In April, King Faisal Hospital’s management changed when the Government terminated a contract with Oshen Healthcare, which had been running the institution for the last two years. The hospital is now under new management, appointed in April. Dr Edgar Kalimba is now the Acting Chief Executive Officer. Dr Kalimba, a paediatrician, brings onboard a wide range of expertise. The New Times’ Collins Mwai spoke to him on a number of issues in regard to the facility, including termination of the previous contract, the extent of depreciation, current challenges and way forward. Excerpts: What led the Government to terminate the contract with Oshen Healthcare? On April 2, the Government terminated the agreement with the former management, Oshen Healthcare Rwanda, which had been managing operations and was supposed to invest in the institution. The reason the Government, which is 100 per cent shareholder of the facility, privatised and handed the hospital to a private investor was to ease investment considering that government has many priorities. Healthcare often needs a lot of investment and so to achieve that goal quicker, they decided to give it to a private investor, Oshen Healthcare Rwanda. The concession agreement to manage, operate and invest has been in effect since the beginning of 2017. The main reason why the Government terminated the agreement was because the size of investment was not in line with the agreement. The King Faisal Hospital in Kigal. / Net photo After two years, the Government realised that the agreed amount of investment was not honoured, which slowed the process of improving quality. What government has done is to terminate (the contract), and management has gone back to King Faisal Hospital. That is how we got appointed. When Oshen took over, there was a commitment to invest about Euro 21 million in five years. By the time of termination of the contract, how much had been invested? I do not have the exact figures and in fact, we have a team of auditors currently looking into it. What we have for now is a provisional handover. This means we have transferred employee contracts to the new management, we have done inventory of the stock, drugs, consumables, and assets (fixed and movable). That has been handed over to the new management. The financials are being looked at because, as you know, a hospital is a unique kind of business. A majority of payments are through insurance and it takes about 60 days to reconcile payments; there is a lot of things that need to be reconciled. After that it’s when we can know the financial position, how much was invested, how much are the liabilities among other aspects. As someone who was working with the hospital at the time, what do you think went wrong? I would not know the reasons why the investment delayed, it was being run by the management of Oshen. They said that it was not beyond their capacity but it was delaying. However, during that two-year period, we have patients who need care and the Government could not wait longer. Among the changes that the former management made was to terminate contracts of about 70 employees, which led to concerns of hospital’s ability to deliver services. Will you be rehiring? What happened is that when Oshen came in and terminated a couple of contracts of employees, it was based on the numbers they were given. We are a hospital that has got about 160 beds, we have got a certain occupancy rate; they looked at those statistics and said that we need this number of employees. A lot of things have happened over the two years. Activity in terms of patient numbers has increased significantly and by the time Oshen got their contract terminated, they had gone to almost the same number of employees because there were more patients. As it stands now, it’s something we are looking into. If you are asking if we are going to be doing a massive termination or massive hiring, neither of the two. We feel that we have got a reasonable number of employees and depending on activity and the need, we might be hiring more people based on the gaps. By and large, we are fairly well staffed. From my interaction with some members of your staff, there are multiple issues ranging from staff motivation, terms of engagement, challenges of equipment to facilities hindering ability to deliver among others. What’s your approach in adressing these issues? When we talk about staff motivation, there are lots of things in there. Hospitals are a unique kind of work, they work every day, 24 hours a day. That means that there is a lot of demand on personnel in terms of working hours and the quality of what they deliver. There are some concerns in terms of staff motivation. On May 1, we had an exercise where we organised group discussions with all the employees of the hospital and a lot has been discussed in terms of how to improve the quality of services, how to we build a team and how do we motivate each other. And a lot of good ideas came up and we have begun working on some of them and whatever concerns are there are going to be addressed in a methodical manner. Over the last two years, there are many patients who cited unpleasant experiences at King Faisal and others avoided it because of poor services. Do you think you can regain public confidence? The first thing is to reassure people in Rwanda that we will do all possible to ensure the best quality of service and accessibility. We have already started doing this and we will give it priority and attention. There are strategies and partnerships to ensure that we continue to develop going forward. We want to reduce the necessity of Rwandans going abroad for treatment. This means that we will build the necessary capacities, have the right skills and equipment. It’s a work in progress. We ask patients and clients to provide feedback on services for us to be able to know where to improve better. It’s clear that you are going to need a lot of financial resources going forward to fix most of the challenges. What’s your preferred option, seeking loans? Investment partners? When we look at resources and areas that need investment, I can put it into three categories. The first area is skill and competences and the number of highly specialised doctors.That needs investment, which as a hospital we will be able to do on our own. The second aspect is in terms of equipment. As you know, and would expect, for a private facility like this, we need investment in biomedical equipment every five years. This means that if we bought a CT scan, so much has happened in five years in terms of improving diagnostic capacities, what you have is probably not up to current expectations. These equipment are very expensive. MRI and CT scan go up to $2 million. This means that every five years, you have to invest in equipment. Then there is infrastructure, the facility itself, the number of beds, the installations, which need a major investment every 10 years or so. The good thing is that some of the work has been done by government and we will be looking to see how we can build on that. We have all the support we need and are looking at what is the most sustainable way to bring investment onboard. Healthcare in a country like Rwanda is complex in the sense that we want quality, we need to invest so much money. But again we have to make sure that it is accessible to the ordinary citizens. We already have some available investment through the Government and other partners and are looking at other partners as well. Insurance is often a challenge in healthcare in Rwanda due to the low level of development of the sector, terms of engagement, among others factors. What are your thoughts on this? We are always trying to have productive conversation with insurance companies and have got good collaborative experiences and we meet often. As new management, we are going to be looking at that and are going to be looking at the terms. The goal is to make sure that they accompany us in providing services to patients with care. During the tenure of the previous management, among the priorities was to become a regional medical tourism destination. However, the facility is yet to fully serve the needs of Rwandans. Are you going to revise the ambition? I do not think it’s a case of either-or, it’s actually both. Like you said, the vision stays the same, being a centre of excellence in healthcare and educational research. Being an excellent facility and regional hospital. Our first catchment area is people in Rwanda, that is still the focus. We are already laying down strategies and action plans in leveraging the vision of being a regional hub as well. That is still on the table, we are working on both at the same time. There is a lot that has been done by government we already have patients from some countries where RwandAir flies to. We have patients from DR Congo, Burundi, Uganda and other parts of Africa. We are positioning ourselves in line with that. We are preparing to set up an international office that will handle patients and make it easy to be in contact with the hospital before they travel and make sure they get appropriate support. When such change of management happens, there is often scepticism by suppliers and creditors. How is it going for you? That is in two ways, one is how we communicate to our partners. There is always concern when such things happen, how the business works is that it takes about 60 days for insurance firms to pay us. That means that consumables are paid about a month or two after. At any given point, we have debts owed to us and we have debts that we owe to suppliers. For suppliers, there is always concern of the fate of the agreements during the management changes, we have managed that and communicated with all suppliers. The terms have been reviewed and not changed, they will continue to supply us with drugs and consumables, and we committed to paying them as required. The full handover has not yet happened till audit is completed. We have not had any major issues going forward. The facility has been said to lack enough specialists across various departments. How will you bridge this gap? At the moment, we have 83 medical doctors, full-time and part-time. We are looking at building the team further. There is a team of local specialists that we want to bring onboard. In terms of specific skills that we may not have in Rwanda, we have many partners who are very keen to partner with us. We are looking at partnerships with large Indian groups who have specialties in many areas and we have been talking to them. There are many hospitals in India, Turkey and Europe who we are looking at partnering with and getting specialists from, many times when we do this, they will not only provide care but also skills transfer. What is your expectation and request from stakeholders in your line of work, from government, to insurers, to suppliers? My request would be that we are in healthcare business, we are dealing with people’s lives that should be at the forefront of what we are thinking. Whatever we are doing, the patient should come first. They need accessibility and quality. Our goal should be to make sure that the patient gets taken in the best possible way and that has a deeper definition. editor@newtimesrwanda.com
