Monday, April 29, 2013

Who says medics can’t make good managers?

By Lukoye Atwoli

Sunday Nation 28 April 2013

Earlier this past week, the Kenya Medical Association (KMA) issued a statement indicating that they disagreed with the President’s choice of a banker to head the ministry of Health. Indeed the association went as far as suggesting that the President re-designates the nominee to a more relevant ministry, and appoint a health professional to run the Health ministry.

KMA’s statement elicited varied reactions, both positive and negative. The President himself dismissed the statement, indicating that he was interested in appointing managers to run the ministries. The assumption, of course, is that health professionals are either not trained or experienced in management, an assumption that is at total variance with the facts on the ground.

Perhaps it is important to examine the background of KMA’s reaction.Firstly, the Jubilee Coalition’s health manifesto was produced by a team headed by a KMA member who also happened to have held the position of secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU). Throughout the process, it was the understanding of the drafting team that a health worker would eventually be appointed to implement the manifesto.

Secondly, throughout the campaign, the Jubilee team assured Kenyans that each ministry would be headed by a professional with relevant experience in the field. It would be difficult for even the most adept contortionist to demonstrate how a banker would fit the bill as a professional in the health sector.

Some have argued that medics are too few to be wasted on management, and that they should therefore be confined to hospitals seeing patients. However, no one attempts to interrogate the reasons why there are so few medics in the public health sector.

Perennial mismanagement in the ministry has resulted in a situation whereby the numbers of some cadres of health workers have been reducing over time, despite the fact that our universities continue to churn out large numbers of these cadres every year.

Why has the ministry been so poor in retaining high quality human resources for health in sufficient numbers to address the health challenges facing this country? Why are our health indicators either stagnating or sliding backwards over time?

The question KMA was asking is this: Why have successive governments been reluctant to appoint a highly qualified health worker to head the ministry of Health? What evidence exists to show that doctors or other health workers cannot run a ministry? If anything, available evidence suggests that health institutions run by doctors perform better on their core functions than those run by non-medics.

The same research actually suggests that in any field, “insider” managers outperform management experts sourced from outside the field. Why is an impression being created that doctors or other health workers cannot make good managers?

The idea being propagated that health workers are against the nominee as an individual is completely off the mark. The association is very clear that the nominee is highly educated and experienced in his field. The only grouse is that he is probably not best suited to head a ministry that is so bedevilled by problems that it needs immediate measures to resuscitate it.

One would remain hopeful that the President will listen to professionals on this matter, and perhaps appoint relevant people to posts they are suited to hold.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s school of medicine; Twitter @LukoyeAtwoli

Sunday, April 21, 2013

Medics must be more proactive in the counties

By Lukoye Atwoli
Sunday Nation 21 April 2013

On Thursday, members of the Kenya Medical Association will congregate at Maanzoni Lodge in Machakos County for the 41st annual scientific conference and Annual General Meeting.
Doctors from all over the country will be deliberating on healthcare delivery in the devolved government, and it is hoped that at the end of the meeting a communiqué shall be issued providing professional guidance on the direction devolution of health care should take.
For a long time, governments have paid lip service to the importance of a healthy population in meeting development goals. Indeed, our government signed up to the Abuja declaration, committing itself to spending over 15 per cent of the budget on health.
Subsequently, we embraced the millennium development goals, whose underlying thrust is an improvement in health indicators in order to reduce poverty and suffering in the world.
Unfortunately, we have barely made a dent on the health problems that afflict us, and only recently are we awakening to the burden of new and emerging diseases.
Chronic diseases such as mental disorders, cancer, cardiovascular and respiratory diseases and diabetes mellitus are becoming the new scourge for our generation. Despite being styled the diseases of wealthy countries, these illnesses today afflict all echelons of our largely poor society, and are becoming the greatest causes of illness and death among our people.
It is becoming clearer with each passing day that we cannot solve modern problems with the archaic approaches we have been using since independence.
Refreshingly, the new Constitution lays emphasis on devolved government, and a huge chunk of health care delivery has been devolved to the counties. This may just be the solution that is required to begin making a difference in the health of our people.
It is encouraging that all our governments, both national and county, are enthusiastically making plans for revamping the health sector to ensure that our people are able to march into the future without worrying that the next sick person in the family will leave them wallowing in penury.
This is an opportunity that cannot be allowed to go to waste. The national and county governments must somehow be compelled to budget 15 per cent of their available resources on health at their respective levels.
The national government’s pledge to deliver maternity care free of charge, and to eliminate charges at primary health care level facilities such as dispensaries and health centres, will go a long way in achieving this goal.
But this will only happen if both levels of government commit resources to compensate health facilities for “free” services offered.
Second, it is time medical professionals crawled out of their hallowed ivory towers and faced the reality that their patients are dying not because of a lack of expertise, but due to a lack of political involvement.
We must engage politicians in charge of policy formulation and the technocrats in charge of implementation more proactively.
We must begin to see more policy papers and technical analyses of government policy emanating from professional associations such as the Kenya Medical Association. We must see more advocacy for our voiceless patients coming from KMA and other associations of caring professionals.
To this end, therefore, one expects to see a radically different meeting this year, with more tangible deliverables as well.
Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s school of medicine; Twitter @LukoyeAtwoli

Tuesday, April 16, 2013

Free maternity care means healthier Kenyans

By Lukoye Atwoli
Sunday Nation 14 April 2013

Upon his swearing in last Tuesday, President Uhuru Kenyatta made a promise that should excite all Kenyans, regardless of political persuasion. He promised that within the next one hundred days, his government will eliminate all charges on maternity care in public health facilities. While many are busy examining the financial implications of this promise, and perhaps making conclusions on its feasibility, I would whole-heartedly endorse it as the beginning of better healthcare for all Kenyans.

Indeed, increasing the proportion of deliveries assisted by skilled attendants in hospitals has many benefits. Firstly, the money that would have been spent on deliveries can be put to other use by the family, such a buying food and clothing or paying for education and accommodation.

Secondly, this move will ensure that babies are born in safe environments, reducing the risk of complications and ensuring that they get all requisite immunisations and treatment early in life. Their mothers are also more likely to get educated on better childcare techniques, improving the health of their offspring. 

The resulting good health will inoculate children against malnutrition and diseases, and give them a healthy start in life. This will improve their chances of succeeding in academics, sports and any other areas they choose to participate in. The benefits to society would be incalculable when we have a large pool of highly motivated, healthy youth ready to put their ideas into practice.

But there are a few bottlenecks that will threaten the president’s declaration, right from inception. Firstly, all healthcare services at the county level are meant to be under the county governments. The role of the national government in health is limited to supra-county functions such as national referral health facilities, disaster management, and health policy.

Before rolling out the free maternity care services, it will be prudent for the national government to constructively engage the county governments to work out modalities of its implementation. Ad hoc implementation will result in a chaotic situation where counties allied to the national executive do one thing, while others do another. The loser will be the ordinary Kenyan.

Secondly, free health services of any shade require investment in infrastructure, human resources and consumables. In order to implement this promise, the government will have to develop a plan to improve the existing infrastructure, train and recruit a qualified health workforce, and ensure consistent supply of medications and other supplies.

Finally, maternity services cannot be offered in isolation. The incoming government needs to develop a comprehensive health policy that will ensure that all common causes of morbidity and mortality are addressed. One would expect that these plagues would also come under the “free service” ambit, in order to more comprehensively improve the health of Kenyans.

If the government increases health expenditure to at least 15 per cent of the budget as set out in the Abuja Declaration, we shall be able to offer not only free maternity services, but also free child health, mental health and public health interventions. This can be accomplished within the next five years, if the government is prepared to back its promises with political goodwill and financial support. 

Hopefully the president will demonstrate this when he addresses Parliament on Tuesday.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s School of Medicine; Twitter @LukoyeAtwoli

Sunday, April 7, 2013

An open letter to the incoming president

By Lukoye Atwoli
Sunday Nation 07 April 2013
Dear Sir,
I must apologise for being so forward as to imagine that in your busy schedule you will find time to read this piece. I can only hope that you will come across it either in this newspaper or on the various social media platforms you actively use.
First, congratulations on your hard-won victory in the just-concluded presidential contest.
The queues of political parties’ leaders itching to sign post-election deals with you confirms the superiority of your campaign infrastructure, and justifies the optimism with which you and your team view the future of this country.
As you prepare for your inauguration, I would like to bring a couple of things to your attention. Please keep in mind that your predecessor will be remembered for all time as the president who introduced free primary education, as well as subsidised secondary education and expanded university education. In short, President Kibaki will be remembered as the “Education President”.
Sir, this is your moment to begin the journey towards your future designation as Kenya’s “Health President”.
First, I would challenge you to keep your promise of spending at least 15 per cent of the budget on health. There is no shortage of needs in this field, and I can assure you that the plans for this expenditure are gathering dust on shelves at the ministry of Health headquarters.
Useful suggestion
The latest report in this regard, the Musyimi Taskforce report, was handed to ministry officials over a year ago. It makes useful suggestions on where immediate and medium-term investments in health ought to be made in order to begin improving the health of our people.
The report discusses challenges in the sector, including deficiencies in infrastructure, human resources, supplies and indeed ideas. The biggest problem, though, has been under-financing despite government commitment to spend 15 per cent of its budget on health.
It then provides solutions, pinpointing areas where increased investment is necessary, and even providing numbers that are needed to fill in the gaps.
The second area that may interest you, Mr President, is that of mental health. Even as we lament the lack of investment in health, within the health sector, mental health suffers the tag of the ignored child in the family. Within health expenditure, less than one per cent is spent on mental health. The problem here is that expenditure on mental health is completely out of tune with the magnitude of the problem.
A quick scan of any daily newspaper will reveal the extent of the problem. Daily, people are committing suicide for a variety of reasons while others are committing homicides for the most outlandish of reasons. It is not beyond the realm of possibility that some of our leaders are making very important decisions that affect the entire country while suffering from untreated mental illnesses.
The truth of the matter is that a significant proportion of our population suffers from mental illness. Due to under-investment in this area, all other sectors of our economy and daily lives are affected adversely. Mr President, this is your opportunity to begin building a legacy as the president who revolutionised mental health services and subsequently led Kenya on a path of unparalleled growth.
Faithful citizen.
Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s school of medicine; Twitter @LukoyeAtwoli