JUST A WORD AND I WILL STOP KILLING.

I watch in a shuddered frenzy as the moonlight becomes dimmer. Having been the person that put-off the lights at the hospital on 12^th December, I stand in doubt. Ok not exactly doubt. The yolk of the moon has burst on my head. The sky has fallen. Is falling. Where is James Bond?

But it always does. The sky always falls on health matters, and we have learnt a clever way of putting it back and holding it in place. We have learnt ways of devising and improvising. Making do. Moving on.  What this current frenzy has brought to the limelight is the heartfelt empathy of our leaders.

I heard one yell “doctors are killing people, by being on strike” I couldn’t help notice the stench of semi-raw boiled egg mixed with garlic, French beans, mushrooms and mrenda jetting out of his mouth and aromatizing the misty sorrounding. He did a belch or two. I couldn’t really count. But it was the belch of a well satisfied man. Much more disgusting was his pretence. His I-cannot-even harm-the bacteria-in-my-mouth-by-brushing kind of attitude. I suspect brushing teeth to him was considered as foreplay. Lucky wife he got.

I thought, silently, lest he belches on my sweaty face.

“But the country leadership has been on strike since Mau Mau left the forest!”  How would you explain the lack of basic emergency drugs in hospitals in country that has been independent and warless for 50 years? A very easy extrapolation…you don’t stock our hospitals with the basic drugs, lives are lost…and it has been that way since the black man in Kenya was allowed to wear trousers. Deliberate or not, people have died as a result. So much so that I think as a country we are wasting an opportunity to export manure derived from decomposed human flesh. If we did that, I can bet my bottom dollar, Singapore would be taking soft loans from Kenya’s pocket change. The tones would be back-breaking. The Honorable Minister of trade should seriously think about this venture.

Back to the man with egg/garlic/beans/mushrooms/mrenda mouth perfume. He stands tall on the roll of honor of hypocrisy. The Pharisees should sit their buttocks down and seriously take notes on modern day double speak (a laptop will be provided for that I am sure). Is he the same gentleman who flies out to have his flu treated?  The same man who takes the Boeing to get his testicles examined. I wonder what his ‘fundamendos’ are made of that a black doctor in Kenya is not allowed to give them a therapeutic squeeze. These are the epitomes of our leaders who do not live by their consequences. When their shit hits the fan and splatters on your face, they are up in the skies that very moment. As we are left with a open mouths and a stench, wondering what has happened, they are back again with more promises, they don’t even have the courtesy of reminding you to spit what has collected in your mouth as you let out a disgusting sycophantic cheer. You Kenyans are cool. And so am I.

Then comes another one to take the podium. Just the other day she was as thin as an apostrophe. You could see the head of the femur through her tie-and-die skirt. The trappings of power have however done her good. She walks pulling her linen skirt from between her buttocks. Life’s good. Wonder why the minister of energy hasn’t made some megawatts from the vibrations of her rear yet we import stima from Jinja, Uganda.

Amidst ululations she confirms to the mothers of the country that they can now give birth free of charge. I find myself clapping, against two odds. One, that am a man so I have not had the privilege of getting  myself pregnant yet and two because I know what this free entails. But hey dude, everyone is clapping and cheering, so take your silly sulking face to your grandmother’s grass thatched mansion. Bure wewe, mavi ya kuku kabisa!

As she goes to sit down, amidst wild cheers, still pulling this stubborn linen skirt from the embrace of her buttocks I remember she has forgotten to mention that the mothers need to come to the hospitals ‘self contained’. They should buy gloves, cord clamps, fluids, blades and hey the doctors are very few too (WHO standards) it might be polite of them to carry a one-use-only doctor from China in their kiondo. Those are the details, the devil!

Before the dust settles, another one takes the podium. This one has his tummy moving freely and graciously to the blast of the song ‘kanungo’ . I wonder how he does it so effortlessly, but one thing that is obvious for sure is that he has been eating his lunch without fail for a long time now. The song stops and he looks lost. Like a rabbit caught in the glare of the headlights. But he too has to say something. So he picks on the unpatriotic Kenyan doctors who are on strike.

“We are going to sack all of you and replace you with students..” he says, again his tummy moves with every word. It’s like it’s got a life of its own. I like it. What a show.  “You cannot let Kenyans die like this and get away with it..” he says in a cracking voice. At this point I heard him belch because I was close enough. I doubt if others did hear. Then tears rolled freely from his eyes. It was such a scene. The crowd got worked up, emotionally. And felt the sting of the words of mheshimiwa. They thought he was crying, but I was close enough to notice that it was the eye-tearing stench of raw onions from his belch that made him tear. You see, this man had a three-course meal. Some onions were used to make his food, and some he ate them raw. I learnt this kind of eating from books.

“You cannot let Kenyans die because you are on strike” are the words that got my thoughts to race. Trying to put it into perspective. I thought we already knew the country had gone on strike against its very own people and their health since 50 years ago. And as a result, the mortality had risen in proportions. We were however doing well with security. We were even at war with in a neighboring country. A good thing. You see, Kenya was a safe country to die in.

The failure to increase budgetary allocation in proportionate to the growing population had led to preventable deaths.  But those were not deaths. The lack of diagnostic equipment had led to preventable deaths. But those were not deaths. The failure to expand our ICUs had led to deaths. But those were not deaths. The overwhelmed doctor and nurse who was expected to attend to multiple patients like he is some sort of a DJ…mix here, mix there… had caused preventable deaths. But those were not deaths. In fact, they had come up with new solutions, that was to bundle up these health sector  workers into tribal circles for management as a way to address all the above. This, they called ‘the constitution. ‘ You should have seen their sleek suits, fat ties and staright faces when they were talking about this.

As darkness engulfs, the rocky hills of Mutsuma have a way of making the sky climax. The heavens opened, the men at the podium ran to their SUVs as we stood to watch and exclaim “powerful people we did elect there” living a moment of fantasy as boluses of rain painted our shirts.

 While I was rained on a bit, I didn’t mind, I knew I still had to endure the stretch of the road from Mutsuma Market back to Burundu Health Center, where I worked and lived. For the trouble of the rain, and the cold, I had bought my own penicillin just in case. I hoped the members in the crowd would buy theirs too when they come to the Health centre, because I have none in stock.

Then again I remembered the strike. And the sack. A genius moment for me. So I thought to myself, how about we convert all hospitals to churches, let people die and then let’s pray for them, for the kingdom of heaven is free, and it is indeed a kingdom.

Let us pray,

DIMINISHING PETAL

When she was here we planned earnestly for tomorrow. We, like you, viewed death as an alien. We were trying our best; she was giving her all. What better combination would a doctor want? The litany of body errors had slowed her down a little.

Her once voluptuous rounded waist was now a framework of unpleasant bones buried deep in scaly sagging skin. Her once fitting skirt sagging generously to her knees just to cover them but revealing legs thin like the reeds that hold papyrus. Well-oiled though as if to emphasize her will to get her groove back and turn heads once again.

Up her face, it required a poet’s complex mind to fix her now desolate look to the beauty in one of the snaps she keeps showing to those who cared to lend her a minute. The snaps a constant reminder of her goal.

Her chest no more than a loose blouse worn over the loose skin that was once the mark of her beauty.

She was supporting herself with a walking stick. She was 25 years old. She hoped to live for 65 more years, like her grand papa, she said.

Before the thunder of an unforgiving infection rendered her hospital-chained, Maliya was a student and a single mother to a dotting angel; Angel being her real name.

When she was here we planned each day for tomorrow. We looked forward to her discharge from the boring hospital ceiling. Her daughter needed her more than we did. Of course. For good measure, she needed to fulfill her dreams. The first university graduate in her entire family, she would have been.

“When I get out of here, I swear I will buy a whole sack of mangoes hide in my room and eat them one by one.” She said, interrupting her croaky voice with an equally croaky laughter.

So as I sighed out of relief, my legs up after a long day’s work. My phone rang. It was the hospital. It’s never a good sign. And I heard the narration.

While Maliya groaned in need of attention, the ward nurse was too busy writing in those books they have and when she finally came and realized things ‘were not so good’, she called the doctor. The doctor answered in a lazy tone, that which says without saying it, that a bother is not welcome. “I will come!” the doctors finally said and hang up. He was a good man though, he showed up. Two hours later. Eyes a little too red. Maybe he was glad then that there was no work left. God had done it. The lifeless body lay in bed, mouth open to betray the ignored cries for help.

Without uttering a word, he picked his pen and wrote “pupils fixed and not reacting to light, no cardiopulmonary activity. Patient certified dead” signed. And left. To continue. Yes to continue watching the series he had been interrupted watching. What’s the big deal peeps. That’s life man. Man up.

In as much as we grumble about poor working conditions and poor pay and lack of equipment, what really is our attitude and contribution to needless deaths. Did you play your role in treating another human being like a human being?

I hope Maliya’s baby Angel will grow up to understand the meaning of the words “pupils fixed.” As for now, the clouds have invited a dark night, and I guess it’s time to sleep. Good night peeps, but do wake up when you are needed. And do remember what someone else needs could be as simple as to get to eat a sack of mangoes.

#Someone should hug little Angel really tight for all of us :)

ALONG CAME THE UNION- KMPDU

For decades, the Kenyan doctor had suffered and worked under circumstances that were at best to be abhorred. Disillusioned, many chose to leave hoping for a better future for their families elsewhere. Inevitably something had to give.

In 2010 as the camel toiled under the heavy burdens, its back finally broke when the government decided to throw on more baggage. Sponsorship was stopped for post graduate doctors and enough being enough, the young doctors arose.

Initially we approached the ministry and when we were dismissed in the manner that has become customary at Afya house, we decided to rally doctors and stand up to the policy makers. That same week, we called a meeting/demonstration at Afya house to which all post graduate students whose sponsorship had been stopped were invited. Petitions were delivered to senior officials including both ministers but their manner did not suggest the slightest change of stance.

Coming from the meeting, it was clear that they had to spread the word about what was happening to all doctors. The press was an immediate obvious choice and they knew how to get them to their direction but we had no forum as yet.

As this was ongoing, Thika was abuzz. Doctors had strongly expressed their distaste for the developments to high ranking health officials in the region, a move for which some later had to pay with their jobs. Working with the local (THIKA) KMA branch, a meeting was organized (the Thika meeting) to discuss these concerns. This would be the perfect forum to launch the awareness campaign and begin the next steps. With no existing database, we needed to send out information about the meeting to as many doctors as possible in the limited time to the date of the meeting.

The use direct phone calls was favored, chain sms’s and the internet including existing groups such as ‘united against the poor pay of doctors’ though they weren’t sure how effective any of these means would have been .

By the Grace of God, something had happened in the preceding month that was very much to their advantage. The new constitution that entrenches the right of every Kenyan to form a union in the bill of rights had been adopted. The proposal for the formation of a Union would later take on its own life albeit under many different names.

As the union was born, our work was clearly cut out for us. It was daunting to say the least.

While a doctor had a net pay of approximately 500$, he was expected to work with limited resources and still deliver quality healthcare. The new constitution also providing for ‘the right to any acquire the highest possible echelons of healthcare’ meant that the pressure was on the unmotivated workforce. Little was being done to address this.

As nature would permit, our country recorded the highest brain drain in terms of the health sector workforce. At 51% this stood and still stands to be the highest in the world. What that meant was, even war torn countries could afford to better retain their workforce than we would. It was a tragic trend.

Tragic and made worse by the worsening mortality rates. While the rest of the world was actively achieving its goals in terms of ‘acceptable’ mortality rates, Kenya was backsliding and had no consolidated entity to agitate for healthcare reforms.

The union once registered embarked on some of these issues.

We pride in having taken proactive role in not just criticizing but offering practical solutions towards abating the negative trends.

One such solution base can be found in the “Musyimi Taskforce Report on Improvement of Health Services in Kenya’. This particular report details the various areas of concern as experienced first-hand by the Kenyan Doctor. Some progress has been made towards its actualization but the momentum has largely been lost.

Other areas we have actively taken on and addressed the concerns were;

1.     Streamlining post graduate training in Kenya

2.     Key concerns about to be addressed in the devolution of healthcare

3.     Factors that have led to the negative trends of our mortalities

4.     How to co-opt the health sector workforce to actively achieve our health goals

We do realize as a union that the needs In terms of health for our population are growing. We experience these deficits first hand and thus we believe that our input simply cannot be overlooked.

Besides being the single entity that unites all Doctors, pharmacists and Dentists, our input will provide that essential voice from the workforce that is being looked at to deliver healthcare.

The devolution structure remains largely new, almost experimental. There are very few countries with evidence based studies to compare its success. Our entity has worked with stakeholders to try evaluating various models. The Philippines’ model, the Ugandan model, the Rwandan and Ghanaian model amongst others. With this background information our input must be valuable, you would agree.

It would be unwise at this juncture for any county to jump into the mistakes of our peers and neighbor countries, with the inclusion of the Union, this could easily be averted. This is not only because of our participation in the studies but   also because we experience the health sector every day, first hand and out in the field.

Fully aware that our country has not lacked apt policies. In fact, we have sat through various conferences and been part of many of them. The persistence of the problem in the sector therefore implies that we could be missing the point. The point is we have largely excluded the point man in all these, and that is the health provider. Not the kind that makes policies and rules, but the one that implements or tries to implement them. This is what the union is endeavoring to bring.

THE GOVERNMENT MUST STOP VIEWING WORKERS AS BURDENS.

In a recent televised interview The Deputy President asserted, quiet correctly that the country’s wage bill is far too high. He further suggested that the solution to this would be to freeze salary increments for all civil servants as a mechanism to address it. I would like to contest his perception of the probable solution. Is freezing civil servants wage bill a sure mechanism of fostering economic growth or does it just end at that; a low wage bill for the country (of course with the confounding ripple effects of an unmotivated workforce).

First of all I chose to wonder why such a statement would be made with such finality at a time when tax payers are paying a lot of money to sustain the Salaries and Remunerations Commission. The statement from the outset implies that the work of this commission is done and dusted since they cannot recommend increments and of course you realize the effect of recommending salary cuts on any of the cadres. Why should we then elect to pay such a commission and engage it on a full time basis while the decision seems to have been made? The paradox of the situation is that, the commission meant to downsize wage bill is itself, by inference, an unnecessary addition to the escalation of the same since the statement by His Excellency the Deputy President renders it redundant. And for sure, they cannot recommend their own disbandment.

For a country that has its eyes set towards achieving economic emancipation, judged by the gusto the new government has decided to correct most of the errors from the past, I must be fair to note that they indeed do present a great break from the past. Our wage bill is unreasonably high. There is urgent need to address this with keenness and pragmatism and neatly lay out strategies that would see us achieve an amicable bare minimum. This must be looked at within a broader context of issues and every attempt made to avoid simplistic inferences and conclusion. The cause-affect analysis has to be well comprehended too.

The single most important contribution to the economy is the Kenyan people and its dedicated workforce. It will be prudent therefore to assume that increasing the output of our workers should result in an improved GDP. What we need to lower this wage percentage of the total GDP should practically focus on the denominator and to a much less extent the numerator. Efforts should be put in place to encourage and compensate increased output, to reward workers’ productivity and set down a cascade of motivated and productive workers in competition not only with themselves but with set targets. Attempts to decrease the numerator, which in this case is the wage bill, will have confounding effects on the productivity of the workforce and subsequently obliterate any conceived positive effect.

The seduction to direct inferences is very tempting. The failure to recognize the impact brought by the social pillars of our economy is also extremely fanciful. The bottom line effect would be to assume that these ‘non important’ sectors, whose effects to the economy are less than direct, can be ignored and we get away with it. For instance what is the impact of teachers, accountants, nurses and doctors on the economy? These immeasurable contributors are likely to suffer from this kind of ‘direct-relation’ mindset.

If we are to look at the stratification of the wage cadres, we do find some astonishing ironies; too many redundant commissions and commissioners. In addition to that, our leaders do not seem to live by the rules that they create. We are all too aware how our members of parliament maneuvered a pay rise and concealed it in hazy details. A recent study by the UK-based independent Parliamentary Standards Authority (IPSA) and IMF showed that Kenya MPs come second in global salary ranking. The government will still pay this. So who really should take the blame for these lopsided comparatives? Condemning the Civil servants because they are meek suggests a notion of anti-poor policies. The leadership of the land must live by their own rules, we must advocate for equal pay for an equal day’s work irrespective of the social status.

The conception that the Government pays better than the private sector is actually a semantic gymnastics; the actual statement should be –some private sector players’ pay poorer than the government. We cannot use a positive comparative when we are analyzing dismal performance. The reason for this must also be laid bare. While the government’s main aim is to build the economy and develop the country, the private sectors’ main drive is to maximize on profits. As a result they cannot be vilified for hiring the cheapest human resource. The government however must be disparaged for a poor minimum wage and for a wide wage disparity. These are very important indicators in a country. These two sectors cannot be compared using the same indicators.

The move to freeze salary hikes must be viewed holistically and should not be applied selectively. At the same time parallel efforts must be rolled out to address the high cost of living. Choosing to start on one and leaving the other behind would be akin to setting out to row with a paddle and going for the boat later. We cannot have a rising cost of living with a diminishing remuneration. In the same breath, we cannot vilify the very resource concerned with improving the country’s productivity and await positive results on the other end. We only get out what we put it, methinks.

DEMOCRACY IS NOT THE PANACEA; WE NEED GOOD LEADERSHIP WHICHEVER WAY IT COMES

The picture painted by those democratically elected to our leaders portrays the end of democracy as an illusion that we will never get to touch. While we thought that democracy and its anticipated end should serve to offer if not better lives then lives desirable by the citizens, it has not been further from reality.

The world over, the unaudited claim of democracy is that which makes the people get leaders they desire. The end of this is supposed to be an acute translation of services and leadership as fairy as it should be.

Like the bad proverbial mother that eats up her own children, our kind of democracy is proving to be our Achilles heel.  It is, day by day confirming that it is an extra burden with no transposed results to the ordinary mwananchi. How be it that the leaders you stood in long spiraling queues to elect turn your back against you the very moment you cast your vote? The ink still wet and the brow still drowned in sweat.

The first thing the members of the lower house ganged up to do was to unceremoniously coerce the structures of the country to increase their pay. Never mind not a single bill had been passed as yet. Concurrently, the county governments; meant to bring services closer to the people resulted to join in the financial gymnastics and the governors too were not left behind.

Further gapping the already eclectic poor-rich divide while being hopelessly clueless on real issues that concern the people.  In a good country (and that’s probably Wonderland where Alice lives) we would expect that the penultimate leadership would play tough ball and direct the coterie of leaders who hide under mass impunity and bring them back on track. What happened was that they chose to handle them with kid’s glove and opened a further Pandora’s Box that is now spiraling out of control. If our leaders can be allowed to dip their fingers in the honey jar then everyone else must be allowed to do it. As a representation of the general population, they ought to be a reflection of what we are. What they want and need should extrapolate what we want and need. There should be no doubling of standards.

Teachers were the streets for three weeks, putting a not-so-enviable focus on the prospects of education in our country. An education system characterized by uncertainty and poor stewardship breeds youths that are uncanny and unnecessarily abrasive. These, while our peers are embracing the dancing lights of modernization.

Nurses and doctors might also be sitting on the edge, waiting for their turn to pounce. Characterized by poor pay in a sector that is as hazardous to work in as was the battlefield of World War 2, we are left with few probable guesses.

The most nauseating thing however is not our leaders’ unfairness but their indifference. As it is said, you would rather an unjust god than an indifferent one. They chose to almost deliberately ignore the obvious displeasure of the people and chose to with religious discipline adorn political correctness as a means to their selfish ends.

In all these confusion, the obvious question becomes ‘what is it that they claimed was the magic in the wand of democracy?’ Why should those who embrace it be glorified and those who think against it be castigated.

In a population where many people live miserably below the benchmark of poverty, it would be wise to guide democracy into its right path. We have to get back into the lane. Define astutely what it is that we need as a country and brand our own path to get there. 

I SIT HERE WRITING

His liquid petite eyes told a story. Delicately emblazoned on his seemingly decrepit face would tell you of the tales in his short life. His nose sticking out and letting out a camber like a whip. His temporals sunk to an almost meeting distance. The skin on his brow and cheeks established thin creases as he changed from one facial expression to another. While his neck struggled to hold up the weight of his head, you could see monstrous veins threatening to let way occasionally distracted as he swallowed saliva.

Cupping his left hand to support his cheek, he looked at the floor as if reading it. You could easily tell how deeply in thought he was but never guess the filling. He momentarily shifted his eyes from the floor to the empty ceiling and back to the floor again. Avoiding as much as he could our eyes being caught in the snare of the silent tête-à-tête.

When I just thought he would open up and mumble, he ended up calmly swaying his right hand and noisily scratch the dorsum of his left. Letting out white skin marks. He would then look underneath his nails as if he expected something different.

I sat there pensively. Wondering what in his one decade of experience in life had disturbed him to this extent.

“Mmmmmmhh…” he finally started.

I leaned forward to encourage him on. Our skulls almost touching. I could smell the sweat of his once white T-shirt.

“I wish she could love us as much as my mother did,” looking from his left side then to his right side he continued. This time creases formed on my forehead as I tried to read his opaque minds. His disturbingly slow let-out sending out an avalanche of thoughts and conclusions.

He continued to narrate the ordeal of his life. His spongy penetrating voiceand  girlish fidgeting informing me of a distressed mind.

So he narrated.

He had lost his mother two years back while she was giving birth to his sister Shida. She had bled to death, doctors told his father. He was eight years old then when his father came home carrying a noisy shrilly bundle of a baby and some clothes in a paper-bag. He ran out of the house to see if his mother was taking her shoes off to get into the house, but no one was there. Then his father broke it to him.

 His father, a man who used to labor in the rich neighborhoods, would shortly get married and bestow them to his new wife. He would then be ‘lucky’ as he got a job as a truck driver in the United Arab Emirates. Time to time, he would send them money for food and clothes. He can only bare witness for the food bit as he never saw any for the clothing. I could tell. Perhaps you too could tell.

Earlier that week, he said, Shida’s body was increasingly becoming hot. She would sweat in the middle of the night. Cold water did her no good. She would now get seemingly strong thrusts in her chest and let out everything she ate. She couldn’t sleep at night. Not that she could but also because he wouldn’t let her. What if she slept and never woke up.

Little Maneno had come to ask for dawa for his sister. The hospital was half a day’s trek in good weather. He couldn’t have come with her because thin as she was, she was still too heavy for him.

It was at this point that I sat back. My pen subconsciously tipped at the edge of my mouth.

I remembered our empty shelves. The circumstances. We would have to get this girl and have her checked up. The machines that were donated by the Chinese government had broken down just around the time Shida’s mother died. So we would have to send them away to get the investigations done elsewhere. Then come back for a prescription.  Then send them away to go buy the dawa.

It was now, like it had started. When we started he was dumbfounded. Now, I am dumbfounded.

It’s been twelve hours since; you might not be interested in how the situation was sorted out. I chose to sit out in the lawn. Gaze at the endless ocean embrace the sky. A sky so starless and lifeless. A sea so selfish and quiet despite having a lot to itself.  Just as endless as the ocean and its infinite love for touching the sky at the horizon, my thoughts race as to the exact meaning of the word FREE.

From the moment of the evening when grayness replaced the earthly colors. When that same grayness was itself consumed by the dark of nothingness. Throughout the sulky sky and quiet sea. I have had nothing to say but just sit and wonder.

So I sit.I sit here writing.

 

UNDERSTANDING THE PROSPECTS OF FREE MATERNITY SERVICES IN KENYA

The president has finally launched the ambitious free maternity services for all Kenyan women. This is a program that needs to be graduated with caution and intense planning because its effects cut across several sectors and affect our sanctity of life

It is estimated that approximately 1.5 million children are born in Kenya every year. Such a program would see to it an end where it would be intended that all these births be conducted in hospitals. Our economic profile only favors that a small proportion would afford private facilities. The rest will deliver in our public institutions.

To better understand the ramifications of this, let me paint to you a picture of our health system as avidly as I can.

The Kenyan health system operates on the concept of cost sharing. Patients are required to pay a much subsidized fee for these services. On their part, the hospitals through their management boards use these funds to keep them running; paying for consumables and employing casuals who are requisite for the running of our health system.

It therefore would be untenable to scrap off this fee without providing an alternative way for the hospitals to survive, they would simply close shop. As a result therefore, the free maternity policy outlines that for every birth conducted, the hospitals would be entitled to a blanket Ksh 5000. As earlier agreed, a majority of the 1.5 million births conducted in Kenya fall in the lower socio-economic quadrant. This is to say that many of them would be anticipated to take up this form of scheme. We are therefore approximating that we would need approximately 7.5 billion Ksh to start off the project.

It cannot be ordered that the money will be reimbursed after services are rendered; the money will be needed to render these services. Where else would the hospitals get the consumables?

Another important aspect to look at would be how often these reimbursements will be made. Making them an annual event would glue our hospitals to year-long debts and in some way incapacitate them. This is likely to affect the quality of services.

While it would be easy to increase the demand for the services through scrapping of the user fee, efforts must be made in the immediate to address the projected increased demand. We still suffer an acute shortage of both nurses and doctors. Increasing the work capacity without adequately addressing this shortfall will definitely injure the quality of health care provision. At present, it would be prudent to employ more nurses and retain the few who were on contract through the economic stimulus program. It would also be far-sighted to increase capacity of both doctors and clinical officers to address the expected surge in demand for these reproductive health services.

While the government allocated just about 2.8% of its GDP to health sector, it is quite obvious that dedicating more than a third of it to just a single sphere of the country’s health strata would have negative end effects on health provision as a whole. More funds need to be channeled to this ministry to better achieve this noble objective.

We also hope that the government will jump over the legal challenge that is the fourth schedule, which clearly stipulates where the mandate of running the affected facilities lie. It is the absolute mandate of county governments to decide the happenings in all public hospitals in Kenya, save for the two referral hospitals.

In the end, we hope for better statistical and substantive result that would pale the dangers of child delivery in Kenya. If that is done, we will surely be many steps ahead of our peers.