NAIROBI – By Moses Wasamu for The Messenger
The world over, doctors have an obligation to work for the survival of patients under their care. But in Kenya, dozens of patients recently lost their lives when doctors abandoned them in a push for better pay and better working conditions. During a 100-day strike ending last month, Kenyan doctors pushed for the implementation of a 2013 collective-bargaining agreement that committed the government to increase pay and restore dilapidated public health facilities. The doctors said the government had reneged on the deal, forcing them to take the drastic step of a strike.
Moses Wasamu for The Messenger spoke to Jay, a clinical officer running a private facility in Nairobi, Kenya, for a post-op on the strike and its impact. Jay (not real name) preferred not to be identified for this article for fear of victimization.
Q: Do you know of cases of death that could have been avoided because of the strike?
Yes, several people died during the season of the strike. I can identify two death cases: one was due to DKA (diabetes) since the family did not have the money to pay in some private hospital and the patient died in the house. There was also a mother with obstructed labor who lost the pregnancy since she was not able to afford caesarian section in a private hospital in the county.
Q: Can you give your personal experience during the strike action, or the experience of your colleagues?
The experience was crazy — private hospitals were crowded with patients from all over the county, with all staff working extra hours to sustain the sudden surge of patients.
Q: Seeing that doctors play a crucial role in public health, were they justified in their strike?
The doctors’ strike was justified. If you read the CBA (collective bargain agreement between doctors and the government) clearly you will realize that if it is fully implemented, then the public hospital facilities would really improve. Unfortunately, the whole process was politicized.
Q: Since it is the public that suffered the most, did the doctors really have the public’s interest at heart?
Yes, they did have because if the CBA was implemented as previously agreed, the common mwananchi (citizens) would be the beneficiary as the services in public service would immensely improve.
Q: In your estimation, did the doctors have a genuine concern?
They did have a genuine concern because this document (CBA) had been reviewed by both parties and was to be implemented 3 years ago, only for the government to take an about-turn. And as I have said, if this document was implemented fully, then the public health systems would really improve.
Q: Now that doctors have agreed to go back to work, will the issues they were agitating for be solved?
Most probably no, because of the devolution of health services to the counties and the county bosses who are not committed to solving any of the issues, unless the President intervenes.
Q: As a practitioner in private practice, what was the effect of the strike on the private sector?
Well, the impact was both positive and negative. Many private institutions made lots of profits during the strike. It was also a good marketing strategy for unknown private institutions as clients traced any institution that offers healthcare services because of desperation. If they received good care, then they would still most likely revisit. The negative impact it created was increased workload.
Q: Is the proposal by the government to import doctors from Tanzania going to work? If implemented, how will it affect Kenyan doctors?
The proposal might not work, since we have Kenyan doctors who are yet to be employed by the government. The proposal was just a way of intimidating the doctors to make them go back to work. If the government can’t pay their own, can they pay the Tanzanian doctors? If it is implemented, it will kill the morale of the Kenyan doctors.
Q: What do you think will be effect of this on the morale of Kenyan health workers?
If the government goes ahead to employ the Tanzanian doctors, they will definitely be sabotaged by their Kenyan counterparts.
Q: If the government gives in to the demand by the doctors, do you see a likelihood of other health workers going on strike because they want to earn more like the doctors?
Definitely, since every union wants the best for its members. Every union negotiates for the benefit of the members. So, this will also depend on the prevailing agreement between the government and the particular cadre of health workers.
Q: In your considered opinion, what does the government need to do to avoid having a situation like what we had, in the future?
I think the government should be able to keep its promises. If the government had agreed to implement the CBA (that was negotiated in 2013) in phases, the strike by the doctors would not have happened. The government should take the health docket back to the national government because as it is, the counties have no capacity and they are not paying the doctors.
Q: The President accused doctors of spending more time in their private clinics than in public hospitals. Could this be true and what should be done to change that situation?
The President was misadvised. We have different cadres of doctors and we specifically have general practitioners who are in hospitals for 24 hours in a week. The consultants only come to review patients when called upon. The consultant is always on call, and if there is no case to be reviewed, the consultant does not need to be in hospital.
Q: Some people have claimed the private sector benefitted from the strike. Is this true, and how did they benefit?
That is true. They benefitted from the crisis but this also led to congestion and setting up of additional beds in corridors. With increased number of patients, there was increased income. But this also meant overworking by workers in private facilities. The private facilities were also forced to employ additional staff on a short-term basis.
Q: What is the long-term cure for the woes bedeviling the health sector in Kenya?
Health should go back to the national government (currently, it is run by county governments). The President should also ensure that there is no infighting in the ministry between the Cabinet Secretary for Health and his Principal Secretary. This can be done through clear delegation of duties between the two. There should be no cronyism in employment.