Debunking the myth of doctors’ opposition to devolution

A commonly repeated argument every time the authorities have trouble with health workers, and especially the doctors, is that the doctors are against devolution and do not want to be closely supervised at their places of work. Another surprisingly prevalent notion, repeated even by the President himself at the height of the doctors’ strike, is that all doctors run private practices and spend very little time (the proverbial two hours) in public hospitals before running off to go and make money elsewhere.

While these matters may have been understandably misrepresented due to the heightened emotions during the strike, it is important to make a number of clarifications lest these perceptions be cemented in the minds of our fellow citizens.

It is common knowledge that doctors, like other Kenyans, voted overwhelmingly for the new Constitution in which devolution was a major plank. Doctors were involved at all levels, and many of their suggestions were incorporated in the document that was subjected to a referendum in August 2010. All organisations associated with doctors have indicated repeatedly that they fully support devolution, and even suggested a roadmap to achieve it in a rational manner in the health sector.

SCARCE RESOURCES

Before the 2010 referendum, doctors and other health workers foresaw the problems that were likely to arise should the scarce human resources for health in this country be mismanaged in the process of devolution. To prevent this, they suggested the inclusion of a Health Service Commission (HSC) to manage the human resources for health, while all other health functions would be shared between the national and the county governments as currently provided for in the Constitution.

The HSC was included in all drafts of the document up to the very last minute, when a caucus of parliamentarians met in Naivasha and decided to expunge it, arguing that it was superfluous. This is part of the genesis of the current crises in the sector. Without a single entity to engage as far as recruitment, deployment, remuneration, and even training is concerned, health workers have been left to work in varying conditions across the country.

“Benevolent” counties have offered very attractive terms to some of the very scarce specialists, while others have either maintained the former terms or even worsened the working conditions for these cadres. Unlike other commodities or services for which competition doesn’t result in irreversible harm to the population, health services do not bear this kind of competition very well. While the improvement of services may look good on the scorecard of one governor, the deterioration in another part of the country results in avoidable deaths and disability that often will not get onto the national radar.

DO NOT

Concerning the argument that most doctors engage in private practice at the expense of the public service that employs them, it is important to realise that most doctors employed in the public service do not have private clinics or health facilities. In fact, it is easier for other health workers to open a practice than it is for a qualified doctor. The regulatory requirements are such that it is easier and more convenient to work at the government hospital than divide one’s time between the public hospital and a private clinic.

Only senior highly qualified and experienced doctors open and run successful private practices, and many of them do this as a full time occupation. A small proportion of senior specialists who work in the public sector apply annually for a part-time private practice licence, which entitles them to work at their private practices or private hospitals outside of their usual working hours at the public facility. They are expected to conduct ward rounds and run clinics in public facilities, and only go to their own facilities once their work is done.

It is manifestly misguided to insult health providers who put their lives on the line in order to ensure our people are safe from disease and death.

Lukoye Atwoli is associate professor of psychiatry and dean, School of Medicine, Moi University.

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