In this interactive series, we invite our readers to send in questions to select public figures.
Answers will be published in the next print and online editions.
This week, Kenya Medical Practitioners, Pharmacists and Dentists Union Secretary-General Ouma Oluga responds to your questions:
1. During President Uhuru Kenyatta’s recent visit to Cuba it was announced that the two countries had agreed that Kenya would be bringing in 100 doctors from the Caribbean nation. What do ordinary Kenyans stand to benefit from that deal?
Abass Katte, Rhamu, Mandera County
The truth of the matter is that all counties and hospitals are understaffed and in need of specialists.
But the other truth is that we have more than 1,000 Kenyan doctors who have graduated with degrees in medicine, dentistry and pharmacy yet they have not been absorbed.
They have awaited deployment since May 2017. An additional 1,000 doctors will complete the mandatory professional internship on April 2018.
Kenya will, therefore, have 2,000 doctors without employment by May 2018.
We have advised the Ministry of Health and the county governments to employ the over 1,000 Kenyans.
Therefore, the importation of 100 doctors will not significantly impact the healthcare system and neither will it help solve the serious health challenges facing Kenyans.
2. Between lack of adequately trained personnel and lack of proper equipment, what most ails Kenya’s health sector today? What can be done to address the challenges?
Paul Gesimba, Nairobi
Kenya’s healthcare system suffers from a serious leadership and governance gap beyond the challenges of adequate personnel and proper equipment.
With a committed healthcare leadership and governance system, we will have accountability of finances meant for healthcare, prioritisation of lives of all Kenyans, including the very poor, in planning and provision of health services.
Kenya is one of the World Health Organization’s 57 countries listed as having a crisis in shortage of health staff.
A critical look reveals that the problem is absorption of health staff into the healthcare system rather than availability of the health staff or adequacy of training.
We train many nurses and doctors but we do not employ them to fill the staffing gaps in public and private facilities.
The solution is to reorganise the governance of health in a way that it brings professional, economic and political accountability and gives power back to the patient as the consumer of health services.
3. As an individual, what are some of your lowest moments in your career as a doctor and as the secretary-general of KMPDU?
Geoffrey Oyoo, The Management University of Africa
More often it is the times I am not able to help a patient.
As a doctor, I make prescriptions while aware that the patient will not afford the medicines prescribed.
At times, it is the knowledge of the treatment a patient needs but the lack of the necessary equipment hinders its access and seeing patients breathe their last is definitely the lowest moment I believe for all doctors.
As the secretary-general, it must be the happenings during our strike.
Particularly on February 13, 2017, when six officials of KMPDU and I were jailed for seeking the best, not only for our members but for the country.
Getting to experience the pretence and doublespeak from leaders from key institutions coupled with their inability to stand up for the common man and what is right is another low moment I experience often.
As a country, we put leaders in place to work on our behalf in solving the big problems that we cannot fix at individual levels – such as the cost or quality of healthcare.
But the people get betrayed. It has no effect when you watch on television but when you see it being done and remember the effects of the betrayal back to a patient then it is a low moment.
4. What is your take on the government’s decision to bring in 100 Cuban doctors to help in providing medical services to county hospitals?
Geoffrey Oyoo, The Management University of Africa
This is actually not the first time the government is doing this.
In 1994, the government imported doctors from Egypt but a majority of the doctors left just after three months because of difficulty in working in a broken healthcare system.
The Egyptian doctors who remained have worked well and some are the revered teachers of medicine in our universities.
Importantly, medicine as a practice in our set-up also requires cultural competency beyond the scientific knowledge.
Cultural competency is the ability of the doctor to connect and understand the patient’s perceptions of illness both spoken and unspoken.
It is foolhardy that doctors are brought from Cuba and yet we have more than 1,000 doctors who are unemployed.
The challenge the Cuban doctors will face is cultural competency as was faced by the Egyptian doctors.
The other challenge will be the fact that whatever good they would want to perform for patients won’t be possible as medicines, equipment or some other enabler are lacking.
This is to mean a dysfunctional health system will fail any doctor, whether from Cuba, Egypt or Kenya.
5. Why is it that you as the secretary-general of KMPDU is always at the forefront to defend the doctors who have been involved in professional negligence and not for the patient? Who is going to speak for the patients?
Solomon Gatobu, Maua
As a representative of the doctors, it is my sacred responsibility to ensure fair treatment of my constituents.
Their concerns and needs as long as they are logical must be addressed in an efficient manner.
However, I will be the last person to defend incompetency and professional negligence.
We believe that doctors’ rights are as important as patient rights.
We speak for patients a 100 per cent of the time because patients need qualified motivated doctors and other health staff.
6. Thank you for the great work you are doing in articulating public healthcare challenges in Kenya. What is your take on the much touted public-private partnership as a financing model towards the realisation of universal healthcare (UHC) in Kenya?
Kenya’s financing model for the health sector has largely been through taxes disbursed as part of the national budget to the Ministry of Health and the county governments.
Kenyans have been bearing a cost burden through ‘out of pocket’ expenditure, which accounts for up to 67 per cent of health expenditures, with effective health insurance covering a paltry seven per cent of health expenditure.
With the President’s political commitment to the achievement of universal health coverage, a proper financing model is worth the discussion of everyone.
The KMPDU believes a public sector-driven model of UHC with a public financing mechanism, public health service delivery system (public facilities) and public accountability strengthening is tenable and the cost-effective method to achieving universal healthcare.
This means defining a standard health package, prioritisation of healthcare budgets to improve public facilities and reduce fund wastage; restructuring of the NHIF to scale up uptake and include health services beyond hospitals such as rehabilitation services, doctor clinics or consortiums; and establishing a robust referral system that enables efficient, quick and coordinated care to each Kenyan households.
This means that a holistic approach to UHC should be adopted.
In this regard, public-private partnerships for financing are least effective for the Kenyan context.
Studies and experiences of PPPs in other set-ups seeking a sustainable model have not worked since PPPs’ financing for UHC are short-term, profit-driven and not scalable for high-impact health services delivery that can be described as universal health.
7. A number of Kenyans are regularly airlifted to western countries, India and South Africa even on slightest illnesses. Is it not a shame that more than 50 years after independence we should still be experiencing such? What does this say of the training of our doctors?
Abass Mohamed, Mandera County
The constant outflow of patients from Kenya to other countries has nothing to do with the training of doctors.
About 10,000 Kenyans seek healthcare outside Kenya for various reasons, namely the perceptions on the low cost of healthcare outside Kenya, a genuine search for specialised diagnostics and treatment not found in Kenya and a referral by friends or family.
The puerility of this arrangement is that Kenya loses Sh10 billion every year in outflow expenditure on medical tourism.
Inadvertently, this negatively influences the improvement of our healthcare system to provide quality services to all our citizens.
I long for the day that no Kenyan, including the ‘MVPs/VIPs’, will have to go out of the country to seek health services.
And our healthcare system is so broken that every single day, there are calls by Kenyans for medical fundraising to enable them to go to India, UK, South Africa, Israel and wherever else to be treated.
Even the ones who seek care locally cannot afford the costs of treatment.
As Kenyans, we should start calling for compelling conversations with policymakers to end this scourge.
It starts by the policymakers and politicians being compelled to seek healthcare in public facilities. In six months, they will all be world standard.
Many Kenyans are worried that most of the errors witnessed in our hospitals may not go down despite the increase in doctors’ salaries because the fatigue in these medical personnel may be as a result of the parallel activities they engage in, mostly running their private clinics.
8. Sir, what do you have to say about this, since Kenyans are interested in quality healthcare as taxpayers?
Komen Moris, Eldoret
Less than 340 doctors run clinics outside of their government employment.
These doctors have been given licences and mandated by law to do so in order to increase access to specialised skills to Kenyans.
This arrangement was endorsed by government over 25 years ago to enable universities and other Kenyans who required specialists to share the scarce resource.
The KMPDU proposed ways in which doctors can be adequately remunerated so that they only work in one facility.
This was part of the CBA proposal that the government rejected.
Fatigue by doctors is due to overworking, understaffing, lack of support and a poor work environment in public facilities.
There are far too few doctors and the government must quickly put up a mechanism to continually absorb, train for specialisation and support doctors as soon as they finish their internship.
9. What impact has the recent increase in salaries and allowances for doctors in public hospitals in Kenya had on stemming their flight to other countries?
It has increased retention of doctors from 27 per cent in 2011 to 65 per cent by 2017, which guarantees access to doctors by ordinary Kenyans who previously did not get served by doctors.
10. While the Kenya Medical Practitioners and Dentists Board has exonerated doctors involved in the recent surgery mix-up at Kenyatta National Hospital, what is KMPDU’s position regarding the incident? What role do doctors play in preparing patients for a surgery?
Kenyatta National Hospital should be adequately funded, well-resourced in both equipment and staff including employment of more doctors and quality management systems such as patient tracking and bar coding in order to minimise future medical errors.
Doctors prescribe and perform surgeries to patients who need them.
In between the prescription and the operation is a raft of processes that must be monitored to ensure quality before, during and after the surgical operation.