Cancer and blood specialist Chite Asirwa sees about 50 patients on any given day at the cancer clinic in Ampath and the Moi Training and Referral Hospital.
Apart from the overwhelming number, most of Dr Asirwa’s patients are at advanced stages of their cancer and he risks his own burnout trying to attend to all of them.
Dr Asirwa is just one of the 2,089 specialist doctors in Kenya according to the Kenya Health Workforce Report of 2015.
In fact, in his speciality — oncology and radiology — there are only nine doctors registered to be working in a public hospital on a part time or full-time basis.
He told Nation: “If they had been diagnosed early, they would be treated, but now it is just palliative care for most of them”.
The majority of specialised medics are from obstetrics and gynaecology (387), general surgery (338) while diabetology is the least.
Meanwhile, the percentage of deaths caused by communicable diseases such as malaria reduced from 82 to 72 in 2012, while cancers and other non-communicable diseases rose from 11 to 14 in the same period.
Dr Asirwa’s work overload communicates a deficiency in the entire spectrum of human resource for health in Kenya.
There are not enough healthcare workers to see patients even for primary medical care before they are sick enough to need the specialised skills of Dr Asirwa.
As at 2015, there were 5,660 retained medical doctors, 31,896 active nurses and midwives and 10,562 active clinical officers.
The World Health Organisation (WHO) index that measures how many health workers would be needed to achieve the Sustainable Development Goals and take care of non-communicable diseases as well, the country needs 45 physicians, nurses, and midwives per 10,000 population.
Kenya has 13.8 doctors, nurses and midwives per 10,000 population, and this includes clinical officers.
The acute shortage of human resources in Sub-Saharan Africa has been blamed for the region’s poor health indicators such as high maternal and child mortality rates.
The training of healthcare workers in the country has not been sufficient to meet the medical needs of the country - from caregiving, diagnosis to specialised care.
As of 2015, the country had 148 health training institutions accredited by the health regulatory agencies to train in all the six disciplines — nursing, clinical medicine, medicine, dentistry, medical laboratory sciences, and pharmacy — of health and biomedical sciences.
Of these, 102 are nurse-training institutions and 10 for medical doctors, of which two also train dentists while 36 train clinical officers.
There are also 32 pharmacist and pharmaceutical training institutions well as 42 medical laboratory technicians and technologists’ trainings institutions.
Out of these schools come an average of 466 doctors every year, an increase from 287 in 2006 as the number of schools offering medical training moved from two to 10.
In a previous unpublished interview, the dean of University of Nairobi 's School of Medicine, Prof Fredrick Were, said that even with the increase of medical schools, the country is far from training enough healthcare workers.
Prof Were also said that young doctors always found themselves disillusioned after the gruelling medical school to come to a workforce that does not value their effort.
Since Kenya devolved its health services, a series of strikes by health workers rocked parts of the country, with the deadliest being the three-month strike from December 2017 to March 2018.
While a study has not been conducted the extent of both the nurses’ and doctors’ strike, Prof Lukoye Atwoli — Dean, The Moi University School of Medicine — said that the damage the strike caused would affect the health system for a long time.
The strained working relationship between the State and health workers, which is responsible for most of the strikes, are well-documented and dates from as far as the colonial times.
British historian John Iliffe, who is an expert in African history, writes in his book, East African Doctors: A History of the Modern Profession (African Studies), documents the corrosion that Kenyan doctors had with the government and among themselves.
The country has had five national doctor strikes since independence: In 1971, 1981 and in 1994, for three months, with the deadliest in 2013, soon after devolution, and the last one being the 2017 one.
These conditions have pushed healthcare workers to leave the hospital in search of better pay and working conditions.
In 1994, between June and September after the national strike, more than 600 of the 1,200 public hospital doctors emigrated, according to parliament records that were discussing the crisis that time.
Namibia, Botswana and South Africa were the most attractive options then. The number of out-migration reduced but did not stop entirely.
Between 2014 and 2015, the Ministry of Health reports, eight percent of the active practicing medical doctors (about 450) and 17 dentists applied for a certificate of good standing to leave the country.
The numbers were not as high for nurses (482, or 1.8 percent of the total) who applied to leave.
The preferred destination was the USA (54.4 percent), Namibia (16.2 percent), Australia (11.4 percent), Canada (3.8 percent), and UK (2.9 percent).
A 2013 survey by the Ministry of Health and the World Bank titled Health Service Delivery Indicators and Public Expenditure ranked Kenyan healthcare workers as more knowledgeable in the region.
Eighty percent of Kenyan healthcare workers can diagnose common health conditions and have sufficient knowledge of how to handle them.
In 2006, researcher Joses Muthuri Kirigia estimated that the total cost of educating a single medical doctor from primary school to university in Kenya is US$65,997 (Sh6.7 million), and the country loses about US$517,931 worth of return on investment for every medic that migrates.
The cost of educating one nurse from primary school to college a of health sciences on the other hand is US$43,180; and for every nurse that emigrates, a country loses about US$338,868 worth of return on investment.
The recipient country gains because they receive a worker in whose training they did not participate.
The government may have stemmed out-migration but nothing would have prepared the Ministry of Health for the in-country migration, as medics joined the private sector, research or non-governmental organisations from public health settings.
In 2015, Kenya Medical Practitioners Pharmacists and Dentists Union (KMPPDU) secretary-general Ouma Oluga said that since the devolution of health, more than 2,000 doctors left public hospitals due to the poor management of health.