Why quality care for all remains elusive

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.

Dr Victor Ng’ani, the chair of KMPDU, says 80 per cent of doctors leave the public sector by the third year of their career to go abroad or join private practice.

This flight is even accelerating, with COTU reporting that the 3,300 doctors in public health centres are resigning at speed due to poor working conditions, and warning that if government does not set up mitigating measures, by the end of the year public health may remain with only 2,000 doctors - expected to serve 40 million Kenyans.

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.

The aim is an ambitious one, for while high income countries typically spend an average of seven per cent of GDP on health, low income countries spend an average of only 4.2 per cent. But in Kenya, health spending as proportion of GDP has been falling over recent years, until the country’s most recent budget.

However, with quality health care enshrined in the Bill of Rights of the country’s 2010 Constitution, the government has now formulated a platform of health policies that it claims will deliver consolidated progress in health outcomes.

It builds on a platform of some gains. For although Kenya’s life expectancy is still four years short of the global average of 68 years, government measures, which have included compulsory national health cover for everyone in formal employment and low national insurance rates of Sh160 a month for the unemployed and informal sector workers, have played a pivotal role in minimising mortality rates and increasing life expectancy from 55 to 64 years.

The National Health Insurance Fund (NHIF) has lowered health costs and guarantees subscriber the convenience of medical attention in most health facilities.

Medical tourists

But the gains being made in the health sector are probably best illustrated by the emerging inflow of medical tourists, which the National Treasury estimates to be growing at 15 per cent a year.

According to Dr Amit Thakker, Avenue Healthcare founder and chief executive of Kenya Health care Federation, a multi-faceted approach has been put in place to ensure Kenya becomes a medical tourism hub drawing 2,000 patients a month from Burundi, Rwanda, Tanzania, Uganda and Zambia and reducing the increasing number of Kenyans who have been going out of the country to get specialised treatment in India, South Africa, America and Europe.

In East and Central Africa, Kenya has assumed a leadership role in offering quality medical care in cardiology, dentistry, dermatology, endoscopic, general and spinal surgery, obstetrics and gynaecology.

In recent years, Kenya’s largest medical referral facility, Kenyatta National Hospital and private institutions such as Nairobi and Aga Khan Hospitals, have served high profile patients from Uganda, Tanzania, Rwanda, Burundi and the Democratic Republic of Congo (DRC), among others.

Karen, Nairobi, Aga Khan, MP Shah and Mater hospitals are also renowned for their sophisticated medical equipment and qualified personnel who undertake delicate operations such as heart and brain surgery, and kidney transplants.

The private sector’s positioning for this unique form of tourism has also seen Kenyan hospitals invest heavily in diagnostic and treatment facilities, equipment, and professionals.

The 320-bed ward Nairobi Hospital has been expanded and a Doctor’s Plaza with 70 suites for medical consultants built. It has also invested Sh23 million ($287,500) in a modern oxygen plant and now produces and supplies its own oxygen.

Starting for behind, and forever underfunded and strapped for resources, Kenya’s health industry is nonetheless making concrete strides, and now stands at a crossroads in improving health care working conditions in pursuit of universal quality in health delivery.

-African Laughter