Quality care for all: A nation’s dream remains elusive, complex

The shortage of health workers has long been acute in Kenya, and has been getting worse. ILLUSTRATION | JOSEPH BARASA | NATION 

By Julius Omondi and Victor Amadala

In Summary

• Kenya is among the top six countries in Africa for doctors migrating to greener pastures.
• The exit comes after a decade of dwindling health budgets, despite the fact that Kenya was a signatory to the Abuja Declaration of 2001 committing countries to spending 15 per cent of their national government budget on health.

Kenya’s health industry is beset by challenges in meeting the promise of quality healthcare for all. But it is now braced for a new assault, with an increased health budget, and a new wave of medical recruitment.

 

The shortage of health workers has long been acute in Kenya, and has been getting worse.

The Kenya Medical Practitioners and Dentists Board (KMPDB) has registered around 9,000 medical doctors and 1,000 dentists over the past 32 years, but only 75 per cent of these are currently considered “active”, having renewed their medical licences within the past five years, and 11 per cent of the active medical doctors are 61 years of age or older, while an additional 17 per cent are 51-60 years old: although many will continue working after retirement age.

The shortages are not just of doctors: Kenya has just 1.03 health workers (doctors, nurses, midwives, and clinical officers) per 1,000 population, compared with the WHO recommendation of 2.30 per 1,000 population.

Government and other stakeholders have put in place various strategies to address the issue. In 2008, the country launched an Emergency Hire Plan (EHP) and a computer-based distance education programme.

The EHP saw the hiring of an additional 1,836 nurses, increasing the public sector nursing workforce by 12 per cent and functional health facilities by 9 per cent.

While the computer-based distance education programme, developed in a government partnership with the African Medical and Research Foundation, saw a 31 per cent increase in the number of registered nurses, as 5,887 upgraded from enrolled to registered.

Other efforts to scale up of the number of medical workers have included the opening of additional medical training facilities. There are over 70 institutions accredited by the Nursing Council of Kenya (NCK) to train nurses, of which 68 are actively training three classes of nurses.

But up to 2010, The University of Nairobi trained 90 per cent of Kenyan-trained medical doctors, while Moi University trained the other 10 per cent. Now, medical programmes have also been introduced at Kenyatta and Egerton universities.

But it’s a slow and expensive climb. On average, the cost of training a doctor in Kenya, from primary to university, is about Sh5.7 million and after training the government faces an immediate challenge of retention of medical workers in the public health service.

Medics cite poor pay packages as the reason for their exodus from the public sector to private, local or even international organisations.

Money problems

According to the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), in the private sector, doctors earn a gross monthly salary of between Sh120,000 and Sh150,000.

Even consultants in Kenya are paid about Sh250,000, which is less than in neighbouring countries, with Tanzania paying similar professionals about Sh450,000.

As a result, Kenya is among the top six countries in Africa for doctors migrating to greener pastures. According to statistics from Internews Agency, the number of Kenyan born doctors that work abroad is twice the number working in national referral hospitals and for the Ministry of Health.