Handling doctors' strike exposes systemic failures in governance

The ongoing doctors’ strike is set to enter its fourth week. That would mean a full month of total paralysis in public healthcare services. While this is not a new phenomenon in the country, the current healthcare workers’ strike opens the lid on systemic failures that exist not only in the health sector but also across other sectors.

Ever since assuming office 19 months ago,  the KK administration has demonstrated a unique penchant for more money through taxes and levies on anything and everything they can place their hands on.

The narrative that has consistently been sold to the public by the administration’s top leaders is that many of the problems that affect ordinary folks across the country are due to lack of money.

As a consequence, they thus need to tax and levy more to finance their so-called Plan. Based on this narrative, any proposed law to increase taxes or introduce new levies has passed with lightning speed in Parliament. For instance, four Acts that were passed last year to overhaul the management of public healthcare in the country were approved and passed under the tyranny of numbers in the August House.

These are the Social Health Insurance Act, Primary Healthcare Act, Facility Improvement Act and the Digital Health Act, all of 2023.

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Much of the debate has been the Social Health Insurance Act because it increases levies to be deducted from workers towards a Social Health Insurance Fund (SHIF) from a maximum of Sh1,700 to a proportion of 2.75 per cent of an employee’s gross pay. This has been sold as the magic bullet to ensure every Kenyan has access to quality healthcare at no individual or household level costs. The commencement date has been dogged by controversy and incoherence on the part of the government policy pronouncements.

Thanks to the medics’ strike, the March 2024 start date for the levy has been pushed to July with focus shifting towards the demands put forth by the striking healthcare workers. This is a welcome relief to employed workers whose pay slips would have suffered the twin levies on Affordable Housing and Social Health Insurance effective from this past month.

Underbelly

The strike raises a fundamental question on what truly ails our public healthcare system. Is it really a problem of money or is it a systemic failure on the part of the government? Ironically, the healthcare workers are demanding for comprehensive health insurance despite the introduction of the SHIF.  

The questions now open for public debate are: one, could the medics have all along known something that Parliament and the rest of us missed while enacting these legislations?

Two, why should anyone trust the government with more levies from their own sweat if it can’t solve a strike of such high calibre professionals in the economy?

And three, what criteria do we use to select those we chose to entrust with such basic and critical public services?

The Budget Policy Statement (BPS) of 2024/25 proposes that the government shall avail medical staff who would deliver the Universal Health Care among the five priorities in the health sector set for the medium term.

Others include provision of fully financed primary healthcare system, an emergency care fund and a health insurance fund for all Kenyans; installation of digital health management information system and an emergency medical treatment fund.

With this grandiose proposals, it is then ironical how the government can wake up to tell its citizenry that they have no money to deploy medical interns, who in reality are the primary contact persons in our health facilities from the ward to the national level.

Majority of ordinary folks who seek healthcare services in public hospitals rarely ever get to meet the specialist doctors. They are treated by these medical interns, with the help of clinical officers and nurses, yet the government now belittles them in the eyes of the public.

In any case, the majority of the people who seek healthcare in our public health facilities would never care whether the doctor treating them is an intern or a seasoned professional. That realm of choice is beyond them, despite the constitutional guarantee of the highest standard of healthcare under Article 43(1).

This makes it the more reason why the medical interns must be accorded the highest decorum that they justly deserve from the government.

The strike further exposes the fallacy of the government policy to export skilled labour in foreign capitals. It is noteworthy that healthcare workers have been the prime targets for this exported labour. The Council of governor’s health committee has publicly declared the country has shortage of healthcare workers.

They are responsible for the primary healthcare services under our devolved system. This contradicts the national stand on the matter. Any person of reasonable mind cannot, therefore, fail to wonder if this isn’t an escapist strategy on the part of the government to run away from its solemn responsibility to absorb and deploy healthcare workers to serve its people.

Economic cost

The strategic role of quality healthcare in human capital development and consequently to national development is well documented in economic literature. Herryman Moono, the Vice President of the African Federation of Public Health Association, in a blog posted to his LinkedIn account on 22 July 2018, argues on the benefits of national investment into healthcare.

He argues that despite these well-known and obvious benefits of healthcare investments to national development, they are often underestimated or not well understood by governments. The net effect of such underestimations is that healthcare financing never gets the requisite attention in economic policy dialogue.

According to this article, there is a clear transmission mechanism from quality healthcare to individual and household wealth. Quality healthcare allows the citizens of a country to actively participate in the labour market and children to go to school.

This makes it possible for the populace of a nation to innovate and invent, and thus become highly productive. The productivity of the workforce eventually translates into national productivity.

Therefore, it boils down to basic common sense that investing in a quality national healthcare system not only saves lives, but also translates into long term strategic investments towards other sectors of the economy.

On the contra side, ill-health impairs individual/household, corporate and eventually national productivity. In the medium to long term, this consequently destroys a country’s ability to create jobs, exploits opportunities on national endowments and undermines national human capital development.

For example, how many would be doctors, engineers, lawyers, economists, astronauts could we have lost as a consequence of the current strike had it been averted in good time? How many more are we likely to lose before the political and bureaucratic elites come to their senses? More fundamentally, how many dreams among our school going children get killed when they see adults in government and society misbehaving in the way they are?

Imagine as a parent advising your young boy and girl that they can work hard in school to become a doctor some day in the current pre-existing environment.

And if the government cannot absorb doctors, considered among the most elite careers in the economy, who else can it ever assure of some decent opportunities after many sacrifices and labour through the schooling years?