the long term . Such monies should be used in creating industry . By virtue of our punitive taxes and high cost of doing business from ridiculous energy costs especially electricity to even more insane food prices many multinationals have slowly pulled out of the country . It is a very sorry state of affairs seeing big companies winding down their operations in Kenya . The current administration should set up a task force and find out why they are leaving and put measures to encourage both local and international investment in industry . Production of pharmaceutical products locally would be one of the ways of controlling costs .
My brief sojourn in India made me laugh and cry all at the same time . The cost of living is almost a tenth of what it is here . India has managed to ensure food security and has managed to industrialize . Being aware it is not one shoe fits all scenario but the Indian journey is one we should emulate . As a country we have all that it takes to be world class nation and stop being considered a developing nation with our most valuable resource being the people of Kenya . We need to intentionally rethink and reeducate the masses on common values with honesty and respect for others at the forefront .
A good antenatal screen requires monitoring of vital signs , fetal growth including Ultrasounds and lab investigations . These activities require resource , and several health commodities to perform . In as much as there is a KEMSA draw down we all know the “ fantastic ” quality of commodities sourced from this entity let alone the perennial stock-outs .
At present there is the Linda mama scheme which has greatly helped to reduce huge numbers of mothers detained in hospital for non-payment of user fees . This has however not addressed the availability of essential commodities . In many level 4 facilities there is a current stock-out of Misoprostol . This is a life-saving drug for one of the biggest killers among women - bleeding . Whether the bleeding is arising from a miscarriage or childbirth this drug needs to be permanently availed . It is very cheap , temperature stable and has helped to drastically reduce the number of maternal deaths .
Yes , we do use other drugs but in some cases a patient needs more than one kind of drug to stop the bleeding . Whether the stock out is due to financing or supply chain issues
I do not know but all I can say is we want to make health care workers be liable for issues that are not necessarily within their control .
Then there is the issue of the manpower required to perform these services . The ministry has fantastic guidelines but cleverly steers clear of prescribing the ideal number of staff needed to give safe services .
We want to put overworked employees on receiving end of litigation without addressing their basic needs . I wish there was a section on the health workforce required and their needs in terms of working hours and conditions that includes access to all equipment and commodities in which case then the fines would make sense . How does one penalize a person , who is working under duress .
What the maker of this bill does not realize is that currently in the international labor market the hottest thing is medical personnel . We are facing a crisis of brain drain due to many of the factors previously mentioned and giving hostile working conditions will not improve this .
It has been noted that when healthcare providers have punitive sanctions the whole health ecosystem suffers . Midwives and doctors will do many more Caesarean deliveries , ask for unnecessary tests , and go over the top with treatment , as they will not want to be involved in medical enquiries and litigation . This will not be ideal for all parties involved and would make cost of healthcare sky rocket . In as much as some level of sanctions need to in place , there needs to be a systematic approach to unravelling what went wrong in cases of poor outcomes , which encourages the team involved to openly state what happened . If one is scared , they may not necessarily volunteer information for fear of victimization .
In terms of contravening the set standards and guidelines , the bill clearly does not indicate who is going to do that . I feel the Medical Practitioner ’ s and Dentists ’ council ( MPDC ) should be given that mandate . Also on litigation the law should clearly state that no judge should give a determination contrary to the findings of the MPDC . Judges should be limited to only make a determination on the damages to be paid but not on whether the practitioner is liable or not . All medical malpractice claims must go to the MPDC .
I am very amused that the bill article 8 ( 1 ) expects every healthcare provider to give care to children . This is an easy edit to just remove the word every … I was also under the impression that post-natal care is for mothers not children . Another very easy edition . Change post-natal to infant or childhood care .
Things get thick in the matter of consent . Article 8 ( 1 ) provides that healthcare workers cannot offer services without the consent of the parents . While this is generally the case some parents are unable to make proper decisions for the children and there is no mention of room to take these decisions . Providers will be scared to perform life-saving procedures in the absence of legal guardians due to potential for litigation .
The bill goes on to provide adolescent friendly services , which I know may be controversial but were started to give access to adolescents to reproductive health services . Not one to be shy but taking the bull by its horns , parents would rather their 10-year old ’ s get pregnant than have access to age-appropriate reproductive health counselling and services . The whole point of the adolescent friendly services is that they empower the healthcare provider to help the adolescents at risk . With the condition of parental consent , I feel just close up these services and let nature take it ’ s course : teenage pregnancies , infection from unsafe abortions and maternal death from illness from immature mothers facing child birth .
A good trial and I hope that stakeholders were involved in the discussions . An honest appeal to the sponsor of the bill and the ministry of health please do wider stakeholder involvement and ensure large institutions such as Kenyatta National Hospital , Moi Teaching and Referral Hospital , Kenya Obstetrical & Gynaecological Society , Midwives Chapter and even players in the private sector are not left behind in this .
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 .