Earlier this month, I met a travelling party of Spanish speakers who struck a curious sight because some of them tried too hard to speak in Kiswahili. Thinking that they were tourists, I started a conversation with one of them asking what parts of the country he had visited and what were his impressions. My co-traveler reminded me that he has not had any moment to tour Kenya but was on a break back to Cuba before returning for another year. I learned that my interlocutor was not Spanish but a Cuban, wasn’t a tourist but an expatriate doctor.
I learnt four lessons from this fellow traveller.
First, about the most widely believed narrative states that government of Kenya has been unfair to citizens by failing to disclose the process and the purpose for the recruiting Cuban doctors to work in public hospitals in the country. Most of that news about the agreement between governments comes in limited disclosures and has created the impression that this agreement is wholly unsound and against the interest of tax payers.
The history of Cuba’s relationship with other low income countries is replete with examples in which the former send medical corps to work within health systems. Many of these doctors exported to many countries contribute by supporting weaker public health systems and ensuring that citizens of the receiving country have access to health services that would not otherwise be available. This kind of cooperation between countries is commendable. There is no moral failure in asking Cuban doctors to lend a hand to Kenya by working to assist in the same way.
A second lesson is that it is often important to listen to the arguments presented by professional associations and guilds. Their inherent interest in preserving their direct economic advantages should be borne in mind too. One can cull several articles and events in the Kenyan media in which professional bodies representing doctors have expressed strident objections to the arrangement that resulted in the arrival of these Cuban doctors. My summary of the opposition to this policy of employing expatriates comes to three reasons. The Kenya Medical Practitioners and Dentists Union has argued that employing foreigners displaces Kenyan doctors who are equally qualified, that the expatriates have not been locally certified and that the payment terms for the expatriates violates the relevant norms in Kenya’s public service.
It is probable that the Cuban doctors are paid a premium above the Kenyan doctors. However, I have the view that it is preposterous for citizens to be blind to the interest that unions defend and to take the view that some professionals form a special category that must be guaranteed public sector employment. The ratio of physicians to the population in Kenya is low (0.204 per 1000 people) due to government’s failure to expand medical schools and hesitation of professional associations to allow expansion of training, knowing that it opens the doors to more competition.
Thirdly, judging from the description by the doctor that I spoke too, these expatriates are not wet behind the ears. I have confirmed from a map that my interlocutor works in a county hospital that is at least two hundred kilometers from any of Kenya’s largest cities.
The recruitment process in Cuba was demand-driven because the government of Kenya identified the preferred professionals that it required. A competitive process was used to ensure that the professionals who were identified fit the requirements based on clinical experience and capability. He stated that the advertisements to which he and colleagues responded required a minimum of five years of clinical experience in their specialisations These doctors, appointed for two years each are highly educated and the claim that they needed local verification of their capability is an illustration of gate keeping common to professional associations in Kenya.
The other lesson that I learned was that the expatriate doctors are in awe of the Kenyan interns who work with them in patient care. In his assessment, Kenya’s medical students undertaking internship are very well trained but constrained by the inadequate supplies and equipment in the health facilities. Accepting that it is not in the place of the visitor to advise Kenya, his view is that the health system needs deliberate tweaks to make it much better than it is performing today. Specifically, he thinks that for a country that is several times larger than Cuba, Kenya has a very small pool of medical workers and they have enormous power in directing health policy in ways more beneficial to the professionals and not their patients.
Kwame Owino is the chief executive officer of the Institute of Economic Affairs (IEA-Kenya), a public policy think tank based in Nairobi.