Health Cabinet Secretary James Macharia with Ms Barbara Hughes and Dr
Custodia Mandlhate on February 27, 2015. Nothing could have prepared the
soft spoken Macharia for the unique set of challenges that
professionals from the corporate sector experience when they move to
public service. PHOTO | FILE
NATION MEDIA GROUP
That
was the institutional and social logic that guided James Wainaina
Macharia—the Cabinet Secretary for the Ministry of Health— from the
1970s as an A-student in Kagumo High School, to 2013 as the
revolutionary managing director of NIC bank before joining public
service.
Naturally, the 54 year old transferred his mantra from the private service to his work in the government.
Nothing
could have prepared the soft spoken Macharia for the unique set of
challenges that professionals from the corporate sector experience when
they move to public service.
As one
of the most senior public officials in the Ministry of Health, Mr
Macharia has found himself in a quandary as he struggles to reconcile
health policies at the national level with service delivery in the
counties.
Seated at his office in
Afya House, Nairobi, it is clear the CS is loaded with frustration, his
efforts not to point fingers betrayed only by his choice of words.
“In
the private sector, people know you are at A, all they want is the
result at point Z, they are not interested in the challenges you
experience between B and Y”, he says.
DOCTORS EXIT
Six
months after taking up the job, the London trained chartered accountant
found himself on the spot over the week-long strike of health workers
in public hospitals in December last year.
During
the strike, there were reports of premature babies dying in incubators
in Kenyatta National Hospital, HIV/AIDS patients in Mombasa missing out
on life preserving drugs and mothers giving birth unattended at county
hospitals.
Daring the government to
fire them, doctors and union leaders shared reports about the massive
migration of doctors from public hospitals with public.
This further highlighted the low doctor—patient ratio that is making headlines in World Health Organisation crisis reports.
The
CS was appalled as governors told the doctors to return to work or ‘hit
the street’, a statement that was echoed further by Transition
Authority’s boss Kinuthia Wa Mwangi.
Even
after the strike was called off, Kenya Medical Practitioners,
Pharmacists and Dentists Union’s (KMPPDU) Secretary-General, Dr Ouma
Oluga, reported that than 1,800 doctors resigned from the hospitals in
2014 because of deplorable working conditions.
And
early this year, the figure stood at 2,000, a huge enough deduction
from the 8,682 registered doctors recorded in the health management
information system quoted in the economic survey of 2014.
The
healthcare workers were demanding — among other things — that the
government take charge of human resource management until a health
service commission was set up.
Today, Mr Macharia says he knows the real reason why the doctors downed their tools:
“Anxiety.
That is normal for any system in its budding stages, there are no
career prospects, you are not assured of your job security, the
structures are not stable”, he says.
Notably,
signed letters addressed to Mr Macharia from the KMPPDU in January and
February this year show that doctors are still paid by the voucher
system, despite this being one of the contentious issues that resulted
in the strike.
CLIMBING FROM TOP
The
voucher system, makes it hard for medics to have their national
insurance funds deducted from their salaries thus denying them access to
medical services when they fall ill.
Unlike
in the private sector where he had the authority to fire an employee
for not pulling his/her weight, government employees enjoy much stronger
job protection which helps shield them Mr Macharia’s capitalistic
attitude.
“There are things I know I
need to do, but because of constitutional limitations I cannot”, he
says, “yet, when there is a strike in Mombasa, journalists will call to
ask me what I am doing about it, not knowing there is a government there
that will not miss any opportunity to remind all of us that their
autonomy is enshrined in the constitution”.
He
makes a cursory mention of the Sh38 billion equipment project, an
initiative that brought tension between the national government and
governors who opposed the equipping of county hospitals with state of
the art machines.
Mr Macharia was
criticised by the medical fraternity for expecting expensive equipment
to be used in hospitals that lacked foundational requirements such as
medical supplies and drugs.
Kenya
Medical Association’s chair, Dr Elly Nyaim said the CS was ‘climbing the
tree from the top’, ‘buying a vehicle, parking it in the house and then
later going to learn how to drive’.
“Will
patients run the equipment alone when nurses and doctors are on strike
because they have not been paid their little salaries? How will we
perform surgery when the patient cannot even access first line
antibiotics because the hospital has not procured and stocked them?” Dr
Nyaim asks.
KMPPDU’s Secretary
General Dr Oluga questions whether the CS was aware that each region has
disease burden profiles so diverse that some would not need them at
all. The governors on the other hand opposed the project because they
were not consulted.
In his defense,
Mr Macharia will produce signed records of attendance from his meeting
held in 2013 with the governors, their health and finance executives
where he had explained the need to have cancer equipment.
The
response from the governors, he says, annoyed him so much he wished he
had been a CS in the previous government — before devolution.
He told Jobs
emphatically: “If you are aware that there is someone queuing at
Kenyatta hospital for 12 weeks for cancer treatment and that he will die
if he does not get the treatment, there is no justification to extend
that time further even for a second”.
UNHEALTHY BUDGETS
“In
the previous government, nobody cared where the money came from because
whether you stole it or begged for it, all an injured person needs from
the scene of an accident in Ngata, Nakuru is intensive care, not an
explanation on where you got the money to buy the equipment...”, he
trails off.
“There is no time for
endless round table meetings, time is ticking and we gave a manifesto to
the people two years ago whose results we should finish on time”, says
the frustrated CS.
Faced with their
own financial challenges due to structural teething problems, governors
expenditure on health in the last quarter of 2014 has left a lot to be
desired in certain counties.
The report on the expenditure, he says, almost gave him a heart attack.
“There
are counties like Kisii that spent less than two per cent of their
monies on health, and I am certain 98 per cent of that little amount
went into salaries instead of buying even one Panadol”, he says.
“You
know the children of the people who oppose these projects do not seek
treatment there, they can afford to fly out of the country or go to
private hospitals”.
Regardless of the
tribulations he is facing, Mr Macharia says he has not set the bar
modestly for Kenya’s health. He poses a rhetoric question:
“It
is easier to get here from Congo than it is to go to South Africa, but
do you know the Congolese flock South Africa for very basic treatment
that our doctors can handle easily?”
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