A doctors’ union has advised the government to allocate 15 per cent of its budget (approximately Sh569 billion) to the health sector to solve problems it says stem from inadequate resource allocation, misplaced priorities, over-dependence on donor funding, and corruption.
The Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) says that the proposal, as well as conducting annual recruitment of doctors as is done by the military, purchasing hospital equipment instead of leasing, and encouraging local manufacturing of health products and technologies will ensure the delivery of universal health coverage (UHC).
The union wants the Public Finance Management Act 2012 amended to consider human resource for health as development, and also proposes the reorganising of the health delivery system to have community health practitioners (CHPs) and level 1,2, and 3 facilities managed by county governments while the rest are managed by the national government.
KMPDU Deputy Secretary-General Dennis Miskellah said that the government should operationalise the Facility Improvement Fund to allow hospitals to protect and utilise their own funds.
“The biggest challenge of our healthcare system is funding. It’s the funding that will hire doctors and buy drugs. A social scheme can only work in a country where everyone earns a formal salary. In a country where 80 per cent of people are formally employed, you can deduct from them to fund healthcare. But in our country, 80 per cent of our economy is informal, this means that people will only pay for healthcare when they are sick. We need to find a way of establishing some form of health tax, such as allocating 1 or 2 per cent of money from every service to fund healthcare,” said Dr Miskellah.
He added that just like other professions like teaching, doctors need a commission to handle human resource issues. He explained that since the Health Service Commission was dismantled in 2010, health service delivery has deteriorated.
Dr Miskellah also called on the government to adhere to collective bargaining agreements (CBAs), schemes of service and human resource guidelines by the Public Service Commission (PSC).
“In 2017, we went on a strike. We got a 2017-2021 CBA. That CBA is yet to be implemented. Currently, the government owes doctors almost Sh1.8 billion in unpaid salaries,” he said.
Doctors' strike day 1: Medics march outside MoH headquarters
“The PSC has schemes of service detailing job groups for civil servants, qualifications required for each, titles, how people should be promoted, what they need to study to get promotions and how frequent promotions should be done. Right now, consultants are paid under the group for interns. When I do masters, and go to upcountry, I will be posted as a consultant specialist, but receive the salary of a medical officer.
“HR guidelines should also be followed. These detail how officers should be disciplined ... we are seeing doctors’ salaries being halted without notice or undergoing any disciplinary procedure,” he said.
“In 2001, African leaders met in Abuja Nigeria, and made commitments to dedicate 15 per cent of their national budgets to health care delivery. As of 2021, only South Africa and Cape Verde had kept this promise. Of even greater concern is how Kenya has progressively reduced its allocation to health, the latest is Sh141 billion out of a 3.79 trillion budget (3.7 per cent). The highest allocation ever was 7 per cent,” said Dr Miskellah
“The new constitution devolved healthcare to 47 county governments. Currently, more than 90 per cent of health care is devolved with the ministry only managing the level 6 hospitals and overseeing the training and policymaking. Sadly, the resources never followed the function and the MoH budget still runs into billions as counties continue to grapple with inadequate funds,” he said.
These complaints and proposals come as doctors hold demonstrations demanding swift posting of medical interns and payment of school fees for specialist doctors, which have been delayed for eight months and four years, respectively.
Ms Shirley Ogalo is one of the medical interns who hit the streets after waiting for her posting for more than seven months.
The 24-year-old completed her studies in July last year. In November, she and her colleagues balloted for internship centres, and she was placed at the University of Nairobi dental school. However, she could not begin her internship until she received a posting order from the Ministry of Health.
The posting, which should have happened around November, is yet to happen, forcing her into the streets for her first ever protest.
“Most of the time, I’m home. I wake up, eat, watch movies, do some chores, eat, sleep, and repeat. It is frustrating ... We thought we would be posted in February,” she says.
“Going to the streets for the government to hear us is disheartening. As at now, I don’t know what I will be doing a year from now. The Health CS’s plan to do away with payment for interns is also disheartening,” she adds.
Ms Ogalo recalls that on the day of the protests that saw KMPDU Secretary-General Davji Atellah injured, they saw two school buses passing by, and talked about the possibility of some students in those buses wanting to be doctors. She says she wouldn’t advise anyone to pursue a career in medicine.
“When we talk to our senior colleagues they tell us to look outside the country for job opportunities when we are done with our internship, because there is no hope of things getting better. We are not even safe protesting in the streets. I was right behind the KMPDU secretary-general when he was injured. The tear gas canister landed a few metres behind me. Our eyes were hurting, we were sharing water and holding each other up. If that’s what I have to go through every time for my voice to be heard, I think it is very wrong.”
A total of 1,210 medical interns are yet to be posted, despite the internship policy stating that they should be posted 30 days after graduation. They include 849 medical officer interns, 72 dental officer interns and 289 pharmacist interns.
Dr Miskellah explained that besides posting of interns, the union is concerned about the “deliberate and systematic collapse of public healthcare by the government through underfunding” and the State halting automatic absorption after internship. Currently, Kenya has a doctor-patient ratio of 1:17,000, yet 5,000 doctors are unemployed, he said.
The union official also decried lack of career progression and promotions. According to Dr Miskellah, doctors are still being paid as entry-level junior doctors despite going for specialist trainings. Counties are also hesitant to release doctors to go for specialisation training, and the few who make it to school miss exams due to non-payment of fees by the very government that has sponsored them.
“We are also concerned about perennial salary delays and non-remittance of statutory deductions including PAYE and bank loans, putting us at risk with different financial institutions. We also struggle with staff welfare issues such as lack of comprehensive medical cover and clear pension schemes ,” said Dr Miskellah.
In the Kenya Kwanza plan for attaining UHC, President William Ruto promised to hire about 20,000 healthcare workers as a matter of urgency. However, no new hiring has been done. This is despite Health Cabinet Secretary Susan Nakhumicha saying in 2023 that Sh21 billion had been set aside for this exercise, which would be done over three years.
