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Tuesday, February 28, 2017

Why The Doctors' Strike Is A Missed Opportunity

It is now nearly three months since Kenya’s doctors went on strike. The dispute centers on the Comprehensive Bargaining Agreement the national government and the Kenya Medical Practitioners and Dentists Union signed in June 2013 and which the latter is insisting must be implemented.

The Executive has been at pains to disavow the very agreement it signed and the doctors have had to defend the legality of their strike. The quarrel has caused untold misery in hospitals and drawn in the other arms of government as well as the Central Organisation of Trade Unions and the Kenya National Human Rights Commission. However, for all the sound, fury and chest-thumping, the sick and dying in Kenyan hospitals have little explanation for their calamity. Both sides have privileged spin over substance and confusion over clarity.

The government first claimed the CBA would be too expensive to implement, then argued that the document was not a legitimate agreement anyway since it had not been registered, then that the doctors were not its employees but those of the county governments and it was only playing a “facilitation” role; and finally that the CBA was illegally signed by an illegitimate official on behalf of a Ministry that did not exist.

On its part, the KMPDU has ignored court rulings and orders regarding the legitimacy of the CBA and the legality of the strike it has called; and courted public sympathy by seeking to portray the CBA as the solution to Kenya’s health problems and themselves as warriors for the common good not just for improvements in doctors’ welfare.

These mental gymnastics merit some attention. It is not the first time the government is making offers to its workers to avert industrial action that it later claims are too expensive to implement. Far from it. In fact, it is a tactic the state has developed into something of an art. The same ruse was pulled on teachers in 1997 and again in 2015. The country’s university lecturers are today on strike claiming the government has reneged on a similar promise for a 300 per cent pay rise.

Further, it is strange, to say the least, that the government was unaware that the doctors were not its employees when it signed an agreement with them. The CBA many times refers to the Ministry of Health as the employer, not the county governments. Further, in interviews with this writer, doctors themselves have claimed that their contracts, despite the devolution of health, are still with the Public Service Commission, not with county governments, to whom they say they are seconded. That when, in January, President Uhuru Kenyatta tried his hand at brokering a deal, he left the county governments out of the talks is an indicator of the government’s attempted sleight of hand, as is the idea that it took nearly 4 years to realize the document it had signed and that has been the subject of a dispute in the courts, was fraudulent. In any case, the courts have already declared the signature on the document, if not the document itself, is valid.

Some of the claims advanced by the KMPDU are similarly disingenuous. That the legitimacy of the CBA is problematic cannot be gainsaid. The Labour Court last October ruled that it must be negotiated afresh. A judge has already declared“there is no CBA.” While one can sympathize with the doctors as victims of a government confidence trick, that still does not render it a legally enforceable document. 

If anything, by calling the strike, the KMPDU spurned an opportunity offered by the courts to apply to get the CBA registered in January if talks with government had failed to generate an agreement. In so doing, they put themselves in their current predicament, where their officials have a one-month jail sentence hanging over their heads. Further, even a cursory reading of the CBA will reveal that, contrary to the spin being put out by the union, it is primarily about enhancing the welfare of doctors, not that of their patients. In an interview with Citizen TV in December last year, Secretary General Ouma Oluga stated “categorically” that the strike was about doctors’ suffering, not that of patients.

It is of course obvious that improving the welfare and training of medics as demanded by the CBA will have beneficial effects for Kenyans in general, including in helping to stem the hemorrhage of skilled workers out of the public health system. However, the KMPDU has blown these benefits out of al proportion, with claims such as that implementation of the CBA would end shortages personnel in the hospitals. By Oluga's own numbers, the country has about 8,000 doctors and trains just 600 annually against a requirement of 83,000. That means, even if each and every doctor, including those currently in private hospitals, were employed in the public service, it would still take over a century just to cater for the needs of our current population. The CBA thus does not even begin to scratch the surface.

More than anything, the lies and distortions by both the doctors’ union and the government have denied Kenyans an opportunity to deal the failures in the health system. The problems therein stretch beyond the welfare of doctors and encompass the motives behind the decisions that policymakers in the government have taken. Only by moving beyond the empty spin and honestly addressing the real issues can Kenyans begin to craft a system that works for both our long-suffering doctors and their even more traumatized patients.

4 comments:

bend your head said...

Make no mistake about this Patrick....The Doctors strike is not in any way about improving health care for the citizens.
The slogan used can direct you to it's sole purpose...Lipa Kama Tender. There is no mystery about this.

The story of Kenyan Doctors is very Kenyan....very similar for instance, to the quail raising scam. Let me explain.

Many young people who joined the now numerous medical schools in the country, did so believing that they were going to be quite wealthy. This is what Kenyans have believed for a long time. Many parents still direct children who have absolutely no calling to the profession to become doctors as their ticket out of poverty or as a guarantee to never fall into it.
To meet this demand for training, many institutions have quickly set up medical departments that are poorly equipped, poorly run and poorly staffed, but that charge hefty tuition fees. The promise - All you have to do is become a doctor, no matter how poorly trained, and you are going to live the good life.

Do a bit of research on the mediocre state of training that Kenyan Doctors are now receiving with a medical department mushrooming in every other University. The students pay hefty tuition fees, sometimes amounting to over Kshs 600,000 per semester to institutions like KEMU which do not have any permanent teaching staff for their medical programs. They are convinced, mistakenly of course, that after such mediocre training, they will recover this money back when they start working.
Like most things in Kenya, it's all about the money.

However, these young people quickly find out the real state of the nation when they are undertaking their internships. All the money making opportunities, mostly centered in Nairobi City, are firmly held by the older more experienced medics, some running several private clinics at the same time, while holding jobs at Universities and hospitals. Coupled with the high cost of living, they see their dreams of a comfortable life as doctors fading away.

Their poor training has also imprisoned them in a certain sense, they cannot get jobs in more developed economies...The only country that can now accept Kenyan doctors is Kenya..South Africa would not touch a Kenyan Doctor with a stick. They would have to undertake a 5 year re-training and may not even pass the rigorous exams. Same thing with seeking employment in the UAE, USA or UK.
They could get jobs in less developed nations such as Uganda and Rwanda...but for way less pay than the GOK is offering them, so that beats the purpose.

This is why their only option is to demand huge sums of money from the government from their internship period onwards.

They do not care about citizens access to healthcare. Our new young medics and their poor skills and work ethic are the cause of numerous deaths in the hospitals where they already serve. See Mutuma Mathiu's recent article in The Nation about this.
All they want is to recover the money they paid to the scam called medical school back (many took loans for it) and all they want is the comfortable life they were promised when they got conned...and who can blame them. Times are tough. This is why the government must Lipa Kama Tender. Why must Ben Gethi alone get rich?

(Note - The older, more financially savvy doctors have made a killing from this strike - They encourage younger Doctors and to stick with the strike while the queues of patients at their private practices have grown tremendously in the past few months. Always keep your eyes on the money in Kenya and many mysteries are solved.)

Madonaldo said...
This comment has been removed by a blog administrator.
Unknown said...

I so enjoy to reading with this article.
Thanks for sharing!

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