Friday, December 23, 2011

Doctors' Strike Exposed Rot in the Health Sector

Lukoye Atwoli
18 December 2011

The Kenya Medical Practitioners, Pharmacists and Dentists Union called off the doctors' strike on Wednesday last week after some confusion on Tuesday about whether the strike was on or off. This was done after the union membership was convinced that the interests of the common citizen had been addressed, among other things. Today, it is important to reflect upon the effects of this strike.

For the first time in the history of this country, a trade union organised a strike largely with public interest at the core of it. Among the demands the doctors' union had, the most prominent included construction of more health facilities, equipping existing facilities, training and hiring of more health workers and increasing government spending on health.

The union called off the strike after the government admitted that things were not right in the health sector and made commitments to address the concerns raised by the union. Apart from committing to improve the pay of doctors and other health workers, the government agreed to form a joint task force with the union to deliberate on the way forward in addressing the medium and long-term issues raised by the union.

Quite apart from the fact that the government agreed to work with the doctors' union to improve the health sector in our country, the strike also achieved important milestones.

Importantly, the doctors' strike exposed the rot that exists in the health sector. Many Kenyans did not know that government expenditure on health as a proportion of total spending had been declining over the years. This has been happening despite our commitment to the Abuja Declaration that bound governments to ensure that health sector expenditure be raised to 15 per cent of that total government expenditure.

The result of declining health funding has been enormous. Health facilities have remained few and far between, and those that are available have had neither adequate staffing nor appropriate equipment to carry out basic functions of a health facility. There have also been difficulties recruiting and retaining qualified manpower, with the result that some critical health programmes in the country are solely dependent on donor funding.

The doctors' strike also exposed the dearth of leadership in the ministries of health. Throughout the crisis, both ministers were conspicuously absent. Conveniently, it was reported that they had gone abroad for treatment. How ironic that on the eve of the doctors' strike, those that were supposed to deal with it needed to seek the services of doctors outside the country!

Their absence, as well as the bungling display by the assistant minister and permanent secretary in the ministry of Medical Services, raised serious questions. By failing to provide leadership during these critical moments, the ministers might have been communicating to government that they agree with the doctors' union that there is a problem in the health sector but had no power to deal with the issues raised.

Indeed, a few days before the strike, the minister for medical services had indicated in a newspaper column that there were forces beyond his control that were determined that he does not achieve much in his docket. That it took the Treasury's intervention to end the strike may bear out this claim.

It is irresponsible to play politics with the lives of Kenyans, and the principals must act with speed to end this charade.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer, Moi University School of Medicine

Sunday, December 11, 2011

Doctors chose the lesser evil by downing tools

Sunday Nation 11 December 2011

Last Monday doctors in the public service went on strike. Among the issues raised by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) were inadequate staffing, absence of a scheme of service, stoppage of training sponsorships, poor working conditions and inadequate remuneration.

At the onset of the strike, fears were expressed that it would result in needless loss of lives, and it was suggested that it would be unethical for medical personnel to go on strike and leave patients to die. The Hippocratic Oath, which exhorts doctors to put their patients’ needs above all considerations, was cited as a good reason for doctors to call off their strike.

An objective observer would actually be horrified that doctors downed their tools and left their patients to their own devices. However, in order to understand why this happened, it is necessary to examine the events leading up to this strike.

Firstly, it must be appreciated that this is not the first time doctors are going on strike in Kenya or elsewhere.
This is the fourth doctors’ strike in Kenya, and the last one happened in the 1990s, resulting in a massive exodus of doctors to Europe, the United States and southern Africa. The reason for the exodus was that the government totally ignored the doctors’ demands, and instead opted to intimidate those that participated in the strike.

Everything possible

Secondly, one needs to understand the working conditions that the doctors are asking to be improved. When a doctor tells a patient or their relative that everything possible is being done to help them, it is often an intricate public relations exercise meant to hide the deficiencies in the system.

The health system in our country is rotten. Over the years, government expenditure on health as a proportion of total expenditure has progressively fallen, despite a commitment to the Abuja Declaration decreeing that 15 per cent of the budget must be spent on healthcare. The result of this neglect is self evident.

Health facilities are still few and far between, and many people have difficulty gaining access to quality healthcare within a few kilometres of their residence. Those that are available are grossly undermanned, and there are health facilities where one person performs the work of all cadres of healthcare workers. This person is often the only one available to diagnose illnesses, to dispense the treatment, to perform nursing duties and to keep the facility clean and habitable.

Supplies to health facilities have remained erratic and often do not meet the needs of the served population.
Health workers in these facilities are poorly remunerated, and it is often viewed as a punishment to be posted to remote areas of the republic because, among other difficulties, one’s housing allowance is reduced significantly outside the capital city.

In many hospitals, including the national referral facilities, needless loss of lives has been going on for a long time, and doctors are often bystanders who know what needs to be done but have no tools with which to deal with the problem.

The ethical dilemma that faced many doctors at the beginning of the strike was really a no-brainer. What is more ethical: to acquiesce to the continued loss of lives in an underfunded system or to walk away from it all and let everyone know that all is not well?

The striking doctors chose the latter.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association, and lecturer, Moi University School of Medicine.

Monday, December 5, 2011

Ombija’s ruling exposes hypocrisy of our leaders

Sunday Nation 04 December 2011

In a week that saw the former President of Cote d’Ivoire shipped off to the International Criminal Court (ICC) to answer charges of crimes against humanity, including murder and rape, the High Court in Nairobi made a ruling that sent shockwaves across the region. Judge Nicholas Ombija ruled that Sudan’s President Omar Hassan Al-Bashir should be arrested and handed over to the ICC should he ever set foot in Kenya again.

The ruling has clearly ruffled many feathers, if the robust response by our government and regional bodies is anything to go by. Many have accused the judge of ignoring regional concerns, and some have even accused him of serving “foreign” masters.

Regional repercussions

The executive arm of the government has vowed to appeal against the ruling, and has suggested that the judiciary needs to be mindful of the regional repercussions of its activities. From my point of view, it is very clear that the Sudan is a very important component in the regional peace and development efforts under the auspices of Igad.

It is also clear that any disagreement with Sudan would be very inconvenient for Kenya especially as we pursue terrorists into the heart of Somalia.The crisis does not augur well for a country that aspires to brand itself as a neutral arbiter for peace in the region.

Apoplectic response

All this is true and may, to a large extent, justify the government’s apoplectic response to the warrant of arrest for President Al-Bashir.

There is only one small problem, I am afraid. The law, as they say, is an ass, and justice is meant to be blind!

Just over a year ago we passed a Constitution to replace the older document that had over several decades been reduced to an autocrat’s charter. Among other provisions, our Constitution today provides that “the general rules of international law shall form part of the law of Kenya”, and that “any treaty or convention ratified by Kenya shall form part of the law of Kenya under this Constitution”.

Article 3 (1) further places upon all persons the “obligation to respect, uphold and defend this Constitution”.
After the passage of the Constitution, our Parliament went a step further and enacted the International Crimes Act that, in practice, domesticates the provisions of the Rome Statute. Attempts by a section of parliamentarians to get the government to pull out of the treaty that established the ICC were ignored by the executive.

Finally, the government is on record indicating that we are cooperating with the ICC and shall continue to do so in the matter of post-election violence where several prominent Kenyan politicians are among the suspects.

A disinterested observer, such as a judge might be, would be left in no doubt that the government is very serious in its commitments to the Rome Statute, and would expect therefore that any legitimate requests emanating from the Hague would be implemented by all arms of the government as required by our Constitution and local and international statutes.

Rome Statute

The High Court ruling exposes the hypocrisy of our leaders who make laws they do not intend to implement.
As long as we remain signatories to the Rome Statute and retain the International Crimes Act, any other judge worth his salt would rule exactly as Mr Justice Ombija did.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and lecturer, Moi University’s school of medicine