Experts query Ruto's team ability to cure health workers' problems

As a biting shortage of healthcare providers persists, patients in public hospitals continue bearing the pain of long queues with some dying before treatment.

Inadequate staffing, coupled with a lack of harmonisation of salaries, promotions, employment, comprehensive medical cover and delayed salary payment, are among the challenges medics are grappling with.

This comes at a time when Kenya Kwanza administration faces an economic and political crisis unseen before, as it gears towards the actualisation of Universal Health Coverage.

President William Ruto recently appointed a task force to formulate comprehensive strategies and policies on human resources.

In his appointment, the President said, “There exists a need to assess and address current challenges and gaps in the recruitment, placement, training, and retention of healthcare professionals”.

The 24-member Presidential Task Force on addressing Human Resource for Health is charged with identifying legal, policy, administrative and operational constraints impeding the performance of the health sector in Kenya, in regard to human resources for health.

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Kenya Medical Pharmacists Practitioners and Dentist Union (KMPDU) has welcomed the establishment of the task force, having been part of a return-to-work formula that followed 56-day nationwide strike.

“We are fully supporting the task force,” says KMPDU Secretary-General, Dr Davji Atellah.

Atellah adds, “We have a plethora of pending issues, and we asked for a task force in our return-to-work formula”.

However, questions have been raised by experts on whether the Prof Khama Rogo-led task force will cure health workers’ problems.

John Nyangi, a health economist, says several challenges facing doctors, nurses, clinical officers and other medical cadres are well known to the government.

For example, with the current intern doctors stalemate, he says, the solution is the implementation of the 2017 Collective Bargaining Agreement (CBA), by having them posted and paid.

“Do they need this task force to admit and absorb the medical interns?,” poses Nyangi.

He adds, “Having a task force will not tell us anything new about health problems.’’

“What will change with a new task force other than delay tactics for the inevitable?” questions Kenya Medical Association (KMA) Secretary-General, Dr Diana Marion.

Matters on health, she says, have been politicised, hence solutions are far-fetched

Laikipia and Kirinyaga are among counties worst hit by the politicisation of health, according to KMA, with some doctors having been sacked with efforts to have them reinstated remaining futile.

“Issues affecting health workers can only be sorted by a Health Service Commission. We have the Judicial Service Commission and the Teachers Service Commission. They may not be perfect, but they are not politicians. Human resources issues for health sector has been left for the counties to make decisions,” adds Dr Marion.

XN Iraki, an economist and professor at the University of Nairobi, adds that the ministry has not balanced the supply and demand for health workers.

“We have more medical training colleges, but few hospitals, and money to pay new health workers,” says Iraki.

He says the devolution of health means counties are more likely to employ ‘their own’, leading to shortages in some counties and surplus in others, just like food.

Roles bestowed on the task force, KMA observes, are already being handled by the Health Act of 2017 and the Kenya Health Professions Oversight Authority (KHPOA).

The Health Act allowed the establishment of the Kenya Health Human Resource Advisory Council (KHHRAC), which reviews policies and establishes uniform norms and standards for posting interns, inter-county transfers of healthcare professionals; together with welfare and schemes of service for health professionals, management and rotation of specialists, and maintaining a master register for all health practitioners in the counties.

KHPOA, on the other hand, maintains a duplicate register of all health professionals, promotes and regulates inter-professional liaison, coordinates joint inspections, and resolves complaints from patients and regulatory bodies.

The body also monitors the execution of mandates of regulatory bodies, arbitrates disputes among regulatory bodies, and ensures that standards for health professionals are upheld.

“Given the mandates of KHHRAC and KHPOA, the establishment of a presidential task force is deemed ultra vires and duplicates the roles of both,” states KMA.

KMA further elucidates recommendations for addressing human resources issues that are yet to be acted on.

Among them is the 2012 Musyimi Task force Report that proposed the establishment of a Health Service Commission.

The report highlighted the need to delink the Ministry of Health from service delivery, allowing it to focus on policy formulation, standards, guidelines, and regulations.

The Ministry of Health report of 2019 also made recommendations on medical training and deployment challenges.

Another task force on human resource that is yet to be acted on includes the Kericho Declaration on Human Resources for Health, made on October 18, 2023.

The declaration produced a 17-point roadmap for improving health human resourcing in Kenya under KHHRAC’s stewardship.

Kenya Union of Clinical Officers Secretary-General, George Gibore, is in support of a task force but is disappointed with its composition.

The team, according to the official, consists of doctors, leaving other key health cadres that are key in the expected actualisation of Kenya Kwanza’s health agenda of promotive and preventive health.

“I have an issue with the composition of the task force. These are doctors trained on curative services. Where are public health experts?” avers Gibore.

“The focus was on policy shift from curative to promotive and preventive services. I have reservations on its findings that will be adulterated,” observes Gibore.

He argues that majority of Kenyans seek health services and care at Level 1, 2 and 3 facilities, which should be represented in the task force.

The official also wants specification of human resource issue to be addressed. He cites the number of health professions and workforce ratio.

“This (task force) is just a statement. We have good policies, but the problem is implementing the laws with us,” asserts Gibore.

To run healthcare effectively, the official says there is a need to have a Health Service Commission that oversees human resources matters.

The body, according to him, would have solved issues affecting health sector workers in both levels of government.

‘‘We need a centralised managing body, to focus on issues and avoid bureaucracy,’’ Gibore says.