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Health CS Aden Duale at a past event.
The headache of specialist doctors on government payroll neglecting their duties at public hospitals to operate private clinics, is once again threatening healthcare service delivery across the country.
The worrying trend of chronic absenteeism among specialist doctors, especially in county public hospitals, has left patients requiring life-saving surgeries waiting for months, as specialists spend time in private health facilities.
Health authorities say this is becoming widespread, with specialist doctors using public hospitals to build patient lists before sending them to their private clinics for profit.
On Wednesday, Health Cabinet Secretary Aden Duale revealed plans for a crackdown to tame the vice.
“This issue has become so rampant that doctors working in government facilities are opting to send patients to private facilities which they operate, denying the facilities that pay them salaries revenue, or disregarding them completely. I want to put on notice doctors keen on earning on the side during office hours, between 8am and 5pm — that is fraud,” Mr Duale said.
“Starting January, there will be new measures introduced to punish doctors who are working elsewhere within official working hours, especially when they are attached to certain facilities. I have already directed the Digital Health Authority to take stern action, from January, against any claim made by a doctor registered to a public facility who also makes claims from a private facility within working hours,” he added. The Nation has learnt of a planned crackdown to tame the vice, which has affected both referral hospitals and lower-level facilities.
Kenyatta National Hospital.
Citing Kenyatta National Hospital, Mr Duale noted that the facility has about 26 theatres with top-notch doctors, yet a patient may be given a review or theatre date two months away, only to be followed up by one of the doctor’s assistants who proposes a review or theatre date the next day at a different facility.
The CS has now demanded accountability from doctors, while placing their unions on notice.
“The continued practice will no longer be tolerated,” Mr Duale added.
Several governors and county health executives interviewed by the Nation revealed how widespread the menace is, threatening universal healthcare in devolved units.
Trans Nzoia Governor George Natembeya, for instance, says his county faces the same problem.
“It is so bad and widespread. The matter requires an urgent solution or else it will ruin healthcare in this country. Medics must remain in public hospitals to treat and attend to patients,” Governor Natembeya told the Nation.
Governor Muthomi Njuki.
Council of Governors vice-chairperson Muthomi Njuki and also former health committee chairperson said the vice has become a serious threat to healthcare.
“We cannot allow doctors to use public facilities as a retention ground to get patients for their private facilities. Doctors, especially youthful Gen Z medics, are extremely ambitious and want multiple jobs to make more money. In most cases, county facilities are better equipped than the ones doctors send patients to, but because of monetary gain, they do it and deny government facilities resources,” Mr Njuki said.
A governor from the Coast who sought anonymity asked the Senate to intervene and enact legislation to tame the practice.
“Specialist doctors earn huge salaries, yet most do not work as required in public hospitals. They spend most of their time conducting surgeries in private clinics and hospitals, leaving patients to suffer in public facilities. This issue must be tamed,” said the county boss.
In Nairobi and Kiambu, governors Johnson Sakaja and Kimani Wamatangi have on several occasions put medics running private clinics on notice.
Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH).
Some of the most affected hospitals are also the country’s key referral facilities, including Moi Teaching and Referral Hospital, Kenyatta National Hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisii Teaching and Referral Hospital, and Nakuru County Teaching and Referral Hospital — the largest referral facility in the South Rift region.
Governor Njuki came face to face with the problem a few months ago when he stormed Chuka Level Five Hospital in Tharaka Nithi County.
During a surprise visit, Mr Njuki found several specialist doctors absent from duty and later established they were attending to patients in private clinics.
He has since warned that disciplinary action would be taken against the medics.
“It is emerging that there are doctors who are shuttling patients between county facilities and their private clinics and, at times, charging them twice as they seek to maximise profit or claim payments from the Social Health Authority (SHA),” Mr Njuki, who is also the Tharaka Nithi governor, said.
He said the problem is not limited to doctors alone but also includes nurses, clinical officers and other cadres of health staff.
“We have realised that people entrusted with our patients and paid using taxpayers’ money have taken this job because it pays well, yet are the same people referring patients to their clinics with the excuse that there is no medicine,” he added.
“They leave the medicine and laboratory services at Chuka Level Five Hospital and refer patients to clinics. As a result, our people have suffered because some have to pay twice.”
Mr Njuki said some doctors work in public hospitals for only an eighth of their scheduled time, spending the rest in private clinics despite receiving a non-practising allowance meant to limit private practice to off-hours.
To curb the vice in counties, Mr Njuki urged the Kenya Medical Practitioners and Dentists Union (KMPDU) to act swiftly, warning that counties and the national government would take stern action against practitioners violating established protocols.
He said counties have invested heavily in healthcare using both national and county resources, and exploitation of patients will not be tolerated.
The trend of chronic absenteeism by specialist doctors in public hospitals has also caught the attention of the Senate.
Last month, the Senate Health Committee initiated investigations and demanded firm disciplinary action against medical personnel who prioritise private businesses during official working hours.
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