Better pay is just one front in doctors’ war with government

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) secretary-general, Fred Ouma Oluga. PHOTO | FILE

What you need to know:

  • Doctors union’s chief explains the four major issues in the collective bargaining agreement at the heart of their strike.

A one-and-a-half-month long doctors’ strike has left Kenya’s public health system seriously ill and in need of urgent treatment. The strike has caused loss of lives and denied millions of poor Kenyans who rely on public hospitals access to medical services.

The situation has more recently reached crisis proportions as negotiations meant to unlock the impasse fell apart.

Not even the numerous court orders have moved the protagonists closer to finding a solution. The doctors’ union maintains it won’t accept anything less than the government registering and implementing the June 2013 collective bargaining agreement (CBA) as a way out of the crisis.

The Business Daily talked to the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) secretary-general, Fred Ouma Oluga, on what the real issues behind the strike are and how the crisis could be resolved. Here are the excerpts:

The public has multiple understanding of what is at stake in this crisis. Some say you, like politicians, are a greedy lot merely seeking more money without any concern over the pathetic state of health services in the country. What do the doctors want and what are the key segments of the collective bargaining agreement you signed with the government in June 2013?

First I would like to explain that a CBA is the legally recognised document that governs the relationship between employees and their employer — in this case doctors and the government. It is not just a piece of paper.

The June 2013 CBA can be summarised in four main pillars namely; training, employment, working environment and conditions and pay.

These are all very important for a healthy nation and can produce ripple effects that can boost or undermine the national economy. It outlines issues touching on the welfare of both patients and doctors. Our wish is that it be registered and fully implemented.

The Employment and Labour Relations Court says there is no CBA because it is yet to be registered in court. Did KMPDU complete the court process before taking to the streets? You know you can’t have your cake and eat it.

How can I have my cake and not eat it? I am a very hungry doctor… hungry for change. We have exhausted all mechanisms of bargaining. We went to court on June 8, 2015, nearly two years after the June 2013 CBA was signed by both parties. The court through Justice Monicah Mbaru made its decision on October 6, 2016 and determined that the signed CBA was binding — not unless the government wants to rub off their signatures.

The government should cease using the courts to mislead the country. They themselves have not obeyed the law and are only trying to put KMPDU at loggerheads with the Constitution.

What does the disputed document mean to the common Kenyan who lives below $2 a day?

Health, just like justice and education, is not a commodity but a right for all that any government worth its name must provide.

It is not a favour but an obligation that most governments around the world have a duty to provide. If the government implements the CBA, doctors and specialists shall go back to work thus curbing the deaths.

The June 2013 CBA addresses doctors’ training to become specialists as well as employment of 1,200 new ones yearly so that we can guarantee Kenyans better quality healthcare.

Kenyan doctors are held in high esteem throughout the world and well-trained doctors mean a reduction in cases of negligence or malpractice. Having a solid health services system will also help the country to reduce unnecessary foreign referrals that cost patients an arm and a leg (through harambees).

This will save the country the more than Sh10 billion spent annually sending patients to India, South Africa, and the UK for ailments that can be treated locally.

Currently, Kenya only has 16 neurosurgeons serving a population of over 45 million. Out of the 16, only five work in the public sector and in two hospitals — Kenyatta National Hospital (KNH), Nairobi and Moi Teaching and Referral Hospital, Eldoret. Where does that leave the majority of Kenyans who are struggling to survive on less than $2 a day?

What becomes of the cost of healthcare when doctors get the Sh8 billion annually through the June 2013 CBA?

The country’s annual total health expenditure is about Sh600 billion, including donor funding and primary care of over-the-counter prescriptions before seeing a doctor.

Government input in this is approximately Sh100 billion from taxes and the remaining Sh50 billion from donors. The remaining Sh450 billion (65 per cent) comes directly from families’ out-of-pocket expenditures and insurance.

We can save families the Sh450 billion for investment in education and other needs if the CBA is implemented.

Why should you pay taxes to get social services only to hold fundraisers when you get sick? Innocent delivering mothers die every day simply because there is no blood bank or doctor in the health facilities where they are admitted.

How much would this person have contributed to the economy? If you increase the lifespan of a person by just one year you grow the GDP four times. Is this not something worth going on strike for? Other aspects of the CBA such as improvement of working conditions would not cost much except reorganisation.

Brain drain and minimal enrolment for medical courses have led to a chronic shortage of doctors. How does the CBA address this?

Brain drain is dire. We have already lost 40 doctors to the UK out of the 700 fresh graduates this year, besides 2,200 senior doctors who have left in the past three years. The irony is that it takes about Sh5 million to train an undergraduate doctor for six years.

The cost balloons further if you factor in the cost of primary and secondary education, which is anything between Sh500,000 and Sh20 million depending on the school.

For specialist training it is about Sh15 million for a duration of seven years. The June 2013 CBA looks at the number of doctors spread across all specialties.

All doctors in Kenya should specialise in at least one or two areas — whether in administration or in a clinical area — to close the gap. That is where progressive countries such as Cuba are moving towards.

Kenya’s doctor to patient ratio is wanting. The ratio is at 17 to 100,000, below the World Health Organisation-recommended minimum of 100 to 100,000.

KNH only has two doctors in the casualty section yet it is the largest referral hospital in the region. In such a situation employing more doctors means a reduction in waiting times, speedy response to emergencies and improved access in far-flung areas like Wajir and Mandera.

If the government makes good its threat to sack all the striking doctors come next week, what would be your next course of action?

How do you fire people who have simply told you that you have mistreated us and we need to correct that relationship?

For how long are you willing to push on with the strike and do you think KMPDU has public support? 

We really sympathise with the suffering Kenyans, we know how bad the situation is. The strike will last for as long as the government fails to implement the CBA.

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