Doctors’ dilemma in weak public health systems

In July 1995, Suba district was created out of the Homabay District. As a young medical officer who had stuck to the public service after the devastating 1994 doctor’s strike, I suddenly found myself having to make a very hard decision. To quit and go south or stay on and be posted to a health centre.

I received a call that I had been posted to Sindo Health Centre in the newly created Suba District. That time government was flexing its muscle having resisted the doctors strike.

As I was contemplating what to do, I received a call from the District Commissioner, that he was sending his driver to pick me to accompany him to the new district for a public rally.

I had been caught off-guard. I complied and ended up in Sindo health Centre. I was temporarily housed in Mbita, which is 15 kilometres away.

My first challenge was to get staff, particularly midwives to man the health centres on Mfangano Island.

I called the Provincial Medical Officer, but he demanded data to show need and demand for services before posting midwives. I was confused. There were no staff, therefore there could be no deliveries and hence no data to show workload.

I was forced to call Afya house in Nairobi. I convinced the bosses that I needed staff on the ground for them to conduct deliveries to generate the data they were demanding.

After much convincing I finally received four midwives and delivery packs. I posted two to Senna Health centre in Mfangano and two to Sindo health centre.

Within one month we had more than 100 safe deliveries in the health centre on Mfangano island. Armed with data, I secured a further four midwives and more equipment.

During the current health crisis caused by the doctors strike, many commentators have said the quality of care in public hospitals is very poor, therefore, it does not justify demands being made by doctors.

From my experience above, I believe the way forward is to invest in more staff and equipment as recommended in the Musyimi Taskforce report and the CBA 2013 then reap the fruits.

Getting quality care will entail optimising material inputs and practitioner skill to produce health.

If staff members are to perform to their full capacity, it is not only staffing issues that must be addressed, but also systems and facility issues. The performance of health workers depends not only on their competence (knowledge, skills) but also on their availability (retention and presence), their motivation and job satisfaction.

It also requires availability of infrastructure, equipment and support systems, such as the management, information systems, resources and accountability systems that are in place.