Name: - Sneha Merani

Roll no: - 18
1. What value did Kijabe Hospital bring to the country, the region, and the global
surgery field?
1. In 2010, Kijabe Hospital provided health services over a 50-kilometer
catchment area, including Kiambu, Nakuru, and Nyadarua, where a
combined population of over 2.8 million people lived.
2. Due to the ongoing conflict in Somalia, the hospital served as the primary
referral center for four AIC hospitals and over 50 rural clinics. In fact, over
20% of hospital patients were Somali refugees living in refugee camps for in
Nairobi's Mogadishu neighborhood.
3. In 2005, Kijabe Hospital opened a five-bed Intensive Care Unit (ICU), in
addition to an isolation and a pediatric ward.
4. There were 1,347 patients treated in the ICU between 2005 and 2008, a
quarter of whom were children. Half of these patients underwent major
surgery, with 77% surviving to discharge.
5. It was the vision of hospital leadership that developing competent,
compassionate healthcare providers could further God's work in rural Kenya
and elsewhere. Kijabe Hospital has developed a multilayered medical
education program for Kenyans and others, including undergraduate
electives and internships as well as educational programs in nursing,
professional development, and research.
6. Leaders sought to encourage students to work in rural Africa by exposing
them to high-functioning rural hospitals in East Africa and helping them
understand the nuance of contextual practice there. Most of the teachers
were expatriates.
7. Established in 1980, Kijabe School of Nursing trained 50-60 registered
nurses every year. A KRNA program, as well as online continuing nursing
education credits, were offered. Until 2006, there was only one KRNA
training program in Kenya, training 15 students per year. Almost all KRNAs
were placed in the rural areas of Kenya. Other certificate programs were also
available, including a month-long intensive care unit certificate program.
8. From the 1990s until the present, Kijabe Hospital offered one-year
internship programs as well as clinical officer positions for new Kenyan
 medical school graduates through the Christian Health Association of
Kenya. In addition, it participated in a transitional internship training
program for South Sudanese physicians, the majority of whom were
returning to South Sudan after the country's independence.
9. The Pan-African Academy of Christian Surgeons (PAACS), a Christian
organization training general surgeons at eight hospitals throughout Africa
since 2003, has partnered with Kijabe Hospital to offer surgery residency
training accredited by COSECSA, which has been running the program
since 2008.
10. According to Dr. Rich Davis, the director of the surgery residency program
at Kijabe Hospital, PAACS is dedicated to finding residents who are willing
to be missionaries within their own countries rather than open boutique
plastic surgery practices in Nairobi. It's probably best to look for people like
that who are committed to their faith and to serving people without access to
care.
11.With a similar apprenticeship model to western countries, the PAACS
training model focused on clinical skills. In addition to free housing, books,
and internet, residents received a stipend of USD 15,000 to cover basic
living expenses for their families. The PAACS program in Kenya was the
first to train women. There were only two women surgeons practicing in
Kenya before.
12.Davis aimed to accept one resident per year, depending on PAACS funding
and housing availability. In order to train highly competent "African
surgeons," who could provide essential surgical care anywhere, he
incorporated basic orthopedic and urologic surgical care into the US surgical
residency curriculum.
13.A number of PAACS graduates worked in remote areas where surgery
would not otherwise be available, which led to the program's success.
Surgical residents from the US and UK went to Africa to "gain perspectives
on global surgery" and learn about the provision of care in a low-income
environment with limited resources. The Kijabe Hospital created the first
pediatric surgery fellowship program in East Africa in 2007, supported by
the PAACS and the COSECSA along with the only pediatric neurosurgery
training in the East, conducted in partnership with Bethany Kids and the
University of Nairobi with private foundation funding.
2. How did the hospital’s mission affect the strategy and its metrics for success?
Ans:- Free care was provided to the poorest patients. A hospital discharge planner
determines whether a patient is unable to pay on a case-by-case basis after
interviewing the family and the chief of the patient's community. Several
externally supported programs (BethanyKids, AIDS-Relief, etc.) also provided free
health care.
Kijabe's mission was supported in large part by churches and individuals who
believed in it. The church decided to raise USD 30,000+ for the ICU during their
Christmas offering weekend," said Newton.
In 2010, Collins Muiruri, who had studied mechanical engineering and business in
the U.S., was appointed head of hospital engineering and facilities. In mission
hospitals, doctors are sometimes responsible for everything from finance to human
resources.
The idea of developing a premium-based model (where there were more
conveniences such as shorter wait times, improved amenities like private rooms,
improved customer service) didn't make sense and was doomed to fail since patient
care was low-cost and affordable since long. Its success was hindered by this.
As a result, there was a potential conflict between the hospital's mission and values
to provide affordable healthcare to the poor and to create sustainable growth
measures.

3. What were the challenges Kijabe faced as it grew?

Ans:- In the United States, doctors learned to balance optimal care and reasonable
costs-a practice unknown to most expats. Patient monitoring, such as pulse
oximetry or non-invasive blood pressure monitoring, was also relatively
inexpensive and could be highly beneficial.10 The ICU also used less expensive
interventions such as rapid fluid resuscitation, early antibiotic treatment, and early
monitoring.
There was a rapid turnover of nursing graduates at Kijabe Hospital. The Nairobi
private hospitals that paid more often recruited Kijabe-trained ICU nurses. After
two months of intensive training, only five nurses remained at the hospital one year
after the ICU opened.
Slow bed turnover was still a problem after the expansion. Fees increased as a
result of more detailed cost accounting. Despite being medically ready for
discharge, patients remained on the floor because they lacked the funds to pay.
With so many occupied beds, it was difficult for the operating room to complete
daily cases, and waiting times for admissions could be two days. Rearranging some
office space and hallways had already optimized the space in terms of bed
capacity.
The salaries of local staff were not competitive with those in the private or public
sectors. Kijabe Hospital did not change its salary scale when the Kenyan
Constitution guaranteed government salaries would match those of the private
sector. Those who just started working at Kijabe Hospital earned USD 325 per
month as diploma-level nurses and advanced-degree nurses. Outside Kijabe
Hospital, the same positions earned USD 470 per month and USD 584 - 701 per
month, respectively. Medical officers at Kijabe Hospital were paid about USD
1,750 per month, while officials at government hospitals were paid USD 2,340. A
consultant's earnings outside Kijabe Hospital were a third as much.