Why counties are stuck with errant doctors despite push to fire them

As the doctors’ strike enters week six, the Health Ministry is digging in for a long siege while governors are plotting a decisive blow.

It is sad sick Kenyans are not staying at home, but Health Cabinet Secretary Cleopa Mailu is telling them to visit public hospitals, which he says are ably manned by nurses and clinical officers. But his prescription is not as curing as it sounds.

The CS has not offered any alternative for patients requiring specialised treatment at the about 260 referral public facilities, including Kenyatta National Hospital and Moi Teaching and Referral Hospital in Eldoret.

But the governors are even more blunt. They are ready to replace the doctors, even with foreigners. For one, Kenya does not have a pool of unemployed doctors.

“Doctors are the only civil servants guaranteed employment on graduating,” says Dr Mailu.

Data from the Ministry, the World Health Organisation and workers unions indicate that the public service has 4,500 medical doctors and dentists. Mailu says only about 2,000 of these are on strike which may be plausible, considering that many doctors in the public sector are in administrative positions and exempted from industrial action.

It is estimated that the country has a shortage of about 27,000 doctors, with only 600 graduating annually.

The contested Collective Bargaining Agreement (CBA) suggests the hiring of 1,200 doctors annually, a position the government concedes, but may find difficult to get the numbers.

This, however, is not a new promise. In its Health Sector Human Resources Strategy 2014-18, the Ministry promised to employ 12,000 health workers annually, including doctors by 2017.

This promise was also made as Kenya’s international commitment at the Human Resources for Health Conference in Brazil in 2013, but according to the current demands by the doctors it has not been fulfilled.

In 2013, former Health CS James Macharia, while launching the first National Cancer Management Guidelines, announced the establishment of regional treatment centres at the Coast, Nyanza, Nyeri and Eldoret.

However, such plans are still on hold until the country is able to train the required 125 cancer specialists broken down as follows; 15 radiation oncologists, 25 medical oncologists and 10 radiation therapy technologists. Others are 50 oncology nurses, 10 medical physicists, eight nuclear medicine physicians and 12 nuclear medicine technologists.

“It was only last year when the first training courses were started at the University of Nairobi,” says Prof Nicholas Abinya, a lecturer at the university and leading oncologist in the country.

He says the bigger problem will be to have enough safeguards and incentives to keep such talent within the civil service or even within our boundaries.

“That is how desperate we are for medical specialists. Anybody saying otherwise is joking,” says Abinya.

Long-time unionist Jeremiah Maina of the nurses union says talk of replacing doctors with local or imports are just tactical threats.

“Sacking yes, but replacing no,” he says.

A sacking threat, another unionist says, could scuttle some of the striking doctors who may opt to break rank with their colleagues and go beg for their jobs.

“Governors would love nothing better that such a scenario, given the bad blood existing between doctors and the county chiefs,” says the unionist.

Doctors have done little to hide their disdain for county officials, who they perceive to be their juniors academically. “Today we say no to the tyranny of the uneducated” were some of the rowdy chants by the doctors at the Railway Club, Nairobi, on the day they commenced the strike.

In an interview with Dr Ouma Oluga , Secretary General of the Kenya Medical Practitioners and Dentists Union (KMPDU), just days to the strike, he was categorical that governors had no role in their current demands.

“They are strangers to the CBA and we do not expect them to get involved,” he said.

During the court hearing over the CBA, the union maintained that doctors are employees of the Ministry of Health through the Public Service Commission.

“The county governments are not the employers of doctors and therefore have no legal obligation that a CBA be negotiated with them,” doctors argued in court and have since maintained this position.

The court of course ruled otherwise, but the union has continued to treat the governors as gate-crashers at the negotiating table. This may explain why governors were not invited when the union officials met the President in Mombasa and why the county chiefs are spoiling for a showdown with the doctors.

- Rocket Science