KMPDU PETITION TO THE MINISTRY 2011

7/31/2019 KMPDU PETITION TO THE MINISTRY 2011

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Author: Dr Hanif

We the Kenyan doctors under The Kenya Medical Practitioners Pharmacistsand Dentists Trade Union (KMPDU) are committed to improving healthcareprovision in our country Kenya. We however note with concern that there

currently exist certain situations that are an impediment to any suchcommitment:

1. Shortage of appropriate health facilitiesThat anyone should have to travel 400km to a health facility at the level of the tworeferral hospitals 48 years after independence is, in a self explicable way, unacceptable.Upgrading of peripheral hospitals means more than to change the signboard to read ahigher level than it previously did. Existing hospitals must be upgraded in terms of staff,equipment, medication and infrastructure. In addition, at a total cost of approximately37.6B, just slightly more than the cost of the Thika Super highway, 47 new state of theart hospitals should be built, one in each county, perhaps two in the most expansivecounties.

We need to emphasize that 90% of Kenyas population cannot afford meaningfulprivate care. It is therefore imperative upon the two ministries of health to ensure thatcare in public facilities is as good as that which they could expect for their familieselsewhere. Given that this is the key responsibility of the two ministries, KMPDUdemands that the construction of these facilities be embarked on in the immediateterm.

2. Inadequate equipment

Equipment for basic yet lifesaving procedures remain absent, inaccessible or run down.For example dialysis machines exist in only four towns and total twenty four in number.Compare this with the more than four thousand kidney failure patients who requiredialysis up to three times a week. KNH with its out of date machine remains the onlytherapeutic radiotherapy centre serving a population of forty million. Functional ICUsare to be found only in the two referral hospitals. Level 5 hospitals still use oxygencylinders while many district hospitals have none. Whatever class of medical equipment

one may think of, there is a gross shortage. KMPDU demands that the ministry laysdown a clear plan to address these shortages over a period of 12 months with animmediate upscaling inn certain centres to show seriousness.

3. Poor staffing


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Our country Kenya faces a shortage of 32,000 doctors as there are approximately 8000doctors in the country. Of these, only 3000 are in public service! The country similarlyfaces a shortage approximately 40,000 nurses. There are only approximately 17,000 inpublic service, and this is while there remain thousands of unemployed nurses in thecountry! Public institutions are greatly understaffed. There is gross shortage of

personnel ranging all the way from specialists to cleaning staff. There is a constant,unchecked exodus of trained personnel from public service resulting from non-progressive and sometimes blind board room policies. The two ministries of health needto get to the ground and see the true needs which they will then have to address inappropriate and lawful ways. KMPDU demands that the ministry immediately employsall the available and qualified medical personnel and sets out a clear plan with atimeline of how the remaining shortages will be addressed. It is noteworthy that theministry has recently resorted to introduction of slavery edicts to try and forcefullyretain staff in public institutions. Meaningful staff retention can only be attained whenstaff stay willingly because of fair treatment, work conditions, personal developmentopportunities and fair remuneration.

4. Staff trainingIn healthcare, training of personnel is mandatory. There is no magical way throughwhich specialists and skilled nurses will appear except by training. The shortages inthese areas are devastating. Patients suffering operable head injury in road trafficaccidents are referred from the City of Kisumu to Nairobi for the surgery because thereis nowhere else to find a neurosurgeon. Needless to say, most of these patients havesuffered irreversible brain damage including brain death by the time they get to there.The ratio of specialists in public service per population ranges from 1 in 600,000 to 0! in

40,000,000! Some ministry officials have been reported as saying that Kenya does notneed specialists. This demonstrates a great degree of either lack of concern or lack ofinformation, or both. Either way, there must be no room for this degree ofincompetence in any ministry of health anywhere. For the sake of the Kenyans theministry purports to serve, the number of specialists to be trained per year should bequadrupled. KMPDU demands that the ministry sets out a clear plan with timelines ofhow it intends to bridge the shortage of specialists.

5. Enslavement of specialists in training

While it should be clear the great need there is to train specialists, while every effortshould be made to encourage doctors to go back to school and acquire the necessaryskills to bridge the aforementioned gap, the Ministry, in collaboration with individualsand the two referral hospitals, has adopted, propagated and sustained a policy ofexploitation and enslavement of specialists in training, coupled to typical slave era likeintimidation of those who dare oppose this. Contrast this with Israel which, as part ofthe agreement to end the recent strike is paying doctors a large financial bonus to


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undertake specialist training. If that is too far out, contrast that with the Agha KhanUniversity Hospital here in Kenya where their specialists in training not only pay nofees, but also take home nearly twice as much as a government doctor, alone in theperiphery. Undoubtedly, industrial and civil action against both the ministry andindividuals to the extent of abuse of office KMPDU intends to pursue individual

responsibility wherever possible rather than have the taxpayer meet the cost ofindividual profligacy is forthcoming. Having made the request for the last one year toyour ministry that this issue needs to be addressed without any response, KMPDU isunder no illusion that your ministry cares what we the doctors think. However, beguaranteed that for as long as the free world follows the policy of compensation forwork done, KMPDU intends to see the end of this madnessslavery of a countryscitizens by its ministry in the 21st century! This is an absolute goal.

6. Intimidation

For the last one year, we have urged that the policy of intimidation should end andareas where doctors have been wronged, such as in the wrongful, unproceduraldismissal of Dr. Onyimbo, should be reversed. One area where we must give yourministry marks is consistency. You have consistently ignored our opinion as doctors andcarried on with whatever action, programs or policies you wished. That public healthprovision is inadequate is not a secret high school students note as much in theirdebates. Roadside declarations arbitrarily transferring doctors, stopping their salaries ordismissing them altogether with the intention of instilling fear in them has not ended.Why then should a qualified doctor be threatened, interdicted and summarily dismissedfor suggesting ways of improving this system? While KMPDU considers the extent of

criminal abuse of office Vis a Vis civil litigation against individuals in several of thesecases, we demand that the ministry puts a stop to this.

7. Retention of officers who have failed to deliver

In a recent newspaper supplement by the ministry of medical services, published on theday of the official opening of the Lucy Kibaki hospital, there is mention of 71%satisfaction by the public with public sector health care delivery. All ministry officialsresponsible for this attempt at deception should be dismissed. This misinformation isthe kind that gets to the principals and other players in other sectors giving the falseimpression that the health sector is doing well for its citizens while the tragic reverse is

the true version. In fairness, let us judge trees by their fruits, individuals by theirresults. The public health sector is in tragic place. The shortages in staff andinfrastructure are catastrophic, maternal mortality has gone up, anyone born in Kenyahas an 11.5% chance of dying before the age of 5 years, funding of healthcare as apercentage of the national budget is on the decline, counterfeit drugs fill our shelves, allthis contributing to bringing the country to the brink of a doctors strike for the first timein 17 years and potentially on the brink of an unprecedented and catastrophic health


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There is a shortage of personnel. More than half of the doctors in KNH and uponwhom the hospital depends are unpaid slaves. The director does share responsibility forthis but only together with your Ministry.

The principle on which this policy is based is itself flawed. Private hospitals arebusinesses and it makes sense to have business managers run these institutions so asto make the maximum profits. However, the primary concern of public healthinstitutions is to provide health services. It is necessary to have health service providersrun these institutions as they understand best what health programs will impact thegeneral populations health in what way. This is critical but was overlooked. We cannotcommercialize public hospitals nor privatize healthcare.

There exist medical professionals who have gone further and done Masters in Businessadministration. This group of professionals would address both qualification concernsbut there seems to be an irrational obsession with removing medical professionals fromthe running of these institutions, therefore having a medical degree has been made adisadvantage in these applications.

The policy is discriminatory against and disparaging of doctors. Nobody is going toargue that because Dr. Willy Mutunga is a lawyer, he is not qualified to run the judicialsystem, nor will they argue similarly in other professional companies. It is only doctorswho are singled out as inept at everything else except treating patients, a clear insult.

9. Working hours

Most civil servants work 40hrs a week. Many doctors work in excess p of 70hrs a week.

In addition, doctors know nothing like public holidays, weekends, or nights. They workwhen duty calls, often at great cost to their own health, families, and relationships.KMPDU demands that working hours as stipulated in the labour laws be adhered towhen it comes to doctors. Any extra work done as necessitated by the unique nature ofthe work be calculated and paid for as stipulated in the same laws.

10. Fair remuneration

The new constitution entrenches each individuals right to fair remuneration. Looking atthe training required to be a doctor let alone a specialist, the value of a doctors work,the extraneous nature of a doctors duties, the shortage of doctors meaning that the

few available are overworked, the risks to personal and family health involved and incomparison to remuneration in other health systems in other countries, it is clear thatthe Kenyan doctor is grossly underpaid. KMPDU recommends the following as the grosspay for the various cadres of doctors in Nairobi.Lowest paid doctors (interns)

Gross income 214,000Intermediate level doctors (medical officers)


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Gross income 285,000Specialists from day 1 out of school

Gross income 428,000Senior specialists, Lecturers and Professors

Gross income 856,000

(All income subject to full taxation as per income tax law)In addition to these gross values, the further from Nairobi one is, the more they shouldearn. This is to encourage urban to rural posting of medical professionals. There shouldalso be a 6 8% automatic annual increment so that the longer serving doctors earnmore than the newer doctors.Doctors are not the only poorly paid medical professionals, nor are they the only onesworking in the highly biohazardous and hence risky hospital environment. While wedont represent the other cadres of staff, their work and presence are critical to afunctioning health system and are key complements to a doctors work. We recommendthat the current gross income for the currently underpaid, overworked, unmotivatedand negelected nurses, clinical officers and other paramedics be quadrupled to stemtheir exit from the public service and thus support doctors better in their work.

11. Comparisons with other civil servants

In denying doctors their rightful dues, doctors have often been compared to other civilservants. One such comparison is with others in the same job groups; whetherproposed income increases would not be way out of the job group. KMPDU derives fromthis the logical conclusion that doctors are currently several job groups lower than theyshould be and this should be addressed. A second comparison is at the entry level

where intern doctors are compared with other doctors in other professions. The currentPS often gives stories of when she was an intern. KMPDU wishes to point out that theonly similarity between an intern doctor and any other intern is in the word

intern.Beyond that, there can be no comparison. For example, how many yet to beborn babies, stuckin their mothers wombs threatened with potentially fatal birthcomplications do other interns deliver alive and healthy, to their grateful mothers? Howmany babys at risk of dying by the end of the day from dehydration do other internssave? Perhaps the more important question is how do life-protecting and lifesavingroles compare to other roles? KMPDU demands that these nose-length comparisonsaimed at devaluing the work of doctors end.

12. Health service commission

This country is witnessing revolutions in the judiciary and education sectors. Thesechanges can be attributed to the meaningful work done by bodies such as the Judicialservice commission and the TSC. A similar body, the Health Service Commission, mustbe created in the health sector.


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13. Underfunding of healthcare by treasury.

While not absolving individuals who have demonstrated great ineptitude at the twoministries of health, a lot of the shortages in the health sector can be justifiably blamedon underfunding by treasury. The two ministries of health must play their part in

pressuring the treasury into meeting basic health funding levels as laid out in the 2001Abuja declaration and as recommended by WHO. The passive approach hithertoadopted has cost lives and its continuation portends disaster for many families who arestuck with public healthcare.

The recommendations made by KMPDU are reasonable in the eyes of any objectiveobserver. Having made similar requests for the last one year to your Ministry withoutany meaningful response, KMPDU is under no illusion that your Ministry cares what wethe doctors think. We do however hope that you will find compulsion from whateverquarters to satisfactorily and in good time address these grave issues.KMPDU on its part will continue to support all initiatives geared towards the attainmentof meaningful healthcare Kenya.

Documents

KMPDU PETITION TO THE MINISTRY 2011