“The way it’s so hard to get a doctor to attend to you in a timely manner in these public hospitals, we just might revert to herbalists,” Joyce Syombua complains as she waits in line for an ultrasound at the Machakos Level Five Hospital.

Joyce has been queuing for two hours. The sonographer, Benard (name changed to protect his identity), finally arrives.

“I am oscillating between two departments as we speak. I’m attending to patients in the General Diagnostic Department, and I’m also here doing ultrasound scans on pregnant women,” said Benard.

Each department is supposed to have a sonographer in any given shift but Benard and his colleagues have to take extra work in other facilities to supplement their meagre income.

Due to what Benard terms as under-staffing and underpayment, he and his colleagues take turns working as locum sonographers in various private facilities to supplement their earnings.

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“We are supposed to be two of us in this shift, but I’m holding down for my colleague tonight,” he says.

“That’s how we work. We are understaffed and underpaid, so we have to find alternatives.”

Five years ago, medical practitioners working in public hospitals were prohibited from working in private clinics. 

According to Kenya Medical, Pharmacists and Dentists Council (KMPDC), which issued the directive, any government medical professional wishing to offer services at a private clinic must first clear with the management of the public hospital he or she works for. 

The then CEO, Daniel Yumbya, said the responsibility of deciding on dual practice would henceforth fall in the hands of the employer.

Initially, doctors would get part-time licences from the board indicating they would work in their clinics on weekends or after official working hours. 

Apart from doctors, workers in public institutions are largely prohibited from engaging in work that directly conflicts with their positions.

The Conflict of Interest Bill (2023), fronted by National Assembly Majority Leader Kimani Ichung’wah, seeks to overhaul potential conflicts of interest within the public service.

It will replace the Public Officer Ethics Act (2003), if passed.

The Bill seeks to entrench the government’s position on workers engaging in private practice in the fields in which they are employed.

The Bill describes conflict as a person who exercises an official power, duty or function to further his or her private interests or the private interests of another person or of his family, relative or associate; one who is in a situation where the private interests of the public officer can reasonably be perceived to impair or influence the public officer’s ability to act objectively in the performance of an official duty; or has private interests that could conflict with the duties of the public officer in future.

The poor pay among health practitioners is laid bare by another General Doctor at a Level Four Hospital in Machakos County, who says some could be tempted to sell Pre-exposure prophylaxis (PrEP) to supplement earnings, rather than go for locum work in private facilities.

Both doctors believe workers would not engage in such malpractices if they were compensated fairly.

“We painstakingly train for six years to save lives only to enter the workforce with a meagre salary compared to what we do,” said the medic in defence of their “side hustles”.

“It is a shame that the government does not take doctors seriously. Training them is expensive and time-consuming, but their skills are not valued at all,” he said.

Junior sonographers in Kenya earn around Sh40,000 per month compared to their counterparts in countries such as Namibia and Botswana, who take home more than Sh200,000 per month.

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) secretary general Davji Atellah, says, currently, it is difficult for general practitioners to do any locum work. 

“Just like in any part of the world, you have hours to serve. Doctors are on duty doing all jobs as ought to be done, when they’re off duty like on a weekend, they can get a locum in another hospital to give services,” says Atellah. “But those days are long gone,” he says, adding that currently there’s a big shortage in public hospitals hence medics don’t have time to engage in locum activities.

“Instead of working 40 hours a week as per their contracts, they end up doing 80 hours a week. Almost 95 per cent of doctors employed by the government as general practitioners do not have any time to do any other locum work. Only consultants have part-time practice licences, meaning they can see patients who don’t want to come to public facilities and prefer private clinics.

Last week, Public Service, Performance and Delivery Management Cabinet Secretary Moses Kuria, while speaking on KTN News, called out doctors for what he termed as working less hours in public hospitals while concentrating on their private practice.

“I will not pay Sh206,000 (to intern doctors as demanded by KMPDU), I will not pay. Call it arm-twisting or leg-twisting, I will not pay,” said Kuria.

He added, “I will not pay. As long as I am the minister for Public Service, hakuna kitu kama hiyo itaendelea (This won’t happen),” he insisted.

The tough talk was based on the agitation of KMPDU to have intern doctors posted and paid the new figure agreed in the 2017 Collective Bargaining Agreement between the union and the government.

Kuria, in defence of the government, accused doctors of not delivering on their contractual obligations.

“And then I do that (paying the agreed amounts) for people who have been on strike for two months, who work for two hours and then work for private clinics, and who divert medicines from public hospitals and take them to private clinics,” said the Cabinet secretary.

Kuria defended his plans to change contractual terms for civil servants, including doctors, to annual and renewable ones with pensions.

KMPDU chair Ibadan Mwachi in a push-back accused Kuria of speaking out of ignorance.

“We should stop looking at semantics and nomenclature, the correct term should be that doctors and the rest of the public and civil servants are employed in an open-ended contract… focus on the issues at hand, as we even have floods that are ravaging and doctors are out of work,” Dr Mwachi stated.

But Atellah reiterated that due to understaffing, there would be a severe lag in service delivery in public hospitals if medical professionals took up extra work in other facilities, let alone working for two hours in public hospitals.

“We have a big shortage of doctors. If we had an annual employment plan, it would take us about 30-40 years to realise the number of doctors that offer services to the standard that is required,” said Atellah.

He added that few doctors are fully employed in their current positions in public facilities.

“This is the exploitation we are fighting. You find a hospital that employs only two doctors, and the rest of the doctors are only on a casual locum basis. This kind of moonlighting and nomading is what many people would confuse that doctors are working in many places,” he says.

“If there was no gross understaffing in public hospitals, the law allows medical professionals with a part-time practice licence to work their hours in a government hospital and offer the same services to those who want private appointments,” he explains.

Dr Atella warns should any consultant take up part-time work; they must not allow their work at the public hospitals to suffer. Otherwise, they will be morally wrong.

“But due to the shortage, you realise that a consultant in a public hospital works like a dog. They end up having no life.

“It’s only those who are unemployed whom you’ll find in different hospitals,” he said.

For those who have the luxury of being permanently employed in public hospitals with a chance to offer locum in private clinics, he said, honour to their first call must be met. But what I can say is that such doctors must never allow their private practice to affect the quality of service they offer in public hospitals.

“I urge people to report such doctors if they find any, who are allowing their private practice to clash with their work in public hospitals,” he added.

Meanwhile, tax-paying citizens will keep waiting for hours in line at hospitals, and many others will lose the fight, begging the question, at least in Syombua’s case, whether traditional potions are the better option.