Stop turning a blind eye to health system problems

Mombasa County health workers

Mombasa County health workers demonstrate along Nkrummah Road.

Photo credit: File | Nation Media Group

What you need to know:

  • Our health services have suffered blow after blow of gross mismanagement.
  • We have put up with this gross inefficiency and continually accepted it until we no longer recognise a functional public health system.
  • It is time to make a new year’s resolution to put a stop to the systematic dismantling of a public health system.


Dr Bhusa* was a work of art.

He showed up at work after 10 o’clock every morning reeking of alcohol, walked through the hospital wards in the name of doing a ward round, sat in his office for an hour to take a quick breakfast and sign whatever was placed in front of him by the hospital administrator and then walk across the road to the chang’aa den to ‘start’ his day.

This was 2003 in a small district hospital in Kenya. The hospital was small but very functional, having benefited from the ‘Nyayo’ era renovation, with a fully-fledged operating theatre, and a 67-bed capacity in-patient unit and a robust outpatient department. Dr Bhusa was the sole medical officer, also functioning as the medical superintendent.

The outpatient units functioned with great efficiency, with dedicated nurses, midwives, clinical officers and pharmacy technologists. The in-patient services were struggling without adequate support from the sole medical officer, resulting in very low bed occupancy rates. The theatre was grossly underutilised as many a times, when Dr Bhusa was called upon to do an emergency surgery, he was too drunk to be of use.

Tolerate incompetence

The story of Dr Bhusa was retold to us by the serving medical superintendent two years later when, as students on attachment at the hospital. We were expected to learn both clinical and health management skills and this was a classic example of how a failed management could greatly undermine clinical service delivery.

Dr Bhusa’s reign lasted two long years, abetted by the same community he served. Those seeking services knew they were getting the raw end of the stick but they chose to look away and ‘cover up’ for their own. Whenever complaints arose about Dr Bhusa’s alcoholism and failure to effectively deliver on his mandate, the elders would say Dr Bhusa was one of theirs and they could not expose his weaknesses to the world.

One afternoon, the village chief’s wife was in labour. She was brought to the hospital and the midwives noted that things were not going well and she needed an urgent caesarian section. Unfortunately, the ambulance was unavailable as it had transferred a patient with a spinal injury to the referral facility almost 200km away.

Dr Bhusa was literally dragged out of the chang’aa den to save the lives of the mother and baby. This did not end well and the mother and baby died. Months of tolerating the incompetence of one of their own had come back to bite. The price paid was too steep.

The following week, Dr Bhusa was diagnosed with alcoholism and admitted to a rehabilitation centre. Meanwhile, two new doctors were posted to replace him.

Looking at the state of health right now in Kenya, I am reminded of Dr Bhusa’s story. Our health services have suffered blow after blow of gross mismanagement from the top for the past seven years. As a people, we have put up with this gross inefficiency and continually accepted it until we no longer recognise a functional public health system.

We have everything we require to run an efficient health system but we have instead stood by and permitted gross looting of our health resources, with scandals robbing patients of billions of shillings. We have watched as gross wastage of resources continues to take centre stage.

Smear campaign

Today, in the middle of a pandemic, we have health workers on strike while our government goes about issuing threats and wastage of even more resources on smear campaigns against the health workers.

What is our breaking point? What else do we need to lose before we agree that our leadership needs to ship out? The striking health workers are telling us just how bad the situation is within the sector, but we have been indoctrinated into believing that strikes are about money, hence these workers are just being greedy.

Let us dismantle this propaganda right now. If the system worked right, there would not be any reason to protest. It takes an extremely callous government to permit outright corruption and theft of public health resources at such a delicate period.

Dear Kenyan, it is not “Feliz Navidad” this year; it is time to make a new year’s resolution to put a stop to the systematic dismantling of a public health system that 90 per cent of us fully depend on.

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