Fulfil broken promises to end the healthcare crisis

Just as an individual cannot lie his way into good health, a country can never deliver the promise of universal health coverage (UHC) without adherence to sound policy and strong strategic plans implemented to the letter. Yet Kenya’s health sector is broken.

The healthcare crisis is a multifaceted issue, affecting the critical foundational pillars of which our health system stands, human resources for health, healthcare financing, healthcare governance and commodity management. These issues are pertinent and long-standing policy concerns.

The ongoing doctors’ strike is an example of what has historically plagued the health sector. There is a dire need for these perennial matters and concerns to be fully addressed to maintain industrial harmony. Service delivery will not happen when the other building blocks of the health system are not solidly in place.

The international health community is becoming increasingly concerned about healthcare worker (HCW) strikes due to their effect on healthcare service delivery. In a lower middle-income country (LMIC) such as ours, issues of policy, governance, human resources for health management and respect for the medical profession seem to be dominant underlying issues leading to industrial action.

A good example is the reality concerning inadequacy in the number of practising doctors. Despite having 15,000 medical doctors and dentists in the country, a mere 10,000 are registered to practise with only 5,000 on the official payroll. This highlights an alarming gap between the available medical workforce and the needs of our population.

According to World Health Organization (WHO) standards, “a ratio of one doctor per 1,000 populations is considered optimal for effective healthcare delivery”. But ours is at a staggering 1:11,000, indicating a severe shortage of medical professionals. That not only strains the capacity of healthcare facilities but also compromises the quality of care.

Among the matters of major concern is that the dignity of doctors, harmony and, more importantly, health as a public good enshrined in Article 43 of the Constitution and the various international obligations made must urgently be given the attention they deserve for the health sector to deliver the services the populace need.

It is critical that the Health committees of the Senate and the National Assembly and other stakeholders urgently find a lasting solution to the seemingly never-ending crisis in the health sector that has grave consequences to the people.

Notably, the signed CBA of 2017 that was birthed to address a number of these perennial issues has not been fully implemented. Secondly, the medical internship posting and pay is crucial as they play an integral role in our healthcare system.

There is a need to distinguish these junior doctors from other interns in the public service. Besides working beyond the legal limit of work hours, they endure exposure to life-threatening occupational risks as seen during the Covid-19 pandemic.

It is imperative to assess and harmonise the overall health sector governance, especially as regards human resources for health. Disparities, including between the national and county governments in relation to employment, posting and training of the health workforce, have resulted in some populations being affected by the facets of inequalities, which stand against the spirit of UHC.

In addition, the current regulatory structure interferes with the critical quality training of medical professionals. The failure to plan and lack of qualified supervision of the training institutions is a major concern.

The other main building blocks of a functional health system—such as medical supplies(KEMSA), health financing (Abuja deficit and NHIF/Shif), and governance are always foci of crisis after crisis. This is compounded by the corruption that plagues the health sector with successive ministers of Health vowing to end it but don’t.

The impasse between government and healthcare workers is unsustainable and must be resolved swiftly. But we must avoid quick fixes and commit to long-term reforms that fundamentally transform our healthcare sector into one that values the dignity of the medical profession and prioritises the well-being of all Kenyans.

- Dr Aluoch Joseph, Dr Bill Lore, Dr Khama Rogo, Dr James Nyikal, Dr Andrew Suleh, Dr Elly Nyaim, Dr Jacqueline Kitulu and Dr Were Onyino are members of Past Presidents Caucus of the Kenya Medical Association (KMA), the umbrella professional association for doctors in the country. [email protected].