Devolution and the paradox of absentee doctors

Research institute Ipsos released an opinion poll finding on Wednesday that showed many Kenyans support doctors, nurses and clinical officers in their demand for increased remuneration, commensurate with the work they do. Lately, doctors in various counties across the country have been on strike demanding better pay. Some resigned from government service to set up private clinics.

To a large extent, the standoff with doctors was informed by the devolving of health services to the counties. While the doctors were opposed to this move, governors have been adamant that medical functions be devolved, as stipulated in the new Constitution. That issue is yet to be resolved amid the political posturing between the national and county governments.

The citizen’s support for better pay is because they believe doctors can only offer good service if paid well. The unfortunate thing is that medical personnel have been giving less than is expected of them in the discharge of their duties. Doctor absenteeism has become an issue that requires immediate attention if the State wishes to restore public trust in government hospitals that are a pale shadow of themselves, and more often have no medication for visiting patients.

A study titled Government of Kenya, 2014: Kenya Service Availability and Readiness Assessment Mapping, decries the high levels of doctor absenteeism at government hospitals which affects and compromises service delivery. Conducted in 2013, the report reveals that in terms of doctor absenteeism, Nyeri, Elgeyo Marakwet, Nakuru, Kiambu, Machakos and Kisii counties top the list with a third of the medical personnel not showing up for duty, yet continue to draw salaries. It is not clear whether the current exercise that seeks to biometrically register all civil servants will nab the workers who draw salaries for work not done.

The counties ranked among the best in doctor turnout were Lamu, Nandi, West Pokot, Laikipia and Wajir. There may be legitimate reasons for some of the absenteeism: Maternity leave, sick leave, chasing after salaries or training, but which still points to a weakness in policy formulation by the Ministry of Health. Why, for instance, would the government send doctors to hospitals then grant them leave to pursue further studies without having immediate replacements for them? This is an oversight that is turning out to be costly to the tax payer who, in desperation, turns to quacks, herbal medication or self-diagnosis for ailments that need laboratory testing.

In areas of Turkana, the chief, the only government functionary close to the people and known to them, is compelled to go beyond the call of duty to become the resident ‘doctor’, dispensing medication purely on conjecture because trained personnel are not there. Turkana represents marginalised areas that the government has neglected for long and whose salvation is the advent of devolution. County governments have the onus of correcting this kind of injustice.

There are cases of absenteeism induced by laxity, disdain for work or pure malice. Most patients visiting government hospitals at night rarely get competent attention. Normally, trainee nurses and clinical officers are left to look after cases as medics take to bars to indulge their passions or undertake to supplement their earnings by working at private clinics which they either own or are run by their friends.

The other tragedy is that while doctors go missing for various reasons, most government hospitals don’t have adequate supplies of medicines. Consequently, patients get medication from private pharmacies, some of which sell counterfeit or expired medication that pose more danger. That many people exasperated by poor services at government hospitals have turned to herbalists is not in doubt.

What is in doubt is the competency of those offering the said services. It is no wonder therefore that treatable diseases are on the increase in the midst of advances in scientific methods of treating all ailments. Both levels of government have a responsibility to the citizens to give them better health care.