Does it bother you that the productivity of the professionals on strike over pay is the hardest to measure? How do you measure the productivity of a medical doctor? The number of patients attended? The number of patients healed? The number of patents?
The best measure would be longevity. But here comes the paradox. The greatest life extensions in the last 100 years did not come from blockbuster drugs, but from improvements in basics like hygiene, clean drinking water, better food and sanitation. Think of malaria.
While millions have been spent looking for vaccine, a cheap mosquito net will do wonders. We have spent millions looking for the Aids vaccine, but a change in behaviour would keep a lot of people from affliction, including absorbing more young men and women into hobbies and sports to dispense off excess energy.
How do you measure the productivity of a lecturer? The number of As in his course? Number of publications? Citations? Interestingly, students will learn more if “neglected”. The best measure would be graduates’ progress in life say 10 years after graduation. They can tell if what you taught them has helped them make success out of their lives.
In both professions, an ‘opinion poll’ might work. Anytime you visit a cluster of hospitals or clinics like Hurlingham or Upper Hill, to see a specialist, general practitioner (GP) or dentist, always go for the one with longest queue, it does not matter how much hurry you are in.
The long queue is a vote of confidence! The same apples to restaurants. In universities, doing away with compulsory courses so that students go for courses where they feel they would get the highest value for their money would do the trick. Enrolment in courses would be votes.
Both higher education and medical field have a unique problem, information asymmetry. Doctors know more about the medicine than the customer (patient). In higher education, the lecturer or professor knows more about courses they teach than the student, including their marketability. This information asymmetry is the cause of prestige associated with these jobs. Some would add and some money.
But the asymmetry can be misused. Can doctors “over subscribe” drugs? There are times I have been given so many types of drugs in a pharmacy that I ask the doctor if I am dying. Can a doctor recommend more medical tests to make more money? Or in some country to protect himself against lawsuits, the so-called defensive medicine.
Are there cases of unnecessary admissions to fill the targeted hospital bed occupancy? And why do hospitals ask if you are paying through the pocket or insurance? Does that affect the pricing? In higher education, lots of courses taught have less job market value, but the ‘course owners’ have to keep their jobs. Ever heard of a don sacked because no one wants to take his or her course? Will students complain if they learn nothing but get As?
Long years of training and specialisation makes dons very attached to their courses even when the reality on the ground has shifted. It does not help that in both medicine and higher education, the regulators are ‘insiders’. Doctors regulate their field, and Higher Education regulators like CUE or even accreditation bodies are packed with former practitioners in the fields which make changes very rare.
Enough digression. What are the unintended consequences of strikes by the nation’s brainiest? The consequences accrue to the nation and professions alike. One, political consequences are obvious. Prolonged strikes in an election year is not good for the incumbent. If you are keen such strikes are common around election time, when the Government is at its weakest. Trade Unions and professional organisations know that.
Expect politicians to capitalise on strikes as the campaign season starts. The elites negotiating the terms or the CBA are paralyzed by politics more than the contents of CBAs. Noted how governors are quiet though health is their domain?
Two, economic loss is huge. The lives lost means economic production lost; economics is about people. That is why countries with falling populations worry about their economic prospects. The idle students have been eating, paying rent with nothing to show for. This idleness has a ripple effect throughout the economy because of interconnectedness. The demonstration effect, where other professions learn that you can earn more money by demonstrating on the streets than working harder or being innovative, will affect other sectors and the whole economy.
Three, the national image will suffer. Imagine if President Donald Trump called UK and after greetings, the next question is when the doctors’ strike is ending. The outsiders read about doctors and dons on strike and their image of the nation changes. Which tourist wants to visit a country where falling sick can mean death? And who wants to invest in a country where workers will demand more pay without commensurate productivity?
Four, some will argue that the downing of tools by dons and medics, shows they can’t be trusted in their work. What are the feelings of unemployed patients who can’t get medical attention? What are the contents of the eulogies read for those who died during the doctor’s strike? Expect more Kenyans to seek medical attention abroad, if they can afford. If foreign hospitals open branches in Kenya, expect them to prosper.
Five, expect more students to study abroad. Locally, the shift from public to private universities will accelerate, particularly now that students can be sponsored by the Government while in private universities. Will employers also shift their preference to graduates from abroad, less interrupted by strikes?
Six, the prestige of the professions will suffer. The public now thinks dons and medics are just like any other employees. They can strike and make noise along the streets and sing “solidarity forever.” Who gets royalty for that song? We could ask high school students if they still aspire to be dons and medics. It did not make matters better by some of us comparing our pay with MCAs.
Seven, and most important is that this strike and others will accelerate the road to irrelevance for public sector. Paralyzed by industrial action (diplomatic name for strike), more Kenyans will abandon the public sector. Think again. We are born in private hospitals, go to private schools, marry in private ceremonies, work in the private sector which has the majority of jobs in Kenya and globally, and often interred in private ceremonies. The rise of Private Public Partnership (PPT) is the clearest sign that the private sector and its thinking are making inroads into the public sector.
We thought some services such as security must be supplied by public sector only. Think again, we see more private security guards and watchmen than police. Could privatisation be the route to end strikes? The inclusion of private hospitals in doctors’ strike was unprecedented, but it has to do with shortage of doctors with most of them working in both sectors. The same did not apply to private universities.
Eight, we are not disputing that the working conditions of Kenya’s brains need improvement, but this should not be intermittent, punctuated by strikes. Why not index salaries to inflation rates to ensure that we rarely lose our purchasing power? After all data on inflation is public knowledge. Inability to measure accurately the productivity of the two professions calls for negotiations.
Finally, one Kenyan asked me an interesting question. If you guys are so brainy, why not start private hospitals and universities and make all the money? I will share my answer next time.
—The writer is senior lecturer, University of Nairobi. [email protected]