By Bosire Boniface in Garissa
Monday, March 31, 2014
Public hospitals in Kenya are struggling to provide life-saving medical services to a large, mostly poor population of patients, as the standoff between county governments and doctors over the devolution of health services continues.
Since September, 201 doctors have resigned from public hospitals in protest over how "the devolution of health services to county governments has been fraught with mismanagement, nepotism in the hiring of new doctors, frozen promotions and reduced or delayed salaries," said Sultani Matendechero, secretary general of the Kenya Medical Practitioners and Dentists Association.
"Late last year we went on strike pressing the national government to reverse the transfer of salaries and the entire management of health services to the county government," he told Sabahi. "The resignations were the last resort after our numerous pleas were not heeded."
Twelve doctors resigned between September and January, and from February 1st to March 15th, another 189 doctors submitted their resignations, he said.
"
Victims of an attack on a church on March 23, 2014, wait to receive treatment at a hospital in Mombasa. The resignation of 201 doctors over the past six months has impacted patients in all of Kenya's 47 counties. [Stringer / AFP]
The doctors [who have resigned] are not against devolution, but we want a proper process to be in place before transfer of management," he said, adding that they may reconsider returning to work if their demands are met.
At the heart of the problem, Matendechero said, is the fact that the devolution of health services did not follow the constitution, which requires the process to be implemented gradually over three years.
Management of non-medical staff was supposed to be transferred to the county government over the first two years, whereas management of technical staff -- including doctors, nurses and pharmacists -- was to be handed over the in the second phase, he said.
"What has happened now is that the entire staff has been handed over to the county in less than a year, creating a mess," he said, adding that the county governments, with less than a year under their belt, have no capacity to manage medical services yet.
The resignations have impacted most of Kenya's 47 counties, with Embu County the hardest-hit with 16 doctor resignations, followed by Nairobi County with eight and Kakamega County with five, according to Matendechero.
Embu County hiring doctors
Embu County Governor Dorothy Nditi said the doctors' resignations were regrettable but offered a chance for the county to hire new doctors who are truly committed to their work.
"We will not be held at ransom," she told Sabahi. "Some of the doctors who have resigned were drawing salaries for services they never rendered. Some are the ghost workers we wanted to weed out in the first place because they were drawing salaries yet they never reported for work."
"Devolving health services is crucial because it gives county governments the opportunity to closely supervise the health workers, which the national government was unable to do. Those who have resigned are afraid of supervision," she added.
Embu County has started advertising for the vacant positions and is asking the remaining doctors to work extra shifts, Nditi said.
"Patients are suffering because the doctors have absconded, but we are doing everything to reduce the suffering," she said.
Cabinet Secretary for Devolution and Planning Ann Waiguru said the government was opposed to the strike.
"The doctors should have waited for the determination of the court case they have filed challenging the devolution before taking the drastic move," she told Sabahi.
The doctors' walkout is particularly affecting Kenya's poor population who cannot afford private healthcare, she said.
"Some counties only have three or five doctors. Resignation of even one doctor definitely puts a strain on patients seeking public health services," Waiguru said. "It is unfair, but we are hoping to find a lasting solution by holding dialogues with the doctors' representatives."
Wajir residents suffer from strike
Miriam Ali Hussein, 32, a resident of Wajir, said she took her 4-year-old son suffering from pneumonia to Wajir District Hospital unaware that the two doctors serving the county had resigned.
"Normally, the services at the hospital are not good because the two doctors are overwhelmed," she told Sabahi. "Now that there is no doctor, it is a bigger problem."
Hussein said her neighbours came to the rescue, helping to raise 5,000 shillings ($60) to pay for her son to receive treatment at a private hospital.
"If the doctors do not rescind their decision and if the county government does not hire replacements, then ordinary citizens will suffer," she said.
Doctor Ali Amin Adan, one of the two doctors who resigned from Wajir District Hospital, said he felt compelled to resign because of what he called "meddling" by county officials.
"It is demoralising to work in an environment where people think you are doing nothing," he told Sabahi. "The allowances we are entitled to, like [uniforms], have been withdrawn. Normally the working hours were eight unless an emergency demands one to extend it or one is called in to perform an emergency [operation], but the county government wants us to work for 12 hours straight."
Wajir District Hospital Medical Superintendent Adan Khalif said the medical workers who have not resigned are continuing to work out of a sense of duty.
"There will be unimaginable problems if we all resign," he told Sabahi. "There is a massive backlog of cases, but I am trying to plug in by putting in more extra hours."
"There are problems that doctors are facing with the devolution [process] but I believe patients should not have to pay the price for our differences with the county government," he said. "It would be unfair for a patient who has come from, say Gurar village which is 200 kilometres away, to be turned away."
"Hopefully the issues will be solved to boost the medical staffs' morale and improve health services," he said.
Parliament health committee seeking resolution
The parliamentary health committee has reviewed the devolution of health services and found that counties should have taken the three-year window provided in the constitution to prepare and systematically devolve medical services, according to committee chairperson and Kitui South lawmaker Rachel Nyamai.
"There was a rush to devolve these health services to county governments in spite of their inability," Nyamai told Sabahi, adding that the hasty implementation has left county hospitals without doctors and forced to turn away patients.
The committee will table a report in parliament April 2nd, recommending that the management of health functions be returned to the national government temporarily and for the devolution process to start afresh, she said.
"We will be seeking a taskforce on devolution of healthcare to co-ordinate and supervise the takeovers of the health services in an organised and consultative manner," she said. "We just hope it is not too late to start the devolution process afresh and that the doctors who have resigned and those who [are still working but] have tendered their resignations will rescind the move."