A

COLLECTIVE BARGAINING AGREEMENT BETWEEN MOI TEACHING AND REFERRAL HOSPITAL PRIVATE WINGS
(HEREINAFTER REFERED TO AS THE HOSPITAL) AND

KENYA MEDICAL PRACTITIONERS, PHARMACISTS & DENTISTS UNION (KMPDU)

(HEREINAFTER REFERED TO AS THE UNION)

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TABLE OF CONTENTS
DEFINITION OF TERMS...............................................................3 ARTICLE I: TERMS OF AGREEMENT..............................................4
A: Preamble..................................................................................4 B. Effective Date and Duration of Agreement..................................4 C: Waiver Clause...........................................................................4 D: Severability Clause...................................................................4 E: Prohibition of unilateral action...................................................4 G: Dispute resolution....................................................................5 H: Labour Management Committee................................................5

ARTICLE II: PRACTICING/ADMISSION RIGHTS...............................6 ARTICLE III: COMPENSATION......................................................7

A: General....................................................................................7 B: Professional Fees: Medical Doctors............................................8 C: Professional Fees: Dentists......................................................10

ARTICLE IV: WORKING CONDITIONS..........................................13

A: Call rota.................................................................................13 B: Support services.....................................................................13

ARTICLE V: GRIEVANCE AND ARBITRATION................................14

A. Basic principles......................................................................14 B. Procedure..............................................................................14

ARTICLE VI: WITHDRAWAL OF PRACTICING/ADMISSION RIGHTS . 16

A. Basic principles......................................................................16 B. Withdrawal of Admission Rights...............................................16

SIGNATURES...........................................................................17 APPENDIX A: RECORDS SYSTEM...............................................19 APPENDIX B: FEES BY SPECIALTY.............................................21

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DEFINITION OF TERMS
Doctor Any holder of the following degrees MBChB, BPharm, BDS, or their equivalents as recognised by the Kenya Medical Practitioners and Dentists Board. A doctor who in addition is a holder of an MMed or MDS degree, COSECSA fellowship or their equivalents. Any aggrieved member of the Union or group of members of the Union similarly affected The person or persons designated by the grievant as his or her counsel to act in his or her behalf.

Medical/Dental Specialist/Consultant Grievant Representative

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ARTICLE I: TERMS OF AGREEMENT

A: Preamble
The parties to this agreement, meeting together in free and voluntary association have determined to regulate the relations between them in the interest of promotion of sound industrial relations, the economic well being of the service industry, its workers and employer. In order to achieve these objectives they have agreed to enter into the following Common Agreement freely and voluntarily negotiated between them and the joint negotiating committee.

B. Effective Date and Duration of Agreement

This agreement shall supersede all provisions of Agreements between the parties and shall be effective from ................................... 2012, and shall remain in force until renewed or amended for a period of two years. The Union shall submit its proposals for the next negotiation to the Hospital not less than 90 days before the expiry of the existing CBA.

C: Waiver Clause
Regardless of any procedure set forth in this agreement, the signatory parties may mutually agree upon any method for achieving goals; or resolving any question, controversy, claim or matter of difference related to this agreement or the performance or breach of any part thereof. No action taken under the provisions of this section shall constitute a past practice for future negotiations.

D: Severability Clause
Any provision inconsistent with or contrary to law shall be considered as deleted from the Agreement without harm to the remaining provisions of the Agreement. If any section of this Agreement or any addendum to it is held invalid by operation of law or by any tribunal of competent jurisdiction, or if compliance with or enforcement of any section is restrained by such tribunal, the remainder of this Agreement shall not be affected thereby, and the parties shall enter into immediate negotiations for the purpose of arriving at a mutually satisfactory replacement for such section.

E: Prohibition of unilateral action

No party shall amend any part of this agreement without consultation with the other party to reach a consensus.
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G: Dispute resolution
In case of a dispute in the interpretation, application or execution of this agreement, the labour management committee shall meet to seek an agreement failure to which channels of dispute resolution shall be followed as described in the Labour Laws of Kenya.

H: Labour Management Committee

A committee is established through this Agreement composed of three members from the Hospital and three members from the Union. This committee shall be convened by either party in any dispute in the interpretation, application or execution of this Agreement. In resolution of a dispute, the Committee shall be guided by the procedures outlined in Article V. The committee shall also meet once every three months to appraise the Agreement and discuss any outstanding issues.

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ARTICLE II: PRACTICING/ADMISSION RIGHTS

i. All doctors have the right to practice and/or admit at the Hospital subject to the guidelines set by the Labour Management Committee or its subcommittee ii. The Labour Management Committee or its subcommittee shall be tasked with setting out guidelines on determining what doctors are allowed to practice and admit at the Hospital.

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ARTICLE III: COMPENSATION

A: General
i. All consultations, reviews, ward rounds/visits and procedures shall be recorded in a way that a copy is availed to the concerned doctor with other copies being kept by the Hospital. Refer to Appendix A. ii. All payments for consultations, reviews, ward rounds/visits and procedures shall be paid to the concerned doctor within twenty four (24) hours of discharge of the patient for the cash-paying clients; for the corporate clients (paid for by insurance companies, HMOs or other organizations) the invoices shall be prepared within twenty four (24) hours of discharge and the bills settled within thirty (30) days of the date of the invoice. iii. All payments shall be made directly to the concerned doctor. iv. No figures in respect to payments due to a doctor shall be changed or varied to the disadvantage of a doctor without his/her consent. v. The concerned doctor shall be responsible for remitting relevant taxes due to the payments according to the taxation laws of the country. vi. In general, compensation for work done shall be based on time spent, effort expended and the level of skill required. vii. The figures indicated below and in the appendix are the net amounts payable to the doctor viii. For surgical procedures, the surgeon is paid in full the amount stated. The assistant to the surgeon, if another specialist, shall be paid 50% of the surgeons fee; if a medical officer/registrar, shall be paid 10% of the surgeons fee. In case the surgeon asks for another surgeon to come in to offer expert assistance for the surgical operation, that surgeon will be paid in full for the procedure he/she is coming to perform. ix. Anaesthesiologists shall be paid according to the nature of the procedure, duration of anaesthetic and other additional factors that include: the patients age, general state of health, the use of specialized monitoring techniques and the use of nerve blocks for post-operative pain relief. Refer to Appendix B. x. Pathologists shall be paid for interpreting, reading or signing out diagnostic pathologic tests at a rate of 40% of the cost of the test. For tests in which they perform a procedure, they shall be paid 100% of the fee stipulated in Appendix B.
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xi. Radiologists shall be paid for interpreting or reading imaging diagnostic radiological tests at a rate of 35% of the cost of the test. For interventional/procedural tests, they shall be paid for performing the intervention/procedure at a rate of 50% of the cost of the test. Refer to Appendix B.

B: Professional Fees: Medical Doctors

1. Consultations a. General Practitioners i. Cash paying First visit Subsequent visits consult ii. Corporate First visit Subsequent visits consult b.Medical Specialists i. Cash paying First visit Subsequent visits consult ii. Corporate First visit Subsequent visits consult 2. Hospital visits excludes psychiatrists a. Daytime i. Cash paying General Practitioners Medical Specialists ii. Corporate General Practitioners Medical Specialists
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KSh. 1,500 per consult KSh. 1,000 per

KSh. 2,500 per consult KSh. 1,500 per

KSh. 3,000 per consult KSh. 2,000 per

KSh. 4,000 per consult KSh. 2,500 per

KSh. 1,500 per visit KSh. 2,000 per visit

KSh. 3,000 per visit KSh. 4,000 per visit

b.Night i. Cash paying General Practitioners Medical Specialists ii. Corporate General Practitioners Medical Specialists 3. House visits excludes psychiatrists a. Daytime i. Cash paying General Practitioners Medical Specialists ii. Corporate General Practitioners Medical Specialists b.Night i. Cash paying General Practitioners Medical Specialists ii. Corporate General Practitioners Medical Specialists 4. Psychiatrists i. Domiciliary visits a. Daytime Cash paying Corporate b.Night Cash paying Corporate ii. Hospital visits KSh. 8,000 per visit KSh. 10,000 per visit KSh. 5,000 per visit KSh. 7,000 per visit KSh. 4,000 per visit KSh. 8,000 per visit KSh. 3,000 per visit KSh. 5,000 per visit KSh. 3,500 per visit KSh. 5,000 per visit KSh. 2,000 per visit KSh. 3,000 per visit KSh. 4,000 per visit KSh. 6,000 per visit KSh. 2,000 per visit KSh. 3,000 per visit

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a. Daytime Cash paying Corporate b.Night Cash paying Corporate iii. Therapy sessions Psychotherapy Family therapy Marital therapy 5. Critical care services (HDU/ICU/CCU) ICU admission ICU visits 6. Medical legal issues a. General medical examination/report b. Psychiatrists medical examination/report c. Medical legal examination/report d. Court appearances session 7. Procedures/surgical operations Refer to Appendix B for details 8. Public Lecture Within town Outside town KSh. 20,000 KSh. 50,000 KSh. 5,000 KSh. 8,000 KSh. 12,000 KSh. 15,000 per KSh. 8,000 KSh. 5,000 per day KSh. 6,000 per hour KSh. 6,000 per hour KSh. 8,000 per hour KSh. 5,000 per visit KSh. 6,000 per visit KSh. 4,000 per visit KSh. 5,000 per visit

C: Professional Fees: Dentists

1. Consultations a. General Practitioners i. Cash paying First visit Subsequent visits consult ii. Corporate
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KSh. 1,500 per consult KSh. 1,000 per

First visit Subsequent visits consult b.Dental Specialists i. Cash paying First visit Subsequent visits consult ii. Corporate First visit Subsequent visits consult 2. Hospital visits a. Daytime i. Cash paying General Practitioners Dental Specialists ii. Corporate General Practitioners Dental Specialists b.Night i. Cash paying General Practitioners Dental Specialists ii. Corporate General Practitioners Dental Specialists 3. House visits a. Daytime i. Cash paying General Practitioners Dental Specialists
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KSh. 2,500 per consult KSh. 1,500 per

KSh. 3,000 per consult KSh. 2,000 per

KSh. 4,000 per consult KSh. 2,500 per

KSh. 1,500 per visit KSh. 2,000 per visit

KSh. 3,000 per visit KSh. 4,000 per visit

KSh. 2,000 per visit KSh. 3,000 per visit

KSh. 4,000 per visit KSh. 6,000 per visit

KSh. 2,000 per visit KSh. 3,000 per visit

ii. Corporate General Practitioners Dental Specialists b.Night i. Cash paying General Practitioners Dental Specialists ii. Corporate General Practitioners Dental Specialists 4. Medical legal issues a. General dental examination/report b. Dental legal examination/report c. Court appearances session 5. Procedures/surgical operations Refer to Appendix B for details 6. Public Lecture Within town Outside town KSh. 20,000 KSh. 50,000 KSh. 5,000 KSh. 12,000 KSh. 15,000 per KSh. 4,000 per visit KSh. 8,000 per visit KSh. 3,000 per visit KSh. 5,000 per visit KSh. 3,500 per visit KSh. 5,000 per visit

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ARTICLE IV: WORKING CONDITIONS

A: Call rota
i. All doctors with practicing/admission rights shall have an equal right to be in the call rota. ii. The Hospital in consultation with the doctors concerned shall develop a call rota. iii.The patient reserves the right to be seen by a doctor of their own choice. iv. In case a doctor on call or a doctor that the patient prefers is not available, the next doctor on call shall be responsible for seeing the patient.

v. A doctor reserves the right to opt out of the call list. vi. The Hospital reserves the right to summarily strike off a doctor from the call rota for a lawful cause.

B: Support services
i. The Hospital shall provide satisfactory support services in terms of nursing, physiotherapy, counselling, records, billing, lab, pharmacy, casualty/emergency room, theatre/operating room and any other relevant support ii. The Labour Management Committee or its subcommittee shall be tasked with setting out minimum standards for members of the Union to utilize facilities of the Hospital. iii.The Labour Management Committee shall also advise the Hospital in ways of improving its facilities and its income generating capabilities.

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ARTICLE V: GRIEVANCE AND ARBITRATION

A. Basic principles
i. These procedures are intended to provide for an orderly settlement of differences in a fair and equitable manner with reasonable promptness. ii. Every doctor shall have the right to present his/her grievance in accordance with the procedures provided herein, free from interference, coercion, restraint, discrimination or reprisal. iii. Each party to a grievance shall have access to all written statements and records pertaining to such case. iv. All hearings shall be confidential. v. Failure to present a grievance within twenty eight (28) days after knowledge of the act giving rise to the grievance or failure to proceed to the next step within the prescribed time limits shall be deemed a waiver of the grievance and the grievance shall abate. vi. If the Hospital shall fail at any step to comply with the required time limits, the grievant may proceed to the next step.

B. Procedure
i. STAGE ONE (Hospital Administrator/Director) a. The grievant shall present his/her grievance in writing to the Hospital Administrator/Director within 28 days after knowledge of the act giving rise to the grievance. b. The Hospital Administrator/Director shall discuss the grievance orally and informally with the grievant. The Hospital Administrator/Director shall undertake such investigations as he/she deems appropriate. c. Within seven (7) days after presentation of the grievance to him or her, the Hospital Administrator/Director shall render his or her determination in writing to the grievant. ii. STAGE TWO (Labour Management Committee) a. If the grievant is not satisfied with the decision made by the Hospital Administrator/Director, he or she may, within seven (7) days of the final determination by the Hospital Administrator/Director, make a written request to the Labour Management Committee for review and determination. All written statements and records of the case shall be submitted to the Committee.
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b. The Committee shall hold a hearing regarding the case within fourteen (14) days of receipt of the request for review by the grievant. c. The Committee shall render a decision within fourteen (14) days after its hearing. iii. STAGE THREE (Arbitration) a. If the grievant is not satisfied with the decision made by the Committee, the grievant, the Union or Hospital may, within fourteen (14) days after the decision, submit the grievance to arbitration as per the Arbitration laws of the country. b. The Arbitrator shall have no power or authority to make any decision which requires the commission of an act prohibited by law or which violates the terms of this Agreement, nor shall he/she have any power to modify or vary in any way the terms of this Agreement. c. The decision of the Arbitrator shall be final and binding, subject to the right of judicial review set out by applicable law. d. The costs for the services of the arbitration will be borne equally by the Hospital and the Union.

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ARTICLE VI: WITHDRAWAL OF PRACTICING/ADMISSION RIGHTS

A. Basic principles
i. Where need be, a disciplinary committee shall be set up to deal with disciplinary issues in accordance with existing human resource laws in the country. ii. No doctor shall be condemned without a hearing. iii. Regardless of the nature of the crime, the Hospital shall not withhold pay which is due or for which work has already been done. iv. Any doctor who feels that any disciplinary action taken against him is unfair can raise the matter using the grievance channel described in Article V.

B. Withdrawal of Admission Rights

i. The Hospital reserves the right to withdraw practicing/admission rights summarily for lawful cause. ii. Where an doctors practicing/admission rights are terminated summarily for gross misconduct such doctor shall be paid his/her dues for the number of days actually worked.

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SIGNATURES
SIGNED FOR AND ON BEHALF OF THE HOSPITAL

Sign: ............................................................................................................. .............. Designation: ................................................................................................. ........... Date: ............................................................................................................. .............

SIGNED FOR AND ON BEHALF OF THE UNION: Sign: ............................................................................................................. .............. Designation: ................................................................................................. ........... Date: ............................................................................................................. ............. IN THE PRESENCE OF: Sign: ............................................................................................................. .............. Designation: ................................................................................................. ........... Date: ............................................................................................................. .............

SIGNED AT ELDORET, THIS................................. DAY OF .............................. 2012

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APPENDIX A: RECORDS SYSTEM

Doctor: .......................................................................................................... ............ Date: ............................................................................................................. ............. Hospital/Ward: .............................................................................................. ........ Patient Name
................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ .......

No
.............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. Page 19 of 57

Procedure

Fee

............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................

................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ ....... ................................................ .......

.............. .............. .............. .............. .............. .............. .............. .............. ..............

............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................ ............................ ................

Signed: ........................................................ (On behalf of the Hospital) Signed: ........................................................ (Doctor) (To be filled in triplicate, original to the doctor, 1st and 2nd copy to the hospital)

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APPENDIX B: FEES BY SPECIALTY

Anaesthesiology Cardiology Cardiothoracic and vascular surgery Dental Diagnostic and Interventional radiology Ear, Nose and Throat surgery Gastroenterology General surgery Nephrology Neurology Neurosurgery Obstetric and Gynaecological surgery Oncology Ophthalmic surgery Paediatrics Paediatric surgery Pathology Plastic and Reconstruction surgery Psychiatry Pulmonary Urological surgery

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Page 22 of 57

ANAESTHESIOLOGY
CODE ANA001 ANA002 ANA003 ANA004 ANA005 ANA006 ANA007 ANA008 ANA009 ANA010 ANA011 ANA012 ANA013 ANA014 ANA015 PROCEDURE Minor Procedures Minor operations under LA CVP catheterisation Tracheal intubation NG tube insertion X-ray guided pain procedures-lumbar spine X-ray guided pain procedures-cervical spine Epidurals: initial insertion or single shot Epidurals: top-ups by anaesthetist (per episode) Lumbar puncture Peripheral venous access Daily ventilator management Initiation of ventilation Extubation and post extubation management Resuscitation Drawing of blood for blood gas analysis Major Procedures Group A: ASA I and ASA II Minimum charge or within first half hour Second half hour Second and subsequent hours (per hour) Group B: ASA III, IV, V and infants Minimum charge or within first half hour Second half hour Second and subsequent hours (per hour) Group C: High risk and/or specialized surgery: Neurosurgery (tumor and posterior cranial fossa), neonates, bronchoscopy, thoracotomy, prone and abnormal Page 23 of 57 positioning, complex oromaxillofacial head and neck surgery Minimum charge or within first half hour Second half hour Eldoret Consensus Procedure Fee 2,500 8,000 7,500 2,000 10,000 15,000 10,000 4,000 4,500 2,000 4,000 4,000 3,000 7,000 2,000

ANA051 ANA052 ANA053

10,000 10,000 10,000

ANA101 ANA102 ANA103

14,000 14,000 14,000

ANA151 ANA152

20,000 20,000

CARDIOLOGY
CODE CAR001 CAR002 CAR003 CAR004 CAR005 CAR006 CAR007 CAR008 CAR009 CAR010 CAR011 CAR012 CAR013 CAR014 CAR015 CAR016 CAR017 CAR018 CAR019 CAR020 CAR021 PROCEDURE ECG Cardiac catheterisation Single pacemaker insertion Dual chamber pacemaker insertion Temporary pacemaker Pericardiocentesis Pulmonary artery catheterisation Pericardial catheterisation Selective coronary arteriography Coronary angioplasty and stent Overdrive pacing for tachycardia Myocardial biopsy Cardiac evaluation (exercise stress test, ECG, 2D ECHO) Holter monitoring Vent care in ICU (daily charges) Ambulatory BP monitoring Intracardiac balloon pump (daily) Intraaortic balloon pump (daily) Electric cardioversion Transesophageal ECHO C-V line insertion Eldoret Consensus Procedure Fee 1,500 45,000 65,000 110,000 15,000 15,000 15,000 22,500 60,000 135,000 15,000 30,000 15,000 13,500 4,500 12,000 15,000 30,000 15,000 15,000

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Page 25 of 57

CARDIOTHORACIC AND VASCULAR SURGERY Eldoret Consensus Surgeons Fee

CODE

PROCEDURE Complex major Pleurectomy/decortication Pericardectomy Vessel bypass surgery Coronary angioplasty/stenting Oesophagectomy Splenorenal shunt Portocaval shunt Excision of carotid body tumour Closed valvotomy Mitral valvotomy/balloon Open heart surgery Pneumonectomy/lobectomy Surgery for achalasia cardia Vascular amputation Aneurysm repair Repair of traumatic arterial transection Thoracotomy Resection of complex AV fistula Subfascial DVT ligation + skin graft Thromboembolectomy Carotid arterectomy PDA ligation Major Insertion of MB tube Mediastinoscopy Thoracoscopy Mini thoracotomy for open lung biopsy Pacemaker implantation: single Page 26 of 57 Pacemaker implantation: dual Excision of mediastinal tumor Ligation/stripping of varicose veins

CVS001 CVS002 CVS003 CVS004 CVS005 CVS006 CVS007 CVS008 CVS009 CVS010 CVS011 CVS012 CVS013 CVS014 CVS015 CVS016 CVS017 CVS018 CVS019 CVS020 CVS021 CVS022

75,000 75,000 87,500 135,000 115,000 60,000 60,000 75,000 50,000 50,000 150,000 100,000 50,000 75,000 100,000 65,000 60,000 65,000 55,000 57,500 50,000 62,500

CVS051 CVS052 CVS053 CVS054 CVS055 CVS056 CVS057 CVS058

60,000 62,500 55,000 55,000 65,000 110,000 67,500 40,000

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DENTAL
CODE PROCEDURE Surgical Procedures Simple extraction 3rd molar extraction Dry socket Open surgical disimpaction Closed disimpaction Wound stitching Incisional biopsy under LA Cyst - enucleation under LA (minor) Simple fracture management under LA (IMF) Complex fracture management under GA Splinting (1st tooth) Splinting (additional tooth) Operculectomy Frenectomy Alveoplasty Apicectomy Conservative treatment Plastic filling composite/GIC Fissure sealing Amalgam Temporary filling Restoration pin Root canal treatment - 1 canal 2 canals 3 canals Pulpotomy/pulpectomy Crown and bridge work ( per unit) Page 28 of 57 Acrylic Porcelain Post- crown Composite masking Eldoret Consensus Surgeons Fee Cash-paying 1,000 2,000 900 6,500 2,500 2,500 4,000 6,000 20,000 2,000 1,000 2,000 2,000 3,000 4,000 Eldoret Consensus Surgeons Fee Corporate 2,000 3,000 1,200 9,000 3,500 3,500 6,000 9,000 30,000 3,000 1,500 3,000 3,000 4,000 6,000

DEN001 DEN002 DEN003 DEN004 DEN005 DEN006 DEN007 DEN008 DEN009 DEN010 DEN011 DEN012 DEN013 DEN014 DEN015 DEN016

DEN051 DEN052 DEN053 DEN054 DEN055 DEN056 DEN057 DEN058 DEN059

2,500 2,000 2,500 2,000 4,000 6,000 8,000 12,000 3,000

3,500 3,000 4,000 3,000 6,000 8,000 10,000 15,000 4,000

DEN101 DEN102 DEN103 DEN104

5,000 17,000 20,000 3,000

7,000 22,000 25,000 4,000

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DIAGNOSTIC & INTERVENTIONAL RADIOLOGY

CODE RAD001 RAD002 RAD003 RAD004 RAD005 RAD006 RAD007 RAD008 RAD009 RAD010 RAD011 RAD012 RAD013 RAD014 RAD015 RAD016 RAD017 RAD018 RAD019 RAD020 RAD021 RAD022 RAD023 RAD024 RAD025 RAD026 RAD027 RAD028 RAD029 RAD030 RAD031 RAD032 RAD033 PROCEDURE X rays of extremities Hand Both hands Digits Wrist Scaphoid views Forearm Both foreams Elbow Both elbows Humerus Both humeri Shoulder Both shoulders Clavicle Both clavicles Sternoclavicular joint Foot Both feet Ankle Both ankles Leg Both legs Knee Both knees Knee skyline view Both knees skyline view Femur Both femora Portable X rays Heels Hip Both hips Pelvis Cost 700 1,100 600 700 1,100 1,200 1,900 1,600 2,300 1,200 1,900 1,600 3,000 700 1,200 1,500 700 1,200 700 1,200 1,100 1,600 900 1,500 1,200 1,800 1,200 2,000 350 660 Page 30 of 57 1,500 2,000 1,000 Eldoret Consensus Procedure + Reading (50%) Eldoret Consensus Reading/Interpretatio n (35%) 245 385 210 245 385 420 665 560 805 420 665 560 1,050 245 420 525 245 420 245 420 385 560 315 525 420 630 420 700 122.50 231 525 700 350

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EAR, NOSE AND THROAT SURGERY

CODE PROCEDURE Complex major Laryngectomy with radical neck dissection Laryngectomy Block dissection of the neck Total/radical parotidectomy Tracheal reconstruction Functional endoscopic sinus surgery (FESS) Radical mastoidectomy Rhinoplasty: soft tissue Rhinoplasty: soft and bony tissue Excision of pharyngeal diverticulum Total thyroidectomy Cricotracheal reconstruction Excision ad reconstruction of head and neck tumours Hemiglossectomy Maxillectomy Cochlear operation Major I Superficial parotidectomy Excision of submandibular gland Septoplasty Simple mastoidectomy Tympanoplasty Parotoplasty Stapedectomy Facial nerve decompression Frontal mucocele Frontal sinus trephination Microlaryngeal surgery Page 32 of 57 Microlaryngoscopy External ethmoidectomy Middle ear tumour excision Eldoret Consensus Surgeons Fee

ENT001 ENT002 ENT003 ENT004 ENT005 ENT006 ENT007 ENT008 ENT009 ENT010 ENT011 ENT012 ENT013 ENT014 ENT015 ENT016

150,000 130,000 80,000 75,000 100,000 60,000 70,000 55,000 90,000 80,000 40,000 100,000 100,000 60,000 100,000 180,000

ENT051 ENT052 ENT053 ENT054 ENT055 ENT056 ENT057 ENT058 ENT059 ENT060 ENT061 ENT062 ENT063 ENT064

50,000 50,000 50,000 50,000 50,000 40,000 70,000 60,000 50,000 30,000 80,000 40,000 65,000 80,000

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GASTROENTEROLOGY
CODE GAS001 GAS002 GAS003 GAS004 GAS005 GAS006 GAS007 GAS008 GAS009 GAS010 GAS011 PROCEDURE OGD Diagnostic Sclerotherapy Diathermy (haemostatic procedure) Pyloric balloon dilatation PEG tube insertion Stricture dilatation (Savary Gilliard) Upper GI polypectomy Stent insertion Stricture dilatation (TTC) Pneumatic dilatation Band ligation Colonoscopy Diagnostic Stricture dilatation Lower GI polypectomy ERCP Diagnostic Sphincterectomy Stent insertion Sphincterectomy + stone removal Others Sigmoidoscopy Rectal snip Liver biopsy Peritoneal biopsy Eldoret Consensus Procedure Fee 12,000 22,000 30,000 25,000 22,000 25,000 12,000 30,000 20,000 20,000 25,000

GAS051 GAS052 GAS053

15,000 30,000 30,000

GAS101 GAS102 GAS103 GAS104

25,000 30,000 35,000 25,000

GAS151 GAS152 GAS153 GAS154

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10,000 3,000 12,000 7,000

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GENERAL SURGERY
Eldoret Consensus Surgeons Fee

CODE

PROCEDURE Complex major Abdominoperineal resection (APR) Anterior resection of rectum Total gastrectomy Partial gastrectomy Total esophagectomy Unilateral adrenalectomy Bilateral adrenalectomy Total resection of colon Partial pancreatectomy Nephrectomy Cholecystectomy + CBD exploration Biliary stricture surgery Major I Open cholecystectomy Laparascopic cholecystectomy Vagotomy + drainage Repair of perforated duodenal ulcer Repair of hiatus hernia Splenectomy Parathyroidedectomy Radical mastectomy Simple mastectomy Breast lumpectomy Drainage of breast abscess Segmental resection of breast Total thyroidectomy Intestinal resection + anastomosis Exploration of retroperitoneal mass Page 36 of 57 Exploration laparatomy Bowel resection and anastomosis Laparotomy for pyloric stenosis

GES001 GES002 GES003 GES004 GES005 GES006 GES007 GES008 GES009 GES010 GES011 GES012

60,000 50,000 60,000 45,000 55,000 50,000 65,000 55,000 50,000 40,000 55,000 80,000

GES051 GES052 GES053 GES054 GES055 GES056 GES057 GES058 GES059 GES060 GES061 GES062 GES063 GES064 GES065 GES066 GES067 GES068

50,000 60,000 50,000 45,000 40,000 45,000 40,000 45,000 40,000 25,000 21,000 30,000 45,000 45,000 50,000 45,000 45,000 40,000

NEPHROLOGY
CODE NEP001 NEP002 NEP003 NEP004 NEP005 NEP006 PROCEDURE Hemodialysis line fixation: internal jugular/femoral Hemodialysis line fixation: tunnelled (PermCath) Vascular access (A-V shunts/fistulae) Renal biopsy Insertion of peritoneal catheter Renal transplant: nephrologists fee Eldoret Consensus Procedure Fee 8,000 12,000 22,500 10,000 22,500 30,000

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NEUROLOGY
Eldoret Consensus Procedure Fee 7,000 11,000 11,000 5,000 10,000

CODE NEU001 NEU002 NEU003 NEU004 NEU005

PROCEDURE EEG Nerve conduction studies Evoked potential Diagnostic lumbar puncture Therapeutic lumbar puncture

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Page 39 of 57

NEUROSURGERY
Eldoret Consensus Surgeons Fee Cash-paying 150,000 100,000 120,000 120,000 100,000 150,000 120,000 80,000 100,000 120,000 Eldoret Consensus Surgeons Fee Corporate 200,000 150,000 180,000 150,000 150,000 200,000 180,000 120,000 150,000 180,000

CODE

PROCEDURE Complex major Endonasal pituitary surgery Transphenoidal pituitary surgery Craniotomy for aneurysm Craniotomy for AV malformation Craniotomy for brain tumour Posterior fossa surgery Spinal fusions with implants Anterior cervical discectomy and fusion: 1 level Anterior cervical discectomy and fusion: 2 levels Anterior cervical discectomy and fusion: 3 levels Major I Microdisectomy: 1 level Microdisectomy: 2 levels Microdisectomy: 3 levels Microdisectomy and rhizolysis: 1 level Microdisectomy and rhizolysis: 2 levels (bilateral) Microdisectomy and rhizolysis: 3 levels Craniotomy for intracerebral hematoma Craniotomy for extradural hematoma Craniotomy for subdural hematoma Craniotomy for brain abscess Craniotomy for tuberculoma Laminectomy (cervical/thoracic/lumbar spine): 1 level Laminectomy (cervical/thoracic/lumbar spine): 2 levels Laminectomy (cervical/thoracic/lumbar spine): 3 levels Arnold-Chiari decompression Page 40 of 57 Laminectomy and excision of spinal tumour Laminectomy and repair of dura Intracranial repair of dura

NES001 NES002 NES003 NES004 NES005 NES006 NES007 NES008 NES009 NES010

NES051 NES052 NES053 NES054 NES055 NES056 NES057 NES058 NES059 NES060 NES061 NES062 NES063 NES064 NES065 NES066 NES067 NES068

70,000 80,000 90,000 80,000 95,000 110,000 60,000 60,000 60,000 50,000 60,000 60,000 80,000 100,000 90,000 90,000 60,000 50,000

90,000 100,000 120,000 100,000 110,000 150,000 80,000 80,000 80,000 70,000 80,000 80,000 100,000 120,000 120,000 120,000 80,000 70,000

Page 41 of 57

OBSTETRIC AND GYNAECOLOGIC SURGERY

Eldoret Consensus Surgeons Fee

CODE

PROCEDURE Complex major Wertheims hysterectomy Ovarian cancer resection (pelvic clearance) Repair of vesicovaginal fistula Repair of rectovaginal fistula AP colpoperineorrhaphy Repair of ruptured uterus Radical vulvectomy Manchester repair Repair of pelvic floor Major I Laparotomy: tubolasty Laparotomy: hysterectomy (abdominal) Laparotomy: myomectomy Laparotomy: ovarian cystectomy Laparotomy: ruptured ectopic pregnancy Laparotomy: pelvic abscess Laparotomy: exploratory/adhesionolysis Laparotomy: ventrosuspension Laparotomy: salpingo- oophorectomy Laparotomy: endometriosis surgery Laparotomy: metroplasty/uteroplasty Simple vulvectomy Vaginal hysterectomy Operative laparoscopy: ovarian cystectomy/drilling Operative laparoscopy: ectopic pregnancy Operative laparoscopy: tuboplasty Operative laparoscopy: adhesionolysis Operative laparoscopy: myomectomy Page 42 of 57 Operative laparoscopy: endometriosis surgery Operative laparoscopy: hysterectomy

OGS001 OGS002 OGS003 OGS004 OGS005 OGS006 OGS007 OGS008 OGS009

125,000 75,000 50,000 50,000 65,000 60,000 125,000 80,000 55,000

OGS051 OGS052 OGS053 OGS054 OGS055 OGS056 OGS057 OGS058 OGS059 OGS060 OGS061 OGS062 OGS063 OGS064 OGS065 OGS066 OGS067 OGS068 OGS069 OGS070

45,000 60,000 55,000 25,000 30,000 40,000 45,000 45,000 35,000 60,000 35,000 75,000 60,000 65,000 65,000 65,000 65,000 72,500 72,500 72,500

ONCOLOGY Eldoret Consensus Procedure Fee 2000 1000 6000 6000 6000 6000 6000

CODE ONC001 ONC002 ONC003 ONC004 ONC005 ONC006 ONC007

PROCEDURE Cannulae fixation Venepuncture IV Chemotherapy Lumbar puncture IT chemotherapy Chemical pleurodesis BMA

Page 43 of 57

Page 44 of 57

OPTHALMIC SURGERY
CODE PROCEDURE Eldoret Consensus Surgeons Fee

OPS001 OPS002 OPS003 OPS004 OPS005 OPS006

Complex major Retinal detachment correction (sclera buckling) Orbital exenteration Orbitotomy Corneal graft /transplant/keratoplasty Corneal graft /transplant/keratoplasty: Button supplied Vitreo-retinal surgery (vitrectomy) Major I Bilateral blepharoplasty Iridolysis Ptosis correction Lacrimal drainage surgery Major II Cataract extraction with implant Cataract extraction without implant Intermediate Glaucoma surgery (GA) Repair of corneal perforation Enucleation/evisceration of the eye Squint surgery Entropion/ectropion correction Lens extraction Lens washout Lid repair Laser surgery (YAG, photocoagulation, trabeculoplasty) Page 45 of 57 Trabeculectomy Goniotomy Capsulotomy

70,000 70,000 70,000 100,000 150,000 120,000

OPS051 OPS052 OPS053 OPS054

50,000 40,000 50,000 60,000

OPS101 OPS102

60,000 40,000

OPS151 OPS152 OPS153 OPS154 OPS155 OPS156 OPS157 OPS158 OPS159 OPS160 OPS161 OPS162

50,000 50,000 35,000 55,000 30,000 22,500 25,000 25,000 20,000 40,000 45,000 25,000

Page 46 of 57

PAEDIATRICS
CODE PAE001 PAE002 PAE003 PAE004 PAE005 PAE006 PAE007 PAE008 PAE009 PAE010 PAE011 PAE012 PAE013 PAE014 PAE015 PAE016 PAE017 PAE018 PAE019 PAE020 PAE021 PAE022 PAE023 PAE024 PAE025 PAE026 PAE027 PAE028 PAE029 PAE030 PAE031 PROCEDURE Receiving a newborn Resuscitation of a newborn/child Exchange transfusion Cannulae fixation Venepuncture IV chemotherapy Intaraosseous cannulation Central line insertion Venous cutdown Femoral vein cannulation Umbilical catheterisation Lumbar puncture, diagnostic Lumbar puncture, therapeutic Pleural tap Pleural biopsy Intubation Suprapubic bladder tap/catheterisation Urethral catheterisation Nasogastric/orogastric tube insertion Flatus tube insertion Proctoscopy Enema Manual removal of impacted stool Removal of foreign bodies: eye Removal of foreign bodies: nose Removal of foreign bodies: ear Removal of foreign bodies: vagina Page 47 of 57 Removal of foreign bodies: rectum Bone marrow aspirate Splenic aspirate Pericardial tap/aspirate Eldoret Consensus Procedure Fee 10,000 8,000 30,000 800 800 5,000 3,000 8,000 4,000 4,000 4,000 5,000 10,000 5,000 6,000 3,000 3,000 3,000 3,000 3,000 1,500 3,000 3,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 8,000

Page 48 of 57

PAEDIATRIC SURGERY
Eldoret Consensus Surgeons Fee

CODE

PROCEDURE Complex major Small bowel atresia Thoracotomy (oesophageal atresia) Biliary atresia (Kasai-Kimura procedures, portoenterostomy) Niessens fundoplication Gut duplication procedure Hirschprungs disease procedure: laparatomy, biopsy, colostomy Hirschprungs disease procedure: abdominoperineal pullthrough (Soave, Swenson) Hirschprungs disease procedure: closure of colostomy Hirschprungs disease procedure: rectal biopsies Hellers cardiomyotomy Bladder neck reconstruction: urinary diversion (rectosigmoidostomy) Posterior sagittal anorectoplasty (PSARP) for anorectal malformation Exploration of retroperitoneal mass Hemicolectomy Excision of liver hydatid cyst Nephrectomy Reflux hydronephrosis (reimplantation) Urethropplasty for hypospadias and epispadias Pelvic ureteric junction obstruction (PUJO) Major I Omphalocele Splenectomy Laparotomy: intussusception Laparotomy: volvulus Laparotomy: malrotation and placation Laparotomy: peritonitis Page 49 of 57 Laparotomy: intestinal resection + anastomosis Repair of fistula after urethroplasty Thyroidectomy

PDS001 PDS002 PDS003 PDS004 PDS005 PDS006 PDS007 PDS008 PDS009 PDS010 PDS011 PDS012 PDS013 PDS014 PDS015 PDS016 PDS017 PDS018 PDS019

51,000 59,000 59,000 50,000 40,000 29,500 51,000 36,000 17,500 51,000 56,000 36,000 59,000 45,000 50,000 59,000 59,000 43,000 59,000

PDS051 PDS052 PDS053 PDS054 PDS055 PDS056 PDS057 PDS058 PDS059

51,000 45,000 52,500 51,000 25,500 36,000 30,000 21,500 29,500

Page 50 of 57

PATHOLOGY
Eldoret Consensus Reading/Interpre tation 1,000 40% 10,000 15,000 40% 40% 2,000 40% 40% 1500 3,000 3000 40% 1000 40% 40% 40% 600 40% 40% 40% 3,000 40% 40%

CODE PAT001 PAT002 PAT003 PAT004 PAT005 PAT006 PAT007 PAT008 PAT009 PAT010 PAT011 PAT012 PAT013 PAT014 PAT015 PAT016 PAT017 PAT018 PAT019 PAT020 PAT021 PAT022 PAT023 PAT024

PROCEDURE FNA- cytology: performing FNA- cytology: reading Clinical post-mortem Forensic post-mortem Biopsy specimen Cytology exfoliative (e.g Pap and fluid cytology): reading Taking of bone marrow aspirate Reading of bone marrow aspirate Reading peripheral blood films Coagulation studies (consultation and interpretation of results) Cytotoxic drug administration Bone marrow trephine biopsy-taking Bone marrow trephine biopsy-reading Protein electrophoresis Readin/interpreting biochemical studies Reading of culture and sensitivity Microscopy of any specimen Blood slide for malaria, filarial, Trypanosome parasites Stool examination Urine examination Rectal snip readings Liver, spleen, lymph node aspirates: performing Liver, spleen, lymph node aspirates: reading Skin snip reading Page 51 of 57

Page 52 of 57

PLASTIC AND RECONSTRUCTION SURGERY

Eldoret Consensus Surgeons Fee 85,000 125,000 75,000 105,000 75,000 75,000 65,000 45,000 50,000 50,000 80,000 55,000 40,000 65,000

CODE PLS001 PLS002 PLS003 PLS004 PLS005 PLS006 PLS007 PLS008 PLS009 PLS010 PLS011 PLS012 PLS013 PLS014

PROCEDURE Complex major Mammoplasty Cranioplasty Classic abdominoplasty Facelift(Rhytidectomy) Liposuction Rhinoplasty Auriculoplasty/otoplasty Unilateral cleft lip repair Bilateral cleft lip repair Cleft palate repair Bilateral cleft lip and palate repair Rotation flaps Release of contractures Tendon transfer and repairs Major I Blapharoplasty Anterior canthotomy and Z-plasty Nerve release and decomprression Insertion and removal of tissue expander Lip reconstruction Digital reconstruction Revision of scars Advancement flaps Syndactyly/polydactyly correction Major II Skin graft Dermabrasion Page 53 of 57 Intermediate I Excision of keloid and lumps (LA)

PLS051 PLS052 PLS053 PLS054 PLS055 PLS056 PLS057 PLS058 PLS059

60,000 50,000 40,000 50,000 60,000 45,000 35,000 40,000 40,000

PLS101 PLS102

32,500 20,000

PLS151

30,000

PSYCHIATRY
CODE PSY001 PROCEDURE Electroconvulsive therapy Eldoret Consensus Procedure Fee 10,000

Page 54 of 57

PULMONARY
Eldoret Consensus Procedure Fee 3,000 5,000 3,000 5,000

CODE PUL001 PUL002 PUL003 PUL004

PROCEDURE Peak flowmetry Spirometry Chest aspiration Chest aspiration with biopsy

Page 55 of 57

Page 56 of 57

UROLOGICAL SURGERY
Eldoret Consensus Surgeons Fee

CODE

PROCEDURE Complex major Retroperitoneal lymphadenectomy Adrenal gland surgery Radical nephrectomy Nephroureterectomy Renal transplantation - recipient Renal transplantation - donor Cystectomy + urinary diversion Radical prostatectomy Major I Pyelolithotomy Nephrolithotomy Simple nephrectomy Congenital ureteropelvic junction obstruction Repair of megaurete Bladder neck resection Repair of urinary vaginal fistula Open prostatectomy Urethroplasty Partial/radical penectomy Transurethral resection of prostate (TURP) Percutaneous nephrolithostomy Pyeloplasty Ureteric reimplanatation Removal of ureteric calculi Bladder diverticulum surgery Repair of ruptured bladder Major II Page 57 of 57 Meatotomy/meatoplasty Orchidectomy Bilateral orchidopexy

URO001 URO002 URO003 URO004 URO005 URO006 URO007 URO008

60,000 65,000 75,000 85,000 80,000 80,000 85,000 75,000

URO051 URO052 URO053 URO054 URO055 URO056 URO057 URO058 URO059 URO060 URO061 URO062 URO063 URO064 URO065 URO066 URO067

67,500 75,000 50,000 57,500 57,500 40,000 55,000 57,500 35,000 35,000 57,500 50,000 67,500 67,500 57,500 40,000 37,500

URO101 URO102 URO103

30,000 25,000 42,500