences. The trainings provided have enabled nurses upon qualification to actively participate in multidisciplinary health care teams in various Centres of Excellence in MTRH.

MTRH Nurses Simulation Centre was commissioned in April 2018 to enhance nurses’ skills and competency by providing a conducive environment for simulated sessions that enhance positive health-caring model. Clinical Nurse Educators mentor nurses to ensure gaps between knowledge and practice are bridged with emphasis on implementation of Nursing Research Evidence.

Midwives at Riley Mother and Baby Hospital provide Post-Partum Intra Uterine Devices (PPIUD) to offer contraception options for parents immediately after delivery. This ensures desired family size is achieved and prevents unintended pregnancies.

Kangaroo Mother Care (KMC), established 2017 in MTRH, has improved survival of premature babies. Premature births are associated with various chronic conditions like multiple births, diabetes, and hypertension though more than 50% is unexplained. KMC ensures that these premature babies are kept in contact with the mother/father skin as long as possible for purposes of bonding, better temperature regulation, faster weight gain and normal development. There has been 100 % discharge rate of live and healthy babies since inception of KMC at the institution with minimal financial costs to the families.

MTRH has embarked on improving quality of life of patients suffering from chronic wounds. This is by establishing wound care services aimed at identifying/treating underlying chronic wound causes, addressing patient-centered concerns, providing local wound care as well as use of modern wound care modalities in a multidisciplinary team approach. This has seen patients recovering from longstanding diabetic, venous ulcer and traumatic wounds for more than a decade.

With the increase in Cancer and and other Chronic Non-Communicable Diseases, MTRH has initiated Ostomy services (various forms of gastro-intestinal functioning diversions) where nurses provide education, coping strategies and ostomy services to patients having colostomies, ileostomies and urostomies.

MTRH Clinical Audit Department reviews the patient care provided to ensure expected standards are achieved. Feedback to lower level referring facilities often leads to improvement in quality of healthcare they provide to the citizens.

In the match to UHC, various MTRH departments conduct Outreach programmes to ensure provision of quality care to the grassroot within Western, North Rift and South Rift regions. An efficient Referral system coordinated by the Nurse Manager, Referrals Desk ensures prompt communication and transition of care from all referring health facilities within our catchment area.

MTRH has collaborated with Linkoping University in Sweden to ensure reduction of harm associated with care provision cognizant of the finding by WHO in 2012 that 1 in 10 Patients are harmed whilst receiving care where patient harm is the 14th leading cause of global disease burden. The Patient Safety Committee does root cause analysis to identify care provision gaps and propose recommendations to ensure better patient outcomes are realized.

MTRH aims to meet patient-centered concerns along healthcare provision for optimal customer satisfaction. The recent appointment of a Nurse Manager, Customer Relations by MTRH Chief Executive Officer has seen enhanced patients’, clients’ and relatives’ understanding of their healthcare processes and prompt resolution of complaints.

All these activities in MTRH are geared towards empowering citizens with disease prevention information, early recognition of disease signs and symptoms, improvement of citizens’ health-seeking behavior as well as provision of quality care, improved patient experience and outcomes at affordable costs appropriate to UHC. However, this has been compounded by increased nursing workload due to high bed occupancy at the institution, which can be alleviated by improving functioning of county health facilities along the various levels of hospitals.

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