Healthcare staff crisis threatens to derail Kenya's UHC ambition

Dr James Nyikal. [Elvis Ogina, Standard] The Kenya Kwanza administration's plan of actualising Universal Health Coverage might stall following a healthcare workers crisis. Ironically, as Kenya grapples with shortage of health providers, the government is encouraging professionals to seek employment abroad. It is this controversy that has time and again seen health workers go on strike to protest county governments' failure to listen to their demands, which often include hiring, and better salaries and working conditions. Today, doctors countrywide are yet again set to down their tools in their push for more budgetary allocation, which will allow the recruitment of more medics, among other expenses. They are demanding the posting of 1,215 medical interns. Dr James Nyikal, an experienced doctor and among those who developed the community health volunteers workers policy in the early 2000s, says failure by the government to employ more healthcare providers might halt the much-hyped UHC programme. Acute shortage "We are arranging their employment outside the country, while we have an acute shortage. We just have to put money in health and get health providers employed," says Seme MP and member of the National Assembly Health committee. A facility report by the Ministry of Health revealed that only 5 per cent of public hospitals have fully operationalised personnel. The report, Kenya Health Facility Census Report, which Health CS, Susan Nakhumicha launched in December, further revealed that only 12 counties have required health worker numbers per the population ratio - including nurses, clinical officers, and doctors. Kenya has 10,102 registered doctors, according to the Kenya Medical Dentist and Practitioners Council (KMPDC). Of the doctors, about 1,200 are hired by the national government, while 4,480 work in county hospitals. Those under the national government are working at Kenyatta National Hospital, Moi Teaching and Referral Hospital, Kenyatta University Teaching, Referral and Research Hospital, Moi University, and the University of Nairobi. Further, the KMPDC report notes that 4,297 doctors are not licensed to practice, while 2,051 work abroad. KMPDU Secretary General Davji Atellah says county and national governments are not employing health providers. "There are many talks, but nothing is working. We are advocating UHC but we have fully abandoned the health workforce that is expected to actualise the programme," says Dr Atellah. From 2017 to 2024, only 1,000 doctors have been employed across county and national governments. To meet WHO demand of 1: 1,000 doctor patient ratio, Kenya needs to employ about 50,000 doctors. According to the union, there are about 5,500 unemployed doctors. "How will they (government) say healthcare is functioning when they do not employ? It means people will go to hospital and wait 24 hours to receive care," he adds. Nyikal said the government should allocate money for posting intern doctors. "Failure to post intern doctors is a big crisis because without internship, they will not be registered to practise in Kenya and abroad," he said. Kenya Union of Clinical Officers Secretary General George Gibore said President William Ruto promised to employ at least 100,000 health providers but this was yet to be fulfilled. Kenya has only 8,700 working clinical officers, against the 33,000 registered ones. According to WHO, Kenya requires 70,000 clinical officers to meet requisite quality care. "Do we have the right numbers to achieve UHC as a country? Are we able to move closer to that," questioned Gobore. He added, "Strategically, we are nowhere next to achieving UHC if we use apparatus of the staffing norm because it is healthcare workers who ensure facilities are giving optimum services". On their part, nurses under the umbrella of the Kenya National Union of Nurses regretted that most hospitals in the country, more so dispensaries, are manned by a single nurse each. There are about 50,000 nurses employed currently in public hospitals, private and faith-based facilities. The union's Secretary General, Seth Panyako, said staffing is a major issue that has resulted in numerous strikes. "We do not have enough staffing in all our hospitals, including at KNH," Panyako told The Standard. He said the government lacks commitment to employing health professionals. "The government doesn't lack money to employ nurses. Employment has simply not been factored in, as health budget should be at least 15 per cent of the national budget," said Panyako. Surprisingly, the union officials have been drumming support for the employment of nurses outside the country, citing a lack of commitment by the government to hire them. "There is high demand of nurses abroad, especially in Europe, Australia, and Canada. Nurses are in the villages, and they do not have jobs, why should we confine them in the villages?" posed Panyako. Community workers Yesterday, efforts to reach the Council of Governors Chairperson Anne Waiguru and Governor Muthomi Njuki, chairman of the Health Committee, were fruitless, but the CoG office said they would issue a statement tomorrow. As experts and health providers' representatives raise the issue of a shortage of workforce, the government has been keen on deploying Community Health Providers (CHPs), to handle primary healthcare. According to Dr Nyikal, the idea of banking on primary healthcare by hiring Community Health Promoters (CHPs) is key, but health providers are required to work at Level 2, 3, 4, 5, and 6 hospitals. "If you are sick of malaria, I cannot say I am not going to treat you because I am preventing malaria. Prevention comes before treatment, and you cannot stop treatment. "So as you (government) are putting up primary healthcare, you must put employees," said Nyikal, adding that there should be a balance between preventive and curative health. But Panyako dismissed CHP programme. "The work they are telling these people to do is done by public health officers, but they decided to kill public health officers, and kill primary healthcare."

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