Why the doctors will strike again

"Bad administration to be sure, can destroy good policy; but good administration can never save bad policy," – Adlai Stevenson, a renowned American politician once said.

The ministry of Health housed in Afya house has earned itself the nickname Mafya House from the doctors and other health workers who work under its employment because of its way of administration and policy.

Two years ago, eight doctors working as medical officers on secondment from the ministry of Medical Services to Pumwani Maternity Hospital, Nairobi, were overcome by the deplorable working conditions, the failing ‘politically correct’ new management and the high maternal mortality that presided over in the hospital. They sought to hold their employers to task for the above.

So they organised to go to the Mafya House to present their grievances. On arriving there, they were met with sympathy from the senior officers, who promised to look into the issues. To their surprise, a few days later, they were called to the administrator’s office in Pumwani Maternity Hospital, accused of being troublemakers and handed transfer letters from Mafya House signed by the office where they had sought address.

Within a year, all eight doctors had resigned from Government service.

Ironically, in that same year, scandals of graft, lack of supplies and gross understaffing rocked Pumwani Maternity Hospital prompting a visit by the Parliamentary Health Committee.

This is just but one example of the failed health service delivery sector under the custodianship of mafya House.

It is an unfortunate truth that institutional policy in Kenya relies heavily on political will. The health sector is not exempted. For technical employees such as health workers, this has proved to be unsustainable and evidently hazardous. Appointments based on political inclinations, retention of said appointees despite evident failures to deliver and skewed performance contracts are issues that must not be taken lightly.

A scenario where pleas for an increase in the number of cardiologists in a province is met with hesitation, a surgeon is deployed to a hospital with no anaesthetist, entire provinces relying on the national referral hospital for patients dialysis and yet no sound reasons are given of what is being done to change the situation, is a reason to worry. There is also lack of warmth and clean water in new born units at district and sub-district hospitals. Worse, the health sector receives severe budget cuts every year with no apparent resistance being met by the health ministries.

Part of the impatience seen in the striking doctors stems from their observation that reforms are taking place in other sectors such as the judiciary and roads, while nothing seems to be going on at the health sector.

This calls for the formation of a Health Services Commission and a Hospital Management Authority funded by the treasury. Their mandate should be to deal with the welfare and terms of service of health workers in Government service and administration of public hospitals.

There is a need to delink the ministries from service delivery through the establishment of a Health Services Commission. Equally, there is a need for establishment of a decentralised body, fully accountable for the running of public hospitals, implementing policies and upholding standards — the Hospital Management Authority.

The ministries’ role will be to focus on policies, standards, guidelines and regulation of delivery of health services.

A recommendation from the Musyimi led task force on strengthening health service delivery was that a constitutional amendment be carried out to enable formation of the Health Service Commission with the involvement of all stakeholders.

Until such a time, when the doctors are not in an active state of disenfranchise and acrimony with their employers and their places of work are accountable to no one, we should prepare for a humanitarian crisis.