Sometimes in the 90s, a think tank realised that the population projections and demands would outstrip the government expenditure and strain the public health system unless something was done.
The proposal mooted — jump-start investments in private health enterprises to fill the gaps that would arise.
The problem though was that in a then-lucrative public service career, what would entice doctors and to turn into entrepreneurship and invest in the private sector?
The route chosen was providing start-ups with “sweet” seed capital terms to the few crazy doctors willing to take this path. This formed the foundation for Kenya’s now vibrant private health sector.
For a long time, the national government was the top employer for graduating doctors.
In the earlier days, it absorbed 100 per cent of those qualifying. Initially, with only two medical schools, this was possible.
Over time this percentage has dwindled. In 2017, for the first time in our medical history, intern doctors were not assured of a posting upon completing their mandatory one-year probation.
The Commission for Higher Education (CHE) suggests there was growth from 100 with over 400 graduands per class in a 50-year timeline at the oldest medical school.
As demand and need for extra resources arose, public universities increased students vide parallel enrolments. The end result is that from one medical school, we now have over eight offering medicine courses.
With about 2,000 new doctors joining the market place annually, for the first time, “unemployed” doctors exist.
Economist Kwame Owino calls such a situation an apparent, not real shortage. While the hospitals have the need for doctors, they lack the money to pay them.
Similarly, when employment opportunities exist, it is not at the pay doctors desire.
From a strategic perspective, some have interpreted this scenario as a government ploy to bring down the ever-ballooning doctors’ wage bill.
By making available an “excess” number of doctors, the classical demand-supply curve shifts to government’s desired side. The downside is that in the meanwhile, the quality of health interventions deteriorates.
Over the weekend, the relevance of this historical “government start-up-seeding” anecdote came to fore. A week ago in a rural township, I ran into a collaboration where young doctors partnered and established a hospital. It has a twofold positive impact: making available skilled services in rural areas that would otherwise not have been available, secondly saving patients both time and money in their former logistics for care in urban areas.
In realising that UHC cannot succeed without adequate personnel and facilities on the ground, the question then is whether the government, National Hospital Insurance Fund or health system managers should repeat this 90s government experiment?
The reality is that in certain areas, patients travel 200km to access doctor-level care. This even with the unemployment among doctors.
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Note: The results are not exact but very close to the actual.
