Nurse exports will derail health

Qabare Wario (right) one of the 19 nurses in the first cohort deployed to the UK receives a flower and gift from Health Cabinet Secretary Mutahi Kagwe (Second left), British High Commissioner to Kenya Jane Marriott and Ministry of Health Principal Secretary Susan Mochache.

Photo credit: Dennis Onsongo | Nation Media Group

Last week, at a ceremony attended by Health Cabinet Secretary Mutahi Kagwe and British High Commissioner Jane Marriot, the first group of nurses from Kenya were flagged off to travel to the United Kingdom to start work.

According to Mr Kagwe, most of the nurses being exported are jobless. He was quoted as saying that, “as a government, we wouldn’t wish to see our many trained nurses jobless when they are critically needed abroad”.

It was reported at the event that 11,000 nurses graduate every year in Kenya. So why has there been a shortage of nurses in Kenyan public hospitals with these number of unemployed nurses about? Secondly, how could the CS be proud to export nurses when there is a shortage at home?

First, my experience with nurses. When my mother [who has since died] was admitted to Coast General Hospital, one thing was glaringly obvious: shortage of nurses. As family, we had to nurse her ourselves, risk to patients and infections notwithstanding. The same applied to other families.

The only time a nurse appeared was to give medication, IV or blood or dress a wound. If patients turned up without relatives, chances were they wouldn’t have anyone to help them with personal care, including feeding.

The situation at Accident and Emergency and the triage wards were dire. Patients who fell on the floor or soiled themselves would remain in that state of indignity for hours because the nurses were insufficient to help them. Indignity and lack of nurses is what I witnessed. Dignity and nursing go together!

As Kagwe shamelessly gloats about the fact that Kenya intends to send more nurses abroad—to countries such as Kuwait, UK and Italy—care and dignity in our public hospitals are threatened by shortage of nurses. He also talked of setting up a task force to recruit nurses for other countries and plans to establish a health attaché at Kenya’s embassies and high commissions.  He was further quoted as saying these steps seek to bolster universal health coverage (UHC) in Kenya.

I’m confused and appalled to think that the CS thinks the best way to build our healthcare system is to take away nurses from it than employ them to build enough capacity. The countries asking for nurses are not operating at below our capacity; neither do they have their patients facing the poor healthcare that Kenyan patients face at home. The intention of developed countries asking for nurses is to maintain high standards in their health sector commensurate with requirements of the World Health Organization (WHO). Most of them are not listed as amber or red.

Nurse-to-patient ratio

The nurse-to-patient ratio in the developed countries is much lower than ours. Developed countries ask for nurses from developing countries to build their health sector. How that is meant to help poor countries with moving their nurses abroad is a myth.

Kenya, incidentally, is on the amber list of countries WHO deems to have public healthcare system that is ‘vulnerable’. The UK stopped recruitment of nurses from Kenya in 2021 due to Kenya’s amber listing. UK’s Department of Health announced that it had stopped hiring jobless nurses from Kenya, citing “an existing labour shortage of the health workers” in Kenya.

Even if the agreement to export jobless nurses is a government-to-government agreement, it does not take away from the fact that it contributes to brain drain and starves Kenya’s public health sector of key medical personnel required to drive UHC at home. We need nurses and doctors now, not in 10 years.

If the government took its thinking away from private hospitals—at which the top officials are treated—and critically assessed the situation in public hospitals, they’ll realise that we have a bigger need for nurses and doctors than they know.

We also need to question why there are jobless nurses in Kenya in the face of shortage in public hospitals. If the training of nurses was commensurate with the needs in the healthcare market, Kenya would have all nurses employed to achieve the WHO’s acceptable nurse-to-patients ratio.

What Kenya is saying is that they train nurses for markets abroad at the expense of a local health sector that is seriously starved of nurses itself. If there are billions of shillings in taxpayers’ money given to church groups and football clubs for votes’ sake, surely, there should be money to employ enough nurses in the country.

We can’t ignore the fact that corruption in the devolved units has led to lack of funding for local health facilities and, consequently, made them unable to recruit the nurses so desperately needed; hence the need for a genuine corruption fight.

The government needs to rethink the export of nurses if it’s serious about building UHC. That is how the country would get out of amber listing to green. As for medical tourism in a poorly supported public health sector, it can only be a fantasy!

Ms Guyo is a legal researcher. [email protected] @kdiguyo


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