An issue in Kenya

A few months ago, we detected an increase in no-show patients at one of the hospitals that provides healthcare to Watsi patients in Kenya. The patients who failed to show up for treatment all needed the same surgery, a total abdominal hysterectomy, and had all been seen by the same doctor.

This anomaly was suspicious, so we asked our implementing partners on the ground, African Mission Healthcare Foundation (AMHF) and Hospital Support Organization (HSO), to investigate the situation. Because Watsi is committed to total transparency, it is important that we share the results.

AMHF and HSO’s teams reached out to all 119 Watsi patients who had ever received total abdominal hysterectomies with that doctor. Their findings were concerning. Of the 65 patients who were successfully reached, the majority reported no irregularities in their experience. But several gave us reason to believe that the doctor had asked them for a bribe -- outside of the formal hospital system, and despite the fact that they’d already been offered free care by Watsi.

With reason to believe that Watsi patients had been asked to pay bribes, we paused our partnership with the hospital. The hospital’s management completed its own independent investigation, confirming that the doctor had indeed been asking patients for bribes outside of their system and pocketing the money for himself.

The hospital fired the doctor and they are taking steps to make their systems less vulnerable to fraud moving forward. However, the hospital will remain paused on Watsi until we’re able to evaluate the success of the improvements they’ve made, and provide them with the operational support they need to scale back up successfully.

While this situation was difficult, it was also an opportunity for us to strengthen our due diligence policies and double down on what’s working in a couple of ways:

1. Our system’s ability to detect a spike in no-show patients was what tipped us off to something being wrong in the first place. This underscored the opportunity for us to expand the system to detect a wider range of other anomalies that could indicate problems. As a result, we’re continuing to invest in monitoring programs that will enable early detection of inappropriate activity at scale.

2. Our ability to immediately send two Watsi team members to Kenya to investigate the situation in person was crucial to our response. But it was reactive. In an effort to be more proactive, we're launching an inaugural class of Watsi fellows who will work alongside our medical partners on the ground to identify issues early on.

3. Our ability to contact individual patients and verify details of their experience helped us get to the bottom of the incident quickly. But it also highlighted the fact that we should be auditing on the provider and patient level more often. In response, we’re launching more frequent random audits to maintain an open channel of communication between Watsi and every individual involved in the process of care.

You can read an overview of our updated due diligence policies here.

We’ve personally notified donors who supported patients we believe may have been affected by this incident. But because Watsi is dedicated to complete transparency, it is important that we share this information publicly as well. If you have any questions, please feel free to email me directly at dan@watsi.org.