Festering wound in health sector needs more than threats to heal

Doctors led by Kenya Medical Practitioners Pharmacists and Dentists Union Secretary General Davji Atela members demonstrate along the streets of Nairobi on March 22, 2024. [Collins Oduor, Standard]

An acute health crisis has just boiled over, again. Unattended to, slow-burning issues in the governance of our health now threaten the right to health for millions.

I can almost see ancestor and health-worker organiser Dr Odhiambo Olel rolling his eyes at us. Haven't we learned anything since he organised that strike in 1972? When will Kenya reach a lasting solution?

The Kenya Medical Practitioners and Dentists Union strike hit day 9 yesterday. As medics marched across Nairobi, public hospitals are slowly turning into waiting rooms with no end in sight.

The union leaders have raised 19 policy issues that relate to pay increases, better benefits, deployment to public hospitals and safer working conditions.

Many of these issues are not new. They stem back to the Collective Bargaining Agreement reached between the union and national, county governments and other stakeholders after the Lipa Kama Tender 100-day strike in 2017. Following several attempts to get the government to implement the 2017 CBA last year, the union has downed its tools, and the strike is beginning to bite.

The Kenya Medical Association has challenged the abrupt introduction of mandatory e-TIMS arguing that introducing digital registration and receipting will violate the right to privacy for their patients.

Under the new system, the government will access health information about patients and all transactions will be taxed. Private health providers across rural Kenya through their association, the Rural Private Hospitals Association of Kenya, have placed a ban on patient's use of their National Health Insurance Fund cards.

They allege that NHIF owes them Sh1 billion to date and have had to cut their losses. The decision is a colossal challenge to their patients, many of whom have faithfully contributed and now find themselves without medical cover when they need it most.

Government attempts to reform national insurance have yielded one of the most ambitious health policy reforms in decades. A cornerstone of the Bottom-Up Economic Transformation Agenda, the Social Health Insurance Fund (SHIF) aims to provide comprehensive health education for all Kenyans.

This week, lawyers argued for their clients that the three new SHIF-related laws were unconstitutional, lacked mandatory regulatory and budgetary consideration and had not been subjected to sufficient public participation given their all-binding mandatory nature.

President Ruto reminded us this week that we will all, one day, stand before God. We will be asked, did we feed the hungry, heal the sick and roof the homeless?

The questions are not just biblical and important when we die, they are also classic human rights theory for how we must live. Government officers have an obligation to find policy and budgetary solutions to those, society and the economy have exploited and discarded. In this context, the absence of senior officials from the Health Ministry, Treasury, Public Service Commission, and the Council of Governors was deeply worrying. Precious days were lost and the potential for a quick settlement delayed for several hours.

It seems to have taken the Chief of Staff and Head of the Public Service to rally the government side.

Public comments by the Health Cabinet Secretary seemed to suggest she misunderstood the purpose and deployment strategy successive governments have established for medical interns after graduating and earned their qualification to practise.

The challenges faced by medical interns prominently featured in the Musyimi Taskforce report and the 2013 Collective Bargaining Agreement.

Most worrying are increasingly open threats of dismissals and arrests. If the experiences of Dr Odhiambo Olel, Dr Ouma Oluga and more recently, Dr Davji Bhimji teach the state anything, it is state aggression that has toughened the stance of the union.

State officers at county and national levels must desist from the threats and come to the table with open minds. They must also resist short-term promises and seek a sustainable solution to what bedevils the right to health. What is ignored, festers and grows with an intensity that is costly to us all.