Category Archives: Kenya Health Crisis

VIDEO: Nurses Union Officials TV Drama, A General MIA & Stephen The man

While we continue to urge concerned parties to alleviate the suffering of Kenyan, this must be viewed as an own goal by the nurses union officials in what is already a difficult task.

Barely a week ago, Dr. Ouma Oluga, the Secretary General of Kenya Medical Practitioners and Dentist Union (KMPDU)in a hard-hitting no chills Facebook post called out underhand government tactics when dealing with health worker’s strikes. During the 100 doctor’s strike, another Facebook post this time to doctor’s in their closed group- ‘leaked’ revealing the real battle union officials face when dealing with an insincere government.

Today, 12 days in, the Nurses union came face to face with the propaganda machinery of the government. Three gentlemen Bii, Maina and Musundi had gathered the press at Railway’s Club ostensibly to call off the nurses strike. Anyone who has been keen on the intricacies of the nurses strike knows to well that the three gentlemen are not nurses union officials and therefore have no legitimacy.

But to the suffering public, any semblance of reprieve would have meant the world. Especially if the general is away.

Nurses Union Officials. Or not? The Stars of the show

The Oscars of this Jerry Springer -esque  reality show by nurses union officials go to:

  1. Maina- For the sublime disappearing act.
  2. Stephen Rutere- It is Napoleon Bonaparte who said: “In politics, absurdity is not a handicap.” However crude his methods, Stephen Rutere achieved three things:
  • Strengthened the resolve of Nurses by his show of open body-in-the-line defiance.
  • In politics, it is said that you should never let the opponent have the headlines. American author Michael Shea, had this to say on how spin doctors achieve this, painting them as : “professional political strategists, able on behalf of their clients to manipulate the media – planting a story here, a rumour there, a tip-off somewhere else – so that any piece of news is tailored to show them in the best possible light.” With an unrelenting spirit, Stephen Rutere brought down the walls of government propaganda.
  • The fury of Rutere’s brand of PR that almost degenerated into a fist fight hands parties in the industrial dispute a place to pick up negotiations from. Thanks to Rutere, this is was a war with spoils, not a nuclear war where the victor emerges with nothing. For example, negotiations towards an amicable solution can start with recognition by both parties of persons X, Y and Z as the bona-fide individuals mandated to negotiate on behalf of nurses.

The Missing General: Seth Panyako

Where is Panyako ?

A Kenyan, Onyinkwa Onyakundi, had this to say:

“Any trade unionist worth the name ought to know that to mount a successful strike, their union may have all the right and justified grievances, the overwhelming support of their membership and everything else in place, but if they get the timing wrong, any decision to call the strike at that particular time will be regretted.

The teachers unions ~ for instance ~ know that strikes called just before the national exams, are a whole lot more successful than those called ‘off season’ because just before the national exams, all the ‘stakeholders’ are normally very attentive. That is why the nurses’ decision to go on strike when Parliament and the Council of Governors are too busy trying to get reelected to care, wasn’t a well thought out decision.

Even the President is too busy defending the IEBC’s decision to single source a company ~ that ‘Al whatever’ ~ associated with him to print ballots, to bother about them. All the senior civil servants at Afya House have been sent to their villages to carry out campaigns for the Jubilee Party as well. James Orengo whom Raila would normally task with the errand of releasing their union officials from jail should Jubilee decide to jail them is too busy campaigning for the Siaya Senatorial position.

Even their own union boss ~ Seth Panyako ~ is too busy campaigning for the Kakamega Senatorial position to focus. This one was not only an ill timed moved, but also an ill advised one. They better go back and attend to the ill ones.”


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Nurses Strike: KMPDU Secretary General, Dr Ouma Oluga, Calls Out SRC, Government on CBA

Ask Kenyan doctors. Going on strike in ostrich-head-buried-in-the-sand Kenya is a lonely affair. You get lambasted for demanding what is rightfully yours as a free men providing labor voluntarily. If the doctor’s strike is anything to go by, the just begun Kenyan nurses strike promises to be even more revolting. Blackmail is real as prosaic over night ethicists pelt you with stones over the tired duty vs. personal rights ethical trade off. When the people who matter do eventually speak, you wish they would have remained mum. To the blackmail, add blatant lies. And some buffoonery about SRC and CBA legality -I wonder what would make a CBA illegal given that is a negotiated document. Forced negotiations? Like the unions hold their employers at ransom? Lol.

During the 100 day doctors strike, KMPDU Secretary General Dr Ouma Oluga showed us his new Mau Mau revolution credentials. He spoke we got inspired. His voice didn’t shake while exposing government lies. He payed the ultimate prize and now Nelson Mandela’s 27 year old sacrifice is real. Now yet again, via his Facebook page, he reminds us of Martin Niemoller’s piece. With these words, Dr Oluga must have given Kenyan Nurses the props needed to survive the lonely path to emancipation.

When the Nazis came for the communists,
I remained silent;
I was not a communist.
When they locked up the social democrats,
I remained silent;
I was not a social democrat.
When they came for the trade unionists,
I did not speak out;
I was not a trade unionist.
When they came for the Jews,
I remained silent;
I wasn't a Jew.

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Dr Ouma Oluga: NURSES, DOCTORS, CBAs, SRC & PUBLIC SECTOR NEGOTIATIONS: THE UNHEALTHY CYCLE

Anyone who reads the constitution Article 230, Article 41, Labour Relations Act, and the County Governments act shall understand that misinterpretation of the law, health policy enforcement vacuum, unclear devolution policy and financial tensions between national and county governments coupled with weak leadership or a complete lack of that leadership are the main reasons why the Ministry of Health and County Governments are struggling to conclude simple documents called Collective Bargaining Agreements.

The impossibilities they both surmount on the paths of public sector health workers would make one think that these documents are some highly valued rare type of gold only found beneath the earth’s core.

Without crises such as strikes, many government officers are zombies who attend meetings just so they are not absent, collect per-diem where applicable or simply to say NO. At best they end the day with ‘I will consult’ while never really returning an answer.

They are not motivated at all to make progress. They don’t prepare for important deliberations with workers unions because they can always simply say NO. Many times, they can lock a meeting’s progress simply on the definition of the word ’employee’ or ‘intern’.

The unions are mostly prepared. Obviously because they are invested in the outcomes to make better the terms and conditions of work for their members. But this too causes a problem. The more a union is prepared with researched facts and policy and legal support on their positions, the more the counterpart negotiators (government) feel inadequate. Naturally inadequacy breeds protectionism and thence obstruction to progress.

So in very technical discussions concerning fundamentals of remuneration or even non-monetary benefits, the government officers often mumble the letters SRC in between their lack of attention.

Now let everyone understand that SRC are three letters every uncommitted officer throws around to hide their inefficiencies or simple not negotiate. The sad bit is that SRC has found a sweet way to use the blame on them to wield an ‘above-the-law’ kind of attitude, reluctance and power so that they suffocate workers. Lately, they even have found double speak comfortable. Giving contradictory advice to unions and completely the reverse to employers.

No court in Kenya can reject registering a signed CBA because it was outside the advice of SRC. SRC has no funds and SRC is not the Treasury. Once an employer is comfortable with budget provisions to pay or meet the agreement terms, SRC advice is nearly a rubber stamp. This in deed has been the case with some parastatals. But with health sector, employers would rather strikes and blame it on SRC.

The end result is that SRC causes more and more confusion wishing that Health Professionals shall forgo their constitutional rights to association, collective bargaining and the right to strike.

Long story short, SRC is not to entirely blame. MOH and County Governments remain the employers and must therefore take the responsibility of health provision including responding to their health employees’ needs. It seems though that they will do anything to pass that buck to SRC. SRC will do a poor job at defending itself and Labour Unrest won’t end until underlying issues I mention at the top are resolved.

Some few government officers actually hold permanent opinions that the suffering Kenyans would award the Government Grade A for being unmoved, non-responsive and or insensitive to the Public Health Sector. These opinions have often given rise to holy righteousness that patriotism cannot be expressed by pointing at the missteps and suggesting alternatives.

Can we now understand why 5 months after the Nurses should have signed their CBA, the country is still blame toasting? Do we now understand why it took 100 days of a strike for the government to commit to signing an already negotiated doctors CBA in 60 days and still fail to do so after their own request of 60 days?

This Feedback, particularly feedback on leadership and governance is usually unwanted and frowned upon. Feedback is punished by more delay or sabotage to unions.

And more and more the Health Sector becomes not only neglected but also mishandled to the peril of Wananchi. The one single problem with health sector in Kenya is no leadership. The second is devolution of health minus supporting structures and policies to guide how workers and finances are handled and protected.

So as Nurses keep away from hospitals, everyone wonders what’s the big deal about this SRC that it must take strikes to work. Surprise not, it take strikes for persons driving GOK fueled and maintained cars to report to their offices while Kenyans unnecessarily suffer the consequences.

Let me finish by telling Kenyans that denying populations health has occasionally been used as a means to dominance. But that story is for another day.

There is no excuse and there never was an excuse worth listening to and worth a strike for not signing and registering the CBAs for doctors and for nurses.

Dr. Ouma Oluga
Secretary General
KMPDU

Dr. Ouma Oluga’s Twitter Salvos

Negotiating with government is a #covfefe affair?

Kenya health crisis to get malignant? Doctors in line

Is SRC advice or lack of it to blame for endless retreats or is it malignant per-deism?


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Excerpts From Dr Ouma Oluga’s Address To Striking Kenyan Doctors Reveals Government’s Dishonesty

Who will listen to the cries of Kenyans? Who among our leaders will rise to the challenge presented by the striking Kenyan doctors? What is this CBA thing and why does the government find it so revolting?

You have to ask yourself why? Why for 95 days, Kenyan doctors have been on strike demanding registration of a CBA. A document negotiated and signed in 2003 that the government is now working so hard to disown, to the extent of admitting to the public treacherous ways, dishonesty and mafia-like tendencies.

Looking at the inforgraphic above, it is hard to envision how and why such a well thought egalitarian plan has precipitated a protracted health crisis that has seen needless loss of life.

In what must have been another frustrating day for the doctor’s union, KMPDU, secretary general Dr. Ouma Oluga addressed his troops in the fight for better public health care. Here are excerpts of his address to striking Kenyan doctors on their secret Facebook page:

360° VIEW: Striking Kenyan Doctors tall their Tale

  • Kenya Health Crisis: This Simple Analysis By Cape Town Based Kenyan Trained Doctor, Will Make You Understand Why Doctors Have Risked It All Since December Of Last Year Fighting For Your Health
  • #CBAforKenyans Check Out These Bad Ass Quotes From Striking Kenyan Doctors Union Officials That are Guaranteed To Raise Your Pulse Rate: “They Tried To Bury Me, But They Didn’t Know That I Was A Seed,”
  • KENYA HEALTH CRISIS: KMPDU Secretary General Dr Ouma Oluga’s First Speech Upon Release From Kamiti Maximum Prison On 15th February, 2017

Striking Kenyan Doctors Are Not In Fight With Government

This was simply a struggle to influence public policy relating to how WE
the Kenyan doctors engage our employer, the Government, and how our
Healthcare can be made to respond to each of our needs as citizens first
and then as Doctors second.

We approached negotiations with utmost good faith and obedience.
Responding to every call of meeting and staying late sometimes up to 3am
even after you advised us to keep it only up to 5pm. Because we
believed we could quickly come to an agreement and restore industrial
harmony.

What The Striking Kenyan Doctor is demanding: CBA

We did eventually talked and concluded the CBA. Yesterday, having
consulted NAC, we decided that the financial offer be put in the CBA
which then should be signed and registered.

And as fate would prove, the goalposts have shifted once again. The same CBA we revised for months should now wait another 30 days for signing and registration thereafter. The fact is no one wants you to have a CBA. Because a CBA is to a union what the constitution is to a country.

No one should never convince you that fighting for what is right is not
worth it. No one deserves your anger beyond the need to protect your
profession.

In All, Remember That Being a Doctor Is a Dignified

Finally, it is important to note that while the payroll and the hospital belongs to the government, your skill is selfishly yours. Use it to serve humanity in the best way possible. But let not you think that it must be forced on you to use it. Your skill as a doctor is what you provide as Labour. How much is it worth? Some dignity perhaps. Some respect certainly!

We await to conclude the signing of Recognition Agreements, CBA and then after RTWF as was guided by the Court of Appeal under the Mediation of Religious Leaders. We hope this shall be done soon.

Update 03/21/2017: It would be another five days away from the business of saving lives for the striking Kenyan doctors working in the country’s public sector. No sooner had the ink dried on the Return-To-Work-Formula (RTWF), than the battle grounds were again drawn.

It appears that to be a Kenyan doctor, entails perpetual striking as it emerges that the government had no plans of honoring the RTWF. Now the government talks of curiously importing doctors from a worse off Tanzania.

The doctors union, KMPDU, one not keen to let the forces against responsive public healthcare prevail have responded: They are not about to cower. They won’t let the bad guys win.


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Doctors’ Strike: Full Text Of Kenyan Government Statement that Critics label as Fundamentally Erroneous, Tyrannical and a Vicious Attack on Professionalism & Unionism

On the 94th Day of the crippling Kenyan Health Crisis, the president finally spoke. Whilst Kenyans had hoped for serene leadership, the Presidency chose to side with the Council of Governor who have been cited as being a hindrance to resolution of the doctors’ strike. This statement, has been labeled by commentators as tyrannical and insensitive to the plight of Kenyans.

360° VIEW: Related Reads on doctor’s strike

  • Kenya Health Crisis: This Simple Analysis By Cape Town Based Kenyan Trained Doctor, Will Make You Understand Why Doctors Have Risked It All Since December Of Last Year Fighting For Your Health
  • #CBAforKenyans Check Out These Bad Ass Quotes From Striking Kenyan Doctors Union Officials That are Guaranteed To Raise Your Pulse Rate: “They Tried To Bury Me, But They Didn’t Know That I Was A Seed,” 
  • KENYA HEALTH CRISIS: KMPDU Secretary General Dr Ouma Oluga’s First Speech Upon Release From Kamiti Maximum Prison On 15th February, 2017

JOINT STATEMENT BY THE NATIONAL GOVERNMENT AND THE COUNTY GOVERNMENTS. READ BY THE COUNCIL OF GOVERNORS CHAIRMAN PETER MUNYA IN THE PRESENCE OF H.E PRESIDENT UHURU KENYATTA IN NAIVASHA ON TUESDAY, 7 MARCH 2017

Fellow Kenyans; since the commencement of an illegal strike by a large section of the membership of the Kenya Medical Doctors, Pharmacists and Dentists Union (KMPDU) serving within the Public Sector, the Government of Kenya has made strenuous efforts to amicably resolve the ongoing impasse.This matter has been in discussion, for the last three months’, even as late as yesterday evening, where His Excellency the President and a number of governors together with religious leaders were in discussion till late into the night.The dispute has been before the Courts; which declared the ongoing Strike as illegal and ordered the Doctors Union Members to return to work.

Those orders were flagrantly violated by the leadership and members of the Union; leading to the Employment and Labour Relations Court (ELRC) extending the room for compliance numerous times. Eventually, and in order to uphold the sanctity of the Rule of Law, the leaders of the Union were committed to Civil Jail for Contempt of Court.

Various players have also been engaged in the Mediation process; including the Kenya National Human Rights Commission, COTU, the Law Society of Kenya and Religious Leaders. However, due to the hard-line position of the Union, which position has not moved an iota since last year, all these efforts have failed.

Further to the generous offer of 50% increment and as a sign of goodwill, an additional Kes. 600 Million was offered to the doctors by backdating the Risk Allowance to commence from July, 2016. In this regard the Doctors Annual Wage Bill as a singular budgetary item would be in excess Kes 14.5 Billion.

This additional offer was on condition that the doctors call off the strike and report back to work, this morning. Consequently for failure to call off the strike, the Government has now rescinded this offer and there will be no further negotiations on remuneration (salaries and allowances).

However it is now time for the die to fall as they may; and for each individual doctor, pharmacists and dentists within the public service to negotiate with his/her particular employer, be it the national government in the
case of those working in national facilities, or in the particular county government.

Following an extraordinary mini summit, the two tiers of government has resolved the following:

The Government’s Offer

Doctors who have and continue being on duty, will receive the Government’s Offer of new allowances with effect from 1st January 2017. Those Doctors who are on strike and who are willing to return to work are expected to resume duty at their respective Duty Stations with immediate effect.

Recall of Registrars & Intern Doctors

All postgraduate medical students (registrars) who are sponsored by the Government are to report to their respective duty Stations with immediate effect. Interns who are currently on internship are directed to report back to their respective internship centers with immediate effect, in order to complete their internship and facilitate registration by the Board.

Disciplinary Action

The National and County Governments and all other employers in the Public Health Sector to continue and conclude disciplinary process being undertaken as against absconding staff in order to facilitate filling of vacancies
that may be left out as a result of the disciplinary action.

Police Protection; and Criminal and Civil Liability

The National Police shall provide adequate security for personnel who have not gone on strike; as well as those who decide to return to work.

We recognize the continued contribution and support of faith based and private health facilities. Subject to the existing law, the government shall immediately review the registration and certification procedures for medical practitioners and the role of KMPDU in that process, with the view of reverting that function to the back to the Ministry of Health.

Every Doctor swears a solemn oath that they shall “Do No Harm.” Continuing with this illegal strike in the face of the enhanced Government Offer which is at the very edge of affordability and sustainability is to betray that solemn Oath. It is to DO VERY REAL AND CONTINUING HARM to the very same Kenyans whose sacrifice in terms of taxes paid for the medical training that the doctors received.

ENDS

Doctors’ Strike: Kenyans On Twitter React to Govt. Propaganda, Threats & Intimidation

Note to self: Don’t ever place yourself at a point where you are on this side and Kenyans on Twitter #KOT are on the other. During this doctors’ strike, the Kenyan government found itself perpetually on the other side of the line. #KOT made it rain on them!


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Public Health System: Designing Kenya’s Health System-Lessons From South Africa

With promulgation of  Constitution of Kenya 2010, observers expected Kenya’s new national covenant- hailed as the most progressive North of  the Cape of Good Hope in Southern Africa and South of  the Mediterranean-  to be a boon to Kenya’s public health system. We explore how this new, liberal, social contract sets the stage for revolutionizing Kenya’s public health sector, drawing our comparisons form the workings of  South Africa’s public health system, a system bed-rocked on another of Africa’s more progressive constitutional dispensations.

The highest attainable standard of health, is the ideal spelt out in Chapter 4 enshrining human rights in the supreme law of the land. This wasn’t empty rhetoric too, a Kenyan could seek redress in court if they had sufficient reason to believe the government was reneging on its end of the contract.

Besides, with introduction of the county governments services, money and the power to make decisions was now in the hand of the people in the devolved units. But it’s been everything but smooth sailing. Kenya’s public health system has intermittently coughed and ground to a halt  There has been a 100 day doctor’s strike. A nurses strike and skirmishes from other health cadres like clinical officers and medical laboratory technicians. Donor organizations like USAID have withheld funding over corruption and lack of funding.

But as Dr. Erick Wekesa Bunyasi, offers, the task is enormous, but necessary and achievable. A robust public health system remains our only hope he prays. In a November 2016 interview with the Financial Times ‘It was defiance’: an interview with Ngugi wa Thiongo, the good prof retorts:

[su_quote cite=”Ngugi wa Thiongo”]I’ve always made a distinction between what we ought to do and what we have to do.[/su_quote]

With this piece, Dr Erick Wekesa Bunyasi -Kenyan doctor studying, living and excelling in South Africa does what he has to do: his civic duty. What we all ought to. Daktari argues that the Kenyan government ‘ have to’ implement the CBA of 2013. A document that is a negotiated road map towards a public health system that will realize Universal Healthcare in Kenya.

Kenyan public doctors’ strike: a brief comparison of the Kenyan and the South African public health systems

Are Kenyan doctor’s strike demands unreasonable? Why would extremely intelligent, highly skilled,hardworking individuals risk income and imprisonment if not for a worthy course?

In South Africa (SA) it is called ‘Black Tax’. Simply put, this refers to the financial demands placed on individuals, usually Africans from constrained family backgrounds, when they finally ‘make it’ or obtain gainful employment and have to support relatives e.g. fundraising for astronomical or catastrophic medical costs or remittances to support relatives.

After my medical training at the University of Nairobi and internship I was posted to an ill-equipped district hospital; with limited lab capability, insufficient and often late supply of drugs and consumables, and was on a meagre salary of Kshs. 55,000 (in 2008). My work was reduced to referring patients for the most basic of tests and procedures that could be competently performed by a newly qualified doctor.

These factors, among others, led me to resign from public service within a year of completion of internship, a fate that many young Kenyan doctors resort to, and joined the Kenya Medical Research Institute (KEMRI).

Fast forward, I look forward to completing my PhD in about 18 months. I have been in SA for 5 years to pursue a master’s degree and then a PhD degree. The PhD is mostly funded by the South African government’s National Research Foundation (NRF) and the Department of Science and Technology (DST).

Despite being away from Kenya for more than five years now, my heart and mind never really left Kenya. I want my relatives and fellow citizens to have access to a functional, efficient and sufficiently staffed and resourced public health system.

I would also love to bring my skills back home, albeit in a functional set up where systems work, and additionally enjoy favorable terms of service. It is for this reason that I have not only closely followed and fervently supported the Kenyan doctors’ strike, but  also conducted  a brief comparison of key aspects of the South African and the Kenyan public health systems relevant to KMPDU’s Collective Bargaining Agreement (CBA) of 23rd June 2013. In summary, the doctor’s strike seeks to improve;

  • Working conditions, access,to equipment and quality of services in public hospitals.
  • Training, professional development and research by doctors.
  • Improve handling of human resource for health
  • Remuneration/terms of service of medical doctors

Other items of relevance to the Kenyan public health system;

  • Universal Health Coverage (UHC).
  • Health Service Commission (HSC). This was covered in the Musyimi task-force report.

What is in the doctors’ Collective Bargaining Agreement (CBA) for any Kenyan citizen or Wanjiku’

There has never been a better reason for mass action by Kenyan citizens than an 85-day doctor’s strike that has been mishandled by the government. Besides denial of access to constitutionally mandated highest attainable level of health care, Kenyans have been denied access to quality public health care via long-standing, systematic under-investment in the public health sector that has resulted in a poorly resourced and dysfunctional public health system.

Inforgraphic simplfying the demands of striking Kenyan doctors who assert that implementing the 2013 CBA guarantees appropriately equipped hospitals adequately manned by well trained, motivated and disciplined health professionals whose skills were equitably distributed across the country.Who can find fault with such a public health system?
This Inforgraphic simplifies the 2013 doctors CBA whilst drawing attention to the struggle it has been to get it operational as evident in the hashtags #CBAforKenyans #ImplementCBA #Lipakamatender #GovernmentOnStrike

If, God forbid, you or any Kenyan were involved in an accident in Lamu while on holiday, the immediate point of resort will be the local public hospital; long before transfer to ‘5-star hospitals’ that your limited insurance cover entitles you access to.

Therefore, my heart bleeds for my family and relatives back home with every passing day that the doctors’ strike remains unresolved.

Being a key constitutionally mandated service, failure to provide highest attainable level of healthcare for almost three months calls for resignation of concerned cabinet secretaries, principal secretaries and even the president.

The following are reasons why the current doctors’ strike is of relevance to you as a Kenyan. You stand to benefit both directly (better quality, cheaper healthcare), and indirectly (e.g. via reduction in ‘black tax’, ‘harambees’ for health care in foreign countries for family, relatives and friends), from a better resourced public health system if the government agrees to provide more resources for health such as drugs, equipment and other medical commodities.

Alma Ata Declaration

The government currently spends a measly less than 5% of its national budget or less than 6% of its GDP on healthcare against a recommended minimum of 15% for the former. Agitation for better public healthcare should be a struggle and concern of all Kenyan citizens, not just doctors. Kenyans need to stand out and be heard in constitutionally permissible protests &/or picketing.

You, and fellow Kenyans, will pay less in public hospitals, than private hospitals, for quality services if the government allocates more resources to the health sector.

Increase in number of doctors in public service will increase access to these key professionals by you and all other Kenyans. This will reduce waiting time for health consultation and procedures. It pains me that the government procured equipment worth Kshs 40 billion that lie idle in some facilities due to lack of expertise to use them yet it’s not keen to commit to training such personnel. The CBA fronted by doctors will cost roughly 8-12 billion, and will serve as a stimulus package to jump-start an abominably and chronically underfunded public health system.

Further training of medical professionals and research will increase access to their expertise in public facilities at a pittance of charges in private hospitals. Further training of doctors, as happens in internship, is done on apprenticeship basis and is fully paid in progressive health and education systems, including SA.

Increase in remuneration of Kenyan doctors will encourage more doctors to stick in Kenyan public service, unlike those like me, and roughly 4000 others, who moved South or North for better career progression and terms of service. Kenya is one of top six African countries in ‘exporting’ doctors: an unfortunate eventuality given dire shortage of this expensive human resource in Kenya.

A Brief Comparison of the South African and the Kenyan Healthcare Systems

Training, professional development and research

Research is heavily funded by the South African government e.g. it was easier for me to obtain a PhD scholarship from the SA government than the Kenya government. My PhD studies are largely funded by the South African government’s DST through the NRF.

The NRF gives close to 5000 new scholarships every year for PhD and Master’s Programs through various calls . These are targeted to projects that are of strategic interest to SA. This funding is separate from loans to students administered via ‘NaSFAS’  a body similar to HELB in Kenya.

Additionally,a dedicated body, The Medical Research Council  provides enormous funding to address the top 10 causes of ill health. The latter provides both career development awards and scholarships largely to doctors. In Kenya, KEMRI receives little funding from the Kenyan government. Most funding is investigator (PI)-obtained from Europe and US-based funders such as CDC, NIH, Wellcome Trust, and the Bill and Melinda Gates Foundation. For example, out of roughly 800 staff at KEMRI Kilifi in 2010 only a handful (<5%) were funded from funds obtained directly from the Kenyan government.

Healthcare, Security and Education are among the key services that need to be steered by any given government. As stated by Prof. Geoffrey Rose, and widely accepted in public health, the chief cause of ill health is social and political and so is the solution. Thus President Uhuru Kenyatta needs to provide direction and demonstrate leadership in this three-month-old health crisis. Strong health systems are not built by courts of law but by focused, concerned and visionary political leadership.

Unlike many professions, advanced training of doctors occurs by apprenticeship and is fully funded in most progressive health systems given consultants-in-training provide a service in excess of 160 hours per month and are a backbone of healthcare provision in teaching hospitals. SA most consultants-in-training or residents receive Kshs 400,000 unlike in Kenya where most do not receive anything, including a stipend. The Kenyan medics’ CBA proposes research funds, and paid residency positions, which is a norm in progressive health and education systems.

Remuneration

Poor remuneration that forces Kenyan doctors to ‘moonlight’ or do locums aggravates output of an insufficient human resource for health. Such doctors have to work many hours, endure burn out and have little time to rest, have more profound social life and pursue other interests, research and continuous education which is key in the practice of medicine.

Kenyan medics’ CBA does not call for a 300% payrise of gross salary as erroneously and widely reported in media. An increase of a salary from Kshs 127,910 to Kshs 325,730 cannot be a 300% increment by any economics, especially after adjusting for inflation.

A medical officer intern in SA public service receives a monthly starting salary of an equivalent of Kshs 235,000-300,000, as compared to Kshs127,910-149,880 in Kenya currently and the union’s proposed Kshs 325,730-342,770 pm. In SA, this increases to Kshs 350,000 to 400,000 on promotion to an entry-level medical doctor, against Kshs135,590-168,840 in Kenya currently and the union’s proposed Kshs. 369,770-389,570.

Out of public service, medical doctors [general practitioners] enjoy a starting salary of between Kshs. 400,000-600,000 depending on employer e.g. the University of Cape Town just advertised such a position for Kshs 441533 per month.

Senior consultants and professors on joint University of Cape Town/SA Department of Health tenure earn roughly Kshs 800,000-1,200,000 pm, excluding other income from leadership roles or undocumented consultancy. Kenyan medics of equivalent training and experience earn between a third and a half as much. The union’s proposal is a salary of Kshs. 402,570-946,000pm.

Currently SA loses its doctors to UK, Canada, Australia and the USA. For example in Canada and UK a consultant doctor earns up to 3-5 times and 2-3 times as much as in SA, respectively. Thus, the demands by Kenyan doctors’ union compare well to the practice in SA, barring comparison of the two economies.

Underpaid

Given the lower doctor-to-patient ratio in Kenya and worse maldistribution of doctors across Kenya, Kenyan doctors no doubt work more hours, are underpaid, and are exposed to extraordinary risks in chronically and severely under-resourced environments. When dealing with a scarce critical resource, effort should be made to keep rather than to let go of the resource, some of which is trained at tax-payers expense. Retention is required more so in public hospitals that serve 99% of the population, than private hospitals that serve 1% of the population. I therefore beg to disagree with CS Rotich on this.

The Kenyan government has capacity to honor the CBA given this will require roughly Kshs 8-12 billion commitment in a country with an annual budget of Kshs. 2.6 trillion and given Kenya spends <5% of its national budget on healthcare [this is 11%for SA] against a recommended 15% as committed by Kenya, which is as a signatory to the 2001 Abuja declaration Parochial business interests particularly linked to the health private sector hospitals’ monumental profits and insurance given the longstanding neglect of Kenya’s public health sector and may be barring progress in current negotiations. For example, NHIF pays Kshs 33 billion to private hospitals serving 1% of Kenyans and only Kshs 5 billion to government hospitals that serve 99% of Kenyans.

Universal Health coverage

Universal health care refers to a health care system that provides equitable, highest possible quality, sustainable health care that confers financial protection to all citizens and households in a country. Countries that have made significant strides towards UHC such as Thailand and Cuba are not the richest.

Achievement of greater strides towards UHC is possible in Kenya but this will require strengthening of the NHIF, the public health system and a carefully designed and aptly managed healthcare financing mechanism. This will inevitably require efficiency in use of current resources dedicated to health, generation of fiscal space for health and, inevitably, progressive increase in healthcare financing.

South Africa is yet to achieve UHC, but the legislation and debate is ongoing and at an advanced stage. Nonetheless, health facilities are better equipped. This is hardly surprising given SA in 2012 spent 8.8% of its GDP on healthcare, against Kenya’s <6%. The Musyimi taskforce report proposes increased funding and better management of health workers. Increased funding will jump start a fledgling health system that has been chronically neglected and underfunded.

Human Resources (read medical doctors for this review) for Health

Kenya has roughly 3,956 medical doctors in public service and roughly 8,000 overall [against SA’s 38,236 medics]. Kenya and SA doctor/patient ratio is 1 doctor/6250 and 1 doctor/1300 individuals respectively. Kenya would require at least 34 years to meet the recommended doctor-to-patient ratio of 1-1.5 doctors/1000 individuals or a total of 44,350 doctors. This assumes a continuation of the current annual training output of 600 medical doctors, that all graduating doctors are employed in Kenya, and that all of them are equitably distributed and none either emigrates/resigns to pursue non-clinical interests. Only 5 countries – Seychelles, Tunisia, Libya, Algeria and Mauritius- have the recommended doctor/patient ratio in Africa.

Health Service Commission (HSC) and National Laboratory Service (NLS).

Given the outcry of tribalism, nepotism and cronyism in management of doctors by some counties, a body equivalent to the Teachers Service Commission or the Judicial Service Commission will greatly improve management of human resource for health.

Counties could continue providing drugs, commodities and health infrastructure but have the financial burden of paying health workers and their management conducted by a HSC. If the HSC is funded by treasury, this will free fiscal space in counties to which could be dedicated to provision of drugs and other supplies.

Governors should support doctors’ demands and compel treasury to provide additional funds for healthcare. This will, most importantly, enable counties to provide better quality health services. At a personal level, this will give governors a higher political rating/appeal that will enhance their re-election. South Africa doesn’t have a central body that manages health workers.

However, given the above misgivings, it will be profoundly useful to have professionalism seen in management of teachers or judges, emulated in health resource management via establishment of a HSC as recommended in the Musyimi Task Force report. A dedicated central body focused on lab services, like SA’s National Health Laboratory Service, could prove pivotal in improving laboratory services that are key in health practice.

About the author: Dr. Erick Wekesa Bunyasi is a Kenyan-trained Medical Doctor and now a PhD student at the University of Cape Town’s Institute of Infectious Diseases and Molecular Medicine. His PhD studies are largely funded by the South African Government.


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Kenyan Doctor’s Strike: These bad ass quotes from brave KMPDU officials are guaranteed to get your pulse racing

Today , Feb 22 , 2017 marks day 80 of the nationwide Kenyan doctors strike. It marks the day when Kenyan parliament (rather late) made an attempt at alleviating the misery, indignity and irreplaceable loss that majorly poor Kenyans have suffered over close to three months. Led by the indomitable, Dr Ouma Oluga, KMPDU officials alongside other stakeholders came before the parliamentary health committee to weigh in on a petition filled by the union a fortnight or so ago.

The injustice of lack of public health care

Rather disappointingly, the August house appeared to get lost in the semantics of the legality of the 2013 CBA. In doing so, they effectively absconded their primary duty of representation. This unfortunate abdication of duty is evident in the butchering of justice- at the alter of sideshows- in the dignified halls of the Kenyan parliament.

We saw a high ranking government official- as former Permanent Secretary Mark Bor currently serves in the KNH board- admit to major crimes just to subvert the course of justice. Justice for the doctors as providers of labor as free men; justice for Wanjiku as she suffers being denied healthcare and injustice to any the well meaning Kenyan tax payers.

I want to believe that there are those serving in government who would want to amicably resolve the impasse, but are under the clutch of #HealthCartels. A confluence of private interests who stand to lose with better equipped, better funded and motivated public health sector in Kenya.

While we ask “Where are you Mr. President ?” Kenyans continue to light candles tonight in prayer motivated by the words, actions and selfless sacrifice of KMPDU, (Kenya Medical Practitioners Pharmacists and Dentist Union) officials. In these words champions for universal healthcare are motivated. Doctor’s and health professionals all over the world burdened by the call to duty find solace. As Kenyans, we see souls dedicated to justice in a land crying out for servant leaders. Humanity sees that the path towards universal healthcare lies in unity, professionalism, courage, unionism, sacrifice, empathy and defiance.

Dr Ouma Oluga, Sec. General KMPDU on  health reforms

It is our unity that shall form the springboard for further health reforms which we urgently need. Let’s not yearn for the rotten status quo. We can’t afford to embrace our rejected past.

-Dr Ouma Oluga, Secretary General, KMPDU

KMPDU, secretary general on unveiling a new dawn for Kenyan health sector

Dr Mwachonda Chibanzi’s Patriotic call to nation servant hood

Mimi daktari wa Jamhuri ya Kenya, naapa ya Kwamba nitalinda kazi yangu, kama nilivyokula kiapo kumlinda mwananchi. Ewe Mwenyezi Mungu nisaidie. (I, a doctor in the republic of Kenya, swear to protect my profession, in the manner I swore to do no harm in the Hippocratic oath. So help me lord.)

-Dr. Mwachonda Chibanzi, Katibu Mkuu (Deputy Secretary General), KMPDU

KMPDU, deputy secretary general on nobility of the medical profession

Dr Samuel Oroko, Chairman KMPDU  On Rising To The Challenges

We have proven to the whole world that doctors united shall never be defeated. That WE the doctors can determine the model and direction of health care in the country. Indeed we are very powerful. A time has come that we must make good use of our power-power to ignite the fire of change.

-Dr. Samuel Oroko, Chairman, KMPDU

KMPDU, Chair on doctor's role in health care system design

Dr Allan Ochanji channels the spirit of the likes of Ken Saro Wiwa

When the union’s inspiration through the workers’ blood shall run, there can be no power greater anywhere beneath the sun…FOR THE UNION MAKES US STRONG!

-Dr. Allan Ochanji. 2nd Vice Chairman, KMPDU

KMPDU, Vice-chair on unionisim

Dr.Titus Ondoro on Purpose

My belief of existence with a purpose is being realized. We will persevere to the bitter end, even if we will sacrifice our freedom to effect the change we deserve.

-Dr.Titus Ondoro, 1st Vice Chairman, KMPDU

KMPDU, Vice-chair on sacrifice

To the downtrodden, Dr. Daisy Korir, KMPDU Treasurer, has got your back. Justice is coming tomorrow

We want everyone in the villages to access the same high quality care as those in Nairobi.

-Dr.Daisy Korir, Treasurer, KMPDU

KMPDU, Treasurer on healthcare access

 Dr Evelynn Chege, finds solace in a Powerful Mexican Proverb

I was told prison is like a hospital, anyone can enter…I have a small memento that I kept to always remind me that they tried to bury me, but they didn’t know that I was a seed.

-Dr Evelyen Chege, Deputy Treasurer, KMPDU

KMPDU deputy treasurer on prisons being like hospitals


KENYA HEALTH CRISIS: KMPDU Secreraty General Dr Ouma Oluga’s First Speech Upon Release From Kamiti Maximum Prison On 15th February, 2017

With the sun setting ushering another African night in dry windy February, a prison shaven unshaken, Dr Ouma Oluga, charismatic secretary general of the Kenya Medical Practitioners, Pharmacists and Dentist Union (KMPDU), stepped out of Kamiti Maximum prison gates in a suit, stripped shirt, no tie & in characteristically infallible mood to find the press waiting.

By the 73rd day of Kenyan doctors strike a lot had come to pass. There was a full blown propaganda war raging on in social media #LipaKamaTender #CBAismorethancash #CBAforKenyans. Lives had been lost. Kenyans had suffered indignity. The government remained obstinate.

Industrial court Judge Hellen Wasilwa, in a judgement that drew wide spread condemnation for partisanship and ignoring the spirit of the law in favor of the letter of the law, had sentenced seven doctor’s union officials #CBA7 to thirty days in prison. Such injustice meted on young professionals of the highest standing for demanding a better work environment. All this in fulfillment of a diversionary contempt of court case filled by the council of governors.

KMPDU officials celebrating with Kenyan doctor's upon release from prison during the 100 day Kenyan doctor's strike. Dr Ouma Oluga is back row second from right
KMPDU officials (back row clad in white t shirts) at Uhuru park upon release from various prisons

Of that 30 day prison sentence, KMPDU officials: Dr. Ouma Oluga, Dr. Samuel Oroko Obegi, Dr. Allan Ochanji, Dr. Titus Ondoro, Dr. Daisy Korir, Dr. Evelynn Chege, Dr. Mwachonda Chibanzi; had served 2 days thanks to an appeal at the court of appeal. Backed by senior counsels and eminent lawyers working pro Bono: Messrs James Orengo, Mutula Kilonzo Jnr and Phillip Murgor, KMPDU officials boxed opposing (council of governors) lawyers to agree to unconditional, immediate release in favor of a return to negotiations.


More On Kenya Health Crisis


Dr Ouma Oluga – The Moran

Masaai Morans, warriors, are courage. To be a leader among the brave, you have to slay a lion with nothing but a wooden club and a spear. Here, we celebrate them as they come. As they slay poverty, ignorance, disease. When they lift their voices where it’s easier to be silent. As they risk it all: blood, sweat, tears and life for others not their kin.

MMIMMC, celebrates 21st Century Morans. Dr Ouma Oluga and the #CBA7 are of this rare extraction. Here is a speech reported to be by KMPDU secretary general, Dr. Ouma Oluga upon his release from Kamiti prison.

I don’t know if the court has gained dignity. It’s been quite an experience. This hasn’t changed OUR resolve and push for what the doctors want. In fact for OUR coming here alone, that should grant liberation to Kenyans and what the doctors wanted. This is the CBA for all Kenyans. Thank you the media for highlighting our coming here and keeping Kenyans updated. Grateful to the prisoners who’ve been my colleagues for the past few days. Not everyone here’s supposed to be here- there are people here who’ve not broken any laws but are here and it’s sad.

To the Justice system: do not put yourself where you can be undermined by being used to cause suffering. There’s no law that’s superior to human life. Human life here means the lives of all Kenyan citizens, especially those that depend on the public healthcare systems.

I have no wealthy background. The conditions here is the life that am used to. The prisoners here are suffering a pain that no one deserves. Not anyone. The first night I slept in the hospital attending to fellow prisoners here. Yesterday I did my first ward round in the hospital here. If I’d remained here I believe I’d have continued to assist in doing the same, because that’s what am trained to do, with conviction.

In prison I was taken care of in a way much better by fellow prisoners than the way the government has ever taken care of me. If you thinking coming here will break the heart and resolve of Dr. Ouma Oluga. As I’ve been here I’ve been thinking about leadership in this country and what we need to do to move forward. There’s been foolishness in this country and I hope we can overcome this to get a solution.

I missed everyone!

Dr Ouma Oluga is the Secretary General of the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU). A man of impeccable character and charisma who rose from humble beginnings in Siaya to earn his place among greats like professor Miriam Were as Kenya’s foremost champions of universal health care.


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