After so many years of OHS in
Kenya, what has slowed us
down?
S.W.O. Ogendo
Cardiac Surgery (World)
4000
cardiac
surgery
units
worldwide
Surgeries per
million and
units per
million
08/04/2015
(Reproduced from Unger F. Worldwide survey on cardiac interventions 1995. Cor Europaeum. 1999;7:128-46; )
Countries able to offer cardiac surgery
• Algeria
• Botswana
• Burkina-Faso
• Cameroon
• Egypt
• Eretria
• Ethiopia
• Ghana
• Ivory Coast
• Kenya
• Libya
• Mauritania
• Mauritius
Countries able to offer cardiac surgery
Morocco
 Mozambique
 Namibia
 Nigeria
 Rwanda
 S. Africa
 Senegal

Sudan
 Tanzania
 Tunisia
 Uganda
 Zambia
 Zimbabwe


TOTAL = 26
Countries without ongoing resident
programmes. Visiting teams

Botswana (Mauritian team)

Burkina Faso (French team)

Rwanda
(American, Australian)

Zambia
(Mutima)

Eritrea
(Switzerland, Italian and German)
Countries not hosting visiting teams
• South Africa
• Sudan
• ?Egypt
Commencement of cardiac surgery
S. Africa
Egypt
Ghana
Kenya
Nigeria
Sudan
Ivory Coast
Mauritius
Zimbabwe
Senegal
Mozambique
Mauritania
Ethiopia
Eritrea
Rwanda
Uganda
1958
1963
1964
1973
1974
1977
1978
1984
1988
1995
1998
2002
2003
2004
2006
2007
Cameroon
2009
Burkina-Faso
2010
Namibia
2010
Botswana
2011
Zambia
2011
Algeria
Unknown
Libya
Unknown
Morocco
Unknown
Tunisia
Unknown
Distribution of facilities
Egypt
S. Africa
Nigeria
Tunisia
Libya
Morocco
Sudan
Kenya
Algeria
Tanzania
Ivory Coast
Mauritius
Namibia
Uganda
48
30**
9
11
7
7
7
7
3**
3
2
2
2
2
Zambia
2
Botswana
1
Burkina-Faso
1
Cameroon
1
Ghana
1
Mauritania
1
Mozambique
1
Rwanda
1
Senegal
1
Zimbabwe
1
Eritrea
1
Ethiopia
1
08/04/2015
Surgical output in Africa
Country
Algeria
Botswana
Burkina-Faso
Cameroon
Egypt
Eritrea
Ethiopia
Number
facilities
15
1
1
1
48
1
1
Cardiac
surgeons
35
0
0
100
0
2
Operative
numbers/year
3000
2
100
0
16000
60
40
Ghana
Ivory Coast
Kenya
Libya
Mauritania
Mauritius
Morocco
Mozambique
Namibia
1
2
4
7
1
2
10
1
2
6
7
11
10
0
2
10
1
2
100
250
250
0
30
500
500
50
10
Nigeria
Rwanda
S. Africa
Senegal
Sudan
Tanzania
Tunisia
Uganda
Zambia
Zimbabwe
9
1
30
1
5
3
13
2
2
2
TOTAL
166
15
0
120
5
17
7
80
3
0
1
397 (933
CSTnet)
12
60
12,000
40
2000
105
2500
50
10
0
37,669
Cardiac surgery
capacity in Africa.
Yankah et. al
History cardiac surgery Kenya
• KNH
- 1973
• Karen
hypothermia
• KNH
- 1975
CPB machine
• Nairobi Hospital
- 1993
• Mater Hospital
- 1996
08/04/2015
• Aga Khan
• Tenwek
• Mombasa (AGK)*
- 2003
Series 1 = KNH, 2 = Nairobi Hospital and 3 =
Mater Hospital (2003)
08/04/2015
KHN figures last 10 years
160
140
120
100
80
60
40
20
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Surgeries Per Population (?Needs)
400.000
350.000
300.000
250.000
200.000
150.000
100.000
50.000
0.000
Average for Africa
What are the positive improvements?
Access to service
•Overall greater availability of cardiac services
•Wider distribution in country
•More personnel available
•Skills transfer
infrastructure
Training
• Training programme for surgeons ongoing
• Return of surgeons from outside the country
• Nursing staff
Challenges/obstacles
• Decision to start a programme
Training challenges
• Nursing and other support staff for programme
• Support units must keep pace training opportunities
• Accreditation
Training Challenges (cont)
•
Cross institution/border corporation (low)
 Training
 Skills
programmes
mix
•
Public private collaborations
•
Government prioritisation of training needs
Equipment challenges
• Lack of front line equipment.
• Maintenance of equipment
• Replacement of equipment
• (Inappropriate) Equipment donations
Financing challenges
• More private institutions
• Public institution more into cost sharing
• Down sizing of cardiac allocation in public institution
• Donor inclusion into programme
• Agenda maybe different
Treatment options outside Kenya
• Challenge as patients go out (e.g. India and South Africa)
Collective Effect of Challenges on Cardiac
Surgery Services
Nigeria: 1974 – 2000.
Tex Heart Inst J. 2007; 34(1): 8–1
Kenya: Authors personal database
Management
• Personnel
• Equipment
• Finances
• Audit
Audit and research
• Audit and value (Operational research studies)
• Research collaborations
Addressing Challenges

Funding

Training

Sustainability plans

Collaborations
Mmed training programmes in Africa
 South
Africa. Universities of;
 Cape
Town
 Stellenbosch
 KwaZulu-Natal
 Witwatersrand
 Pretoria
 Medunsa
 Free State
• Ethiopia
• Ghana
• Kenya
Way Forward
• Better manage what we have
• Improve services by address challenges
• Technology transfer
• Vertical
• Horizontal
• Government support
• Community confidence