errant Governors who pretend to have the interest of their people at heart .
Another interesting case was the threatened closure of county services by the Council of Governors ( COG ). Due to the stalemate on revenue allocation the COG had threatened to stop admissions into County hospitals . I was very deeply perturbed by this action and don ’ t know why Kenyans at large did not declare a vote of no confidence for all Parliamentarians , Senators and Governors . For those who understand the budgetary cycle how do we wait until the end of the first quarter before we reach a consensus on revenue allocation ? I wish we could be like other countries who are budgeting 10-100 years in advance and are implementing budgets that were done for them by their predecessors !
One of the major problems in this country is that we as a people only see and live for the now . We have no concept of “ tomorrow ,” being the distant future on what are we leaving behind for our children , grandchildren or even great grandchildren . Will they be proud of the legacy we have left them stemming from our plans Today ? When we start to think in this manner only then shall we start to be objective and work to ensure we have the healthcare structure that all Kenyans deserve .
Another issue that devolution has brought is the absorption of newly trained healthcare workers into the service . Never in our history have we had such an imbalance . Many hospitals are unable to provide quality and efficient services due to lack of adequate personnel yet at the same time there is a huge number of unemployed healthcare workers . Our young doctors and nurses are being forced to look for greener pastures outside our borders . These nations are benefitting from the most well trained and industrious employees you can ever get leaving our country with a vacuum .
We have to come up with strategies on how to retain these highly skilled Kenyans and avoid the brain drain . Nowhere in the world maybe with the exception of China and Cuba , do they have enough healthcare workers , yet we as a Nation want to let our young experts leave our country to become better paid second class citizens elsewhere . Some of the things fueling this is the “ perceived ” high cost of hiring doctors . Clinical officers will be hired at the expense of doctors , imagining that they are at the same competency levels . In as much as clinical officers provide
My brother ’ s in Embu resorted to pray for divine intervention to enable their employer pay them . You can imagine working relentlessly for months without pay . In the usual fashion they requested for forgiveness but pleaded that they hadn ’ t seen salaries for 4 months , no promotion in the last 5 years , and no funds to feed their families to the extent that their wives were on the verge of fleeing their marital homes .
invaluable service to this country their scope of service is different and the time is ripe to have an honest conversation regarding the progression of this cadre and the perpetuation of this course .
When this course was started it was to bridge the gap in the lack of enough doctors for the country and provide services in hard to reach communities . Over time their progression has been a thorny issue and then some “ bright ” Kenyans opened a pandoras box and decided to start a Degree course in clinical medicine . For those who want a degree in medicine there already exists such a course and in this country it is the MBChB which is a Bachelor of Medicine and Bachelor of Surgery . Let these clinicians have this as the pathway to avoid creating pathways with no clear progression as no matter what you do you will not become a medical doctor without an MBChB .
I feel on our part as medics we have been unable to translate to the public the intrinsic value we help create for the country as a whole vide our practice . I will give two examples , with my bias for all things obstetrics and gynaecolgy .
When a doctor performs an emergency Caeserean Section for the famous fetal distress on time in many cases they avoid the potential for cerebral palsy , which would mean less healthcare costs on management of the condition and more importantly the stress on the family especially those that cannot afford to hire extra care-givers . A mother with a child with cerebral palsy has a full-time job with numerous therapy sessions and just looking after the child at home denies her an opportunity to go and earn an income in whichever way she may chose , massively crippling her ability to create value for the nation .
The other example I would give is the proverbial Road Traffic Accident ( RTA ). If a breadwinner sustains a fracture of the femur , they get an Open Reduction and Internal Fixation ( ORIF ), which means getting a plate or nail to stabilize the fracture . The value of this procedure is that the patient can begin to walk with aids soon after surgery and return to work sooner . The total cost of the surgery in a private hospital would be more than the monthly salary of this surgeon in a public institution .
If the ORIF is not done this same patient would be bed-ridden on traction for almost 2 months meaning no income to the family and we all know that majority of patients admitted to public institutions would not have an insurance or fall back plan to mitigate for this time away . The family would suffer and if we think broadly about the number of RTA ’ s , what ’ s the impact on the economy / GDP of having these patients out of work for long ?
I do not have immediate solutions to all these challenges and maybe I need to sit down with my colleagues to further articulate on these issues . In the meantime , I would propose that talks on setting up a Health Service Commission and returning Health to the National Government be done and done with haste to limit the magnitude suffering Ochieng ’, Chelagat or Muiva has to undergo to access services , and ensure that health workers are motivated and willing to serve their nation with dedication as first class citizens with an impact in their own country .
Dr . Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi . You can commune with her on this or related matters via email at : Drmaureenowiti @ gmail . com .