Thursday, 22 August 2013


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.

Saturday, 10 August 2013


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.