Why Kenya has been unable to end the two-month long doctors’ strike
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Elisabeth Janaina
Feb 13, 2017, 10:21:33 AM2/13/17
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Why Kenya has been unable to end the two-month long doctors’ strike
Posted on February 9, 2017 by Moses Masika
It’s not just about pay.
Since doctors went on strike, millions of Kenyans have been unable to
access care in public hospitals. Credit: CitizenTV.
On 5 December 2016, doctors in public health facilities in Kenya went
on strike, setting off one of the longest and messiest industrial
disputes by health workers in the country. The Conversation Africa’s
Health Editor Joy Wanja Muraya asked Moses Masika to analyse the
current impasse that’s paralysed public hospitals countrywide.
What is the cause of the stalemate? How can the standoff be resolved?
Today marks 65 days of a standoff between government and doctors
that’s deprived many Kenyans the inalienable right to quality health
care and exposing many to extreme physical injuries and financial
strain.
When doctors in Kenya began the strike two months ago they spelt out
their demands clearly: they wanted a collective bargaining agreement
signed in June 2013 to be implemented.
The government has chosen the wrong approach to end the strike. It’s
attempted to coerce doctors to resume work by withholding salaries,
issuing sacking letters and threatening to import foreign doctors from
countries such as Cuba and India.
Union leaders have also been threatened with jail sentences for
contempt of court.
These coercive machinations are intended to force doctors back to
work. Instead they have strengthened their resolve. After so much
sacrifice they feel there’s nothing more to lose.
The doctors’ resolve has also been strengthened by the fact that the
government has refused to make any concessions, sticking to the same
deal that the doctors’ union turned down in the first week of the
strike.
What will get the doctors back to work?
The answer lies in implementing the 2013 collective bargaining agreement.
It covers, among other things, fair working hours, improving work
environments and equipment, training, research and remuneration.
Remuneration has been the most contentious. So far the government has
offered an extra allowance but no basic salary increase. For any deal
to stand a chance of ending the stalemate it needs to address all the
issues, not just the addition of a solitary allowance.
The habit of using technicalities and bureaucratic red tape to
frustrate the negotiations also needs to stop. And all stakeholders
should be ready to come up with solutions rather than erecting
roadblocks along the road to a deal.
Ultimately, the government needs to place the interests of the public
first. It’s required to provide quality health care to all its
citizens. Instead it is disregarding the needs of the majority of
Kenyans who cannot afford private health care.
What effect has the strike had over the last two months?
Millions of Kenyans have been unable to access care in public hospitals.
National data shows that the number of outpatient visits in December
2016 was about half of the average in the previous 6 months.
In addition, the number of inpatients per month has reduced to less
than a third compared to previous months. This shows that millions of
patients have not been able to access care in public facilities.
The most perturbing effect is that many patients have died or suffered
disability because they could not access care. On top of this, many
people have been forced to seek health care services from private
hospitals, incurring catastrophic financial liability.
The strike has also led to delays in training schedules. University
lecturers in all public medical schools across the country have been
forced to stop teaching until teaching hospitals resume work. It’s
impossible to teach medicine without patients in the hospitals.
This is likely to delay the release of new doctors who are supposed to
graduate from medical schools this year, exacerbating the shortage of
doctors across the country.
The strike has also placed heavy workloads on private and faith based
health facilities which have had to contend with higher number of
patients. This has stretched existing facilities and human resources,
potentially reducing the quality of care.
Ethically, should doctors and nurses go on strike?
Doctors are bound by the Hippocratic oath not to harm patients under
their care. That’s why, for instance, those who were performing
surgery when the strike started didn’t abandon their patients but
completed the operations first.
Secondly, the oath places special obligations on doctors towards their
fellow human beings – whether they are ill or not – and charges them
to take all the necessary measures to benefit the sick.
In the current strike, doctors have clearly outlined the benefits of
their demands to the general public. If the government meets its
obligations, there will be more doctors in public service and they
will be better equipped, trained and motivated.
Therefore the burden of abandoning patients is not to be borne by the
doctors: the government bears the responsibility to provide health
care to the people. After all Kenyans pay their taxes to the
government, not to the doctors, and should expect the government to
provide essential services in return.
[#LipaKamaTender: How Kenya’s striking medical workers took control of
the narrative]
What needs to be done after the strike, to restore confidence in
public health facilities?
Resolving the current strike positively would alleviate two major
problems that bedevil Kenya’s public health facilities – the shortage
of doctors and insufficient equipment.
That notwithstanding, the government will need to go further and
address the problem of health care financing by making it equitable.
Currently settling health bills impoverishes many Kenyans.
The National Hospital Insurance Fund has been expanded to cover many
health care costs but the country still falls short of universal
health coverage.
Kenya also needs to empower public hospitals to take advantage of the
fund’s expanded coverage to grow and improve their services.
At the moment a disproportionately large chunk of the National
Hospital Insurance Fund goes to private hospitals leaving public
hospitals with constrained budgets. Public hospitals provide
subsidised services and often fail to receive payment for services
rendered.
This means that the hospitals cannot acquire the supplies or equipment
they need to offer quality services.
Moses Masika, PhD Candidate, KAVI Institute of Clinical Research,
University of Nairobi.
This article was originally published on The Conversation. Read the
original article.The Conversation
If you enjoyed this post, please consider leaving a comment or
subscribing to the RSS feed to have future articles delivered to your
feed reader.
This entry was posted in African Politics Now. Bookmark the permalink.
Posted on February 9, 2017 by Moses Masika
It’s not just about pay.
Since doctors went on strike, millions of Kenyans have been unable to
access care in public hospitals. Credit: CitizenTV.
On 5 December 2016, doctors in public health facilities in Kenya went
on strike, setting off one of the longest and messiest industrial
disputes by health workers in the country. The Conversation Africa’s
Health Editor Joy Wanja Muraya asked Moses Masika to analyse the
current impasse that’s paralysed public hospitals countrywide.
What is the cause of the stalemate? How can the standoff be resolved?
Today marks 65 days of a standoff between government and doctors
that’s deprived many Kenyans the inalienable right to quality health
care and exposing many to extreme physical injuries and financial
strain.
When doctors in Kenya began the strike two months ago they spelt out
their demands clearly: they wanted a collective bargaining agreement
signed in June 2013 to be implemented.
The government has chosen the wrong approach to end the strike. It’s
attempted to coerce doctors to resume work by withholding salaries,
issuing sacking letters and threatening to import foreign doctors from
countries such as Cuba and India.
Union leaders have also been threatened with jail sentences for
contempt of court.
These coercive machinations are intended to force doctors back to
work. Instead they have strengthened their resolve. After so much
sacrifice they feel there’s nothing more to lose.
The doctors’ resolve has also been strengthened by the fact that the
government has refused to make any concessions, sticking to the same
deal that the doctors’ union turned down in the first week of the
strike.
What will get the doctors back to work?
The answer lies in implementing the 2013 collective bargaining agreement.
It covers, among other things, fair working hours, improving work
environments and equipment, training, research and remuneration.
Remuneration has been the most contentious. So far the government has
offered an extra allowance but no basic salary increase. For any deal
to stand a chance of ending the stalemate it needs to address all the
issues, not just the addition of a solitary allowance.
The habit of using technicalities and bureaucratic red tape to
frustrate the negotiations also needs to stop. And all stakeholders
should be ready to come up with solutions rather than erecting
roadblocks along the road to a deal.
Ultimately, the government needs to place the interests of the public
first. It’s required to provide quality health care to all its
citizens. Instead it is disregarding the needs of the majority of
Kenyans who cannot afford private health care.
What effect has the strike had over the last two months?
Millions of Kenyans have been unable to access care in public hospitals.
National data shows that the number of outpatient visits in December
2016 was about half of the average in the previous 6 months.
In addition, the number of inpatients per month has reduced to less
than a third compared to previous months. This shows that millions of
patients have not been able to access care in public facilities.
The most perturbing effect is that many patients have died or suffered
disability because they could not access care. On top of this, many
people have been forced to seek health care services from private
hospitals, incurring catastrophic financial liability.
The strike has also led to delays in training schedules. University
lecturers in all public medical schools across the country have been
forced to stop teaching until teaching hospitals resume work. It’s
impossible to teach medicine without patients in the hospitals.
This is likely to delay the release of new doctors who are supposed to
graduate from medical schools this year, exacerbating the shortage of
doctors across the country.
The strike has also placed heavy workloads on private and faith based
health facilities which have had to contend with higher number of
patients. This has stretched existing facilities and human resources,
potentially reducing the quality of care.
Ethically, should doctors and nurses go on strike?
Doctors are bound by the Hippocratic oath not to harm patients under
their care. That’s why, for instance, those who were performing
surgery when the strike started didn’t abandon their patients but
completed the operations first.
Secondly, the oath places special obligations on doctors towards their
fellow human beings – whether they are ill or not – and charges them
to take all the necessary measures to benefit the sick.
In the current strike, doctors have clearly outlined the benefits of
their demands to the general public. If the government meets its
obligations, there will be more doctors in public service and they
will be better equipped, trained and motivated.
Therefore the burden of abandoning patients is not to be borne by the
doctors: the government bears the responsibility to provide health
care to the people. After all Kenyans pay their taxes to the
government, not to the doctors, and should expect the government to
provide essential services in return.
[#LipaKamaTender: How Kenya’s striking medical workers took control of
the narrative]
What needs to be done after the strike, to restore confidence in
public health facilities?
Resolving the current strike positively would alleviate two major
problems that bedevil Kenya’s public health facilities – the shortage
of doctors and insufficient equipment.
That notwithstanding, the government will need to go further and
address the problem of health care financing by making it equitable.
Currently settling health bills impoverishes many Kenyans.
The National Hospital Insurance Fund has been expanded to cover many
health care costs but the country still falls short of universal
health coverage.
Kenya also needs to empower public hospitals to take advantage of the
fund’s expanded coverage to grow and improve their services.
At the moment a disproportionately large chunk of the National
Hospital Insurance Fund goes to private hospitals leaving public
hospitals with constrained budgets. Public hospitals provide
subsidised services and often fail to receive payment for services
rendered.
This means that the hospitals cannot acquire the supplies or equipment
they need to offer quality services.
Moses Masika, PhD Candidate, KAVI Institute of Clinical Research,
University of Nairobi.
This article was originally published on The Conversation. Read the
original article.The Conversation
If you enjoyed this post, please consider leaving a comment or
subscribing to the RSS feed to have future articles delivered to your
feed reader.
This entry was posted in African Politics Now. Bookmark the permalink.
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