Migration driving shortage of medics in Kenya: Aga Khan CEO

Thursday July 11 2019

Medics strike KNH

Workers under the Kenya Union of Domestic, Hotels, Educational Institutions, Hospitals and Allied Workers are pictured at Kenyatta National Hospital in Nairobi during a strike on August 6, 2018. PHOTO | DIANA NGILA | NATION MEDIA GROUP 

 AGGREY OMBOKI
By AGGREY OMBOKI
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Kenya is facing a shortage of at least 370,000 nurses and 149,000 doctors, Aga Khan University chief executive Shawn Bolouki has said, noting the effect of brain drain.

The CEO did not elaborate but a 2015 report by the Health ministry captured the shortage of medics in Kenya, whose doctor to patient ratio is 1:16,000.

Health workers usually most commonly migrate in search of better work and study opportunities.

"A good number of our doctors and nurses are taking up jobs in medical facilities in Western nations. We need to train more medics and find ways to retain them," Mr Bolouki told a delegation of Dutch healthcare business executives who visited AKU’s main campus in Parklands, Nairobi.

As part of efforts to curb the shortage and ensure the country has competent medical personnel, he said the institution was in the advanced stages of a plan to expand its college in order to train more people.

EQUIPMENT

Mr Bolouki also addressed the issues of medical supplies, technology use for diagnosis and equipment.

He said AKU will only buy products that have passed rigorous certification tests, stipulated by internationally recognised regulatory bodies such as the Food and Drug Administration (FDA) in the United States.

Regarding technology, Mr Bolouki complained that vendors sell products that are difficult to operate and support services are offered after long periods of time, meaning medical staff are kept waiting.

“We need to purchase affordable, sustainable technology that can be supported by appropriate and timely after-sale services. Sometimes we install new technology and then have to wait up to two months before we can get proper technical support,” he said.

DIAGNOSIS

On the use of artificial intelligence for diagnosis, the CEO noted caution in universal adaptation without proper vetting for suitability in practical applications within hospital settings.

He asked, "A 2015 study by the University of Davis in California showed that a group of pigeons could read a breast exam or mammogram with an accuracy level of 95 per cent. Another research is now using dogs to sniff out cancer in patients. Who would want their results read by a pigeon or a dog?”

The AKU boss further pointed out that Chinese companies had acquired an advantage over their European competitors by providing easily serviceable products

“When supplying to local clients, please ensure you match the available technology to availability of resources and the technical capability in the region. This is an area where Chinese companies have recently gotten an advantage,” he said.

He also appealed to pharmaceutical companies to provide drugs at “affordable and sustainable costs”. 

MOBILE SERVICES

The delegation of representatives from 22 Dutch healthcare firms was headed by Erik Gerritsen, Dutch Vice-minister of Health, Welfare and Sports.

Mr Gerritsen said patients must be empowered with “the right tools, information and knowledge” in order to take better care of their health.

“I do not think lack of vision is the problem when it comes to empowering patients to take better care of [themselves]. We already have the technology in place but the main challenge is implementation, which can be achieved by getting medical staff an patients to adopt technological solutions,” said Mr Gerritsen.

The Dutch minister gave an example of the M-Tiba, the Safaricom–powered medical services app, which he said was a major step for the country in provision of mobile health solutions.

“Kenya may not have as many health facilities as The Netherlands but it has a robust mobile applications service sector, which The Netherlands does not have. Use it to provide better services in the Universal Health Coverage programme," he said.

He also said Kenya does not have to use the expensive technology West countries do as it cam tap into all of its available resources and develop “low-technology but high-impact” products.

“M-Tiba is an example of a low-technology, high-impact healthcare product that uses the short message service (SMS) technology but is based on block chain technology principles,” he explained.

M-TIBA

M-Tiba allows the user to save funds and pay for healthcare at facilities that carry the app’s logo.

It is also possible to transfer funds from one’s M-Pesa account to M-Tiba.

Among services available on the app are patient information and self-care services provided by the Afya Pap app, developed by UK-based tech firm Baobab Circle.

According to Afya Pap chief executive Dr Precious Lunga, the app “caters for diabetes and high blood pressure patients by offering lifestyle and self-care tips to help them manage their condition”.

“Our service enable patients to take a more active interest in their health and quality of care from physicians. It enables them to engage with us on a regular basis and get information on better lifestyle and healthcare choices. This includes daily blood sugar tests, alerts and personalised medical advice,” said Dr Lunga.

REPORTS

Some reports on health facilities paint the picture - during a Public Accounts committee meeting at the National Assembly on Monday, County Health Chief Officer Washington Makodingo admitted that Mama Lucy Kibaki Hospital had hired only 468 medical staff against the required 752.

Mr Makodingo further noted that Dandora Health Centre had just 47 health workers instead of the recommended 107.

The report titled 'Kenya Health Workforce Report: The Status of Health Care Professionals in Kenya' was by the Ministry of Health, in collaboration with the Nursing Council of Kenya, the Kenya Medical Practitioners and Dentists Board, the Centre for Disease Control and Emory University.

WHO STANDARDS

According to the Health ministry report, Kenya at the time had 13.8 doctors, nurses and physicians for every 10,000 people, less than three times the World Health Organization's recommendation of 44.5.

“The number of health professionals is still far below what is recommended in the Workforce 2030 report, which specifies the current WHO recommendations," the report says.

"Using the Strategic Development Goals (SDGs) index, which includes coverage for non-communicable diseases, WHO estimates that 44.5 physicians, nurses, and midwives per 10,000 population will be needed to meet the SDGs by 2030."

The report also states that from 2012 to 2014, the NCK issued 31,896 renewal licenses for nurses practising in Kenya.

The ratio of practising nurses to the population was 8.3 per 10,000, compared to the WHO recommendation of 25.

"The figures also reflect a shortage of nurses by at least three times the WHO recommended minimum. A total of 63,792 more nurses would require to be employed to meet the WHO ratio that would work out to 95, 388 nurses."

DEFICIENCIES

The country had 5,660 active doctors and 603 dentists, which translated to approximately 1.5 doctors and 0.2 dentists per 10,000 people, against the WHO's recommended minimum staffing level of 36 doctors per 10,000.

This was a staggering 24 times less than the WHO ratio, with Kenya requiring 130,180 doctors to meet the threshold of 135,840.

There were 10,562 active clinical officers, 1,616 pharmacists, 4,671 pharmaceutical technologists from non-governmental facilities, 5,203 medical laboratory technologists and 3,213 medical laboratory technicians.

This translated to 2.7 clinical officers and 2.2 medical laboratory officers per 10,000 people.

“Achievement of universal access to health will be possible when the health professionals’ density is increased to meet the health demands of the fast-growing population," the report says.

"As of 2015, Kenya had a population of approximately 46 million with a growth rate of 2.7 per cent. The fertility rate in Kenya is 4.32, with a crude birth rate of 34.9 per 1,000 population and a rising life expectancy of 61.71 years (Unicef, 2015). The health workforce will need to grow in proportion to the growing population."

MINIMUM RATIOS

Peterson Wachira, chairman of the Kenya Union of Clinical Officers, said the country has fallen short of meeting staffing requirements due to failure to stick to global standards.

“Had we followed the WHO guidelines, we would have had 16,278 clinical officers, 13,141 doctors and 38,315 nurses in the public sector against the current numbers of approximately 6,000 clinical officers, 5,000 doctors and 25,000 nurses,” Mr Wachira said.

“The ideal minimum health worker to population ratio should be 23 to 10,000 or 40 clinical officers, 32 doctors per and 95 nurses per 100,000 Kenyans."