This week, the news has understandably been dominated by the countrywide strike by health workers. On Monday, doctors and nurses across the country stayed away from work in protest at the government’s failure to implement a collective bargaining agreement signed in 2013, which was meant to govern their pay and conditions of service. The strike has thrown an already rickety health system into chaos and contributed to the deaths of several patients and heartbreaking scenes of desperate suffering at health centres.
It is not the first time public health workers have walked off the job. In recent years, the health sector has been plagued by strikes. In December 2011, hundreds of doctors marched through Nairobi streets to demand a larger stock of drugs in hospitals, better equipment and better pay. Three months later, in March 2012, and again in September 2012, they again laid down their tools to demand government spends more money on health services. Similar strikes followed in December 2013, August 2014 and August 2015.
Throughout, the main focus of media reporting has been on the demands for better pay. Little attention has been paid to the complaints over working conditions and the terrible state of the health system in general.
As I noted in this column more than two years ago, according to the 2013 Kenya Service Availability and Readiness Assessment Mapping report, the country’s first attempt to get a comprehensive picture of the health sector, less than six in 10 of all health facilities in the country are ready to provide the Kenya Essential Package for Health — a sort of standardizsed comprehensive package of health services. Less than half have basic amenities and while two-thirds have half the basic equipment required, 59 per cent do not have essential medicines. Only two per cent of facilities are providing all KEPH services required to eliminate communicable diseases.
Further, as reported by The Star last year, the WHO Global Atlas of Health Workforce identifies Kenya as having a “critical shortage” of healthcare workers since Independence. While the World Health Organisation has set a minimum threshold of 23 doctors, nurses and midwives per population of 10,000, Kenya’s current ratio stands at a mere 13. Yet, according to one 2008 paper, the irony is that there is a large pool of trained, unemployed health workers available, but the process of recruitment is cumbersome.
Despite the government trumpeting its free maternity programme, maternal health is still in the doldrums. In fact, Kenya is still one most dangerous countries to be pregnant and to give birth. Nearly 8,000 women die every year due to pregnancy-related complications, while a fifth of babies don’t live to see their fifth birthday. And then there are the scams, such as the recently exposed Mafya House Scandal where fraudsters have siphoned off up to Sh5 billion via questionable deals or the prevalence of fake doctors.
Devolution has undoubtedly brought health services closer to many who were previously left out, but even here, problems abound. These range from allegations of tribe-based hiring of doctors and questions over the efficacy of county spending plans to the national government foisting medical equipment on reluctant counties lacking the capacity to utilise it. There are also massive inequalities in access to healthcare facilities and in staffing which manifest in statistics such as a third of counties being responsible for 97 percent of all maternal deaths.
The fact is, even before the current strike, Kenya’s health sector was already in a state of crisis. It will not be cured by appeals to patriotism and fellow feeling or even solely by paying our doctors better. Rather than merely addressing the symptoms of decay, Kenya needs a sober examination and diagnosis of the underlying systemic and structural illness afflicting its health system. Then a similarly credible set of proposals to cure it. The campaigns that are underway for next year’s elections provide the perfect opportunity for Kenyan media and society to force the political class to do both. The question is: Will we take that opportunity? Or will we continue acquiescing to management of health by crisis?