The recent action by the Kenya Medical Practitioners and Dentists Board (KMPDB) to strike out a chunk of doctors from the 2019 register (close to 2,000) drew stark reactions. For non-medics, this is akin to the National Transport and Safety Authority (NTSA) revoking drivers’ licences: meaning they are not allowed to drive any public service vehicle on Kenyan roads.
The discussions are on how licensing of doctors should be done, but other bones of contention include the board’s capacity, geographic reach as well as its composition.
As crafted, the KMPDB Act was aligned to policing doctors in an era with low numbers mostly confined in the public sector. This has since shifted, with the private sector now having more doctors than the public sector (about 65 per cent).
Some thoughts arising from the action support the board’s quest to structure and professionalise medical practice in Kenya and shed its tag as an extension of the government.
Post-devolution, counties gained autonomy in certain aspects of healthcare, but policy making, training and licensing remained at the national level. In contrast, countries with devolved systems, state legislative medical boards have their own autonomy, translating to local policing.
In comparing the two, a national approach may be stronger and shielded from influence of local politics. However, its reach is difficult for those with complaints who cannot travel far.
State boards provide this benefit, but need a mature governance system with professionalism shielding them from local political interference. Judging by the management of other devolved professional services where politics creeps in, we are not ready for county level medical boards.
Regarding the board’s recent action, two emerging questions are a redefinition of what constitutes medical practice, as well as the evolving medicolegal jurisdiction on where one practices.
With increasing fluidity across the two sectors, movement of doctors from the public side to the private side (some statistics indicate up to 63 per cent of public side doctor’s work in the private sector) dictates standard laws. How does the board police the ubiquitousness posed by telemedicine and locum tenens medics? Should we still have different rules?
In the specific matter of annual relicensing for public sector doctors, we have an opportunity to learn from aviation’s rigorous checklists for flight crew and pilots. Training, licensing, certification and recertification are the ways to go if we hope to maintain high levels of professionalism.
The KMPDB should start thinking about its future and being cognizant of a need for broader and wider representation, public involvement and mandated teeth that bite across both the public and private sectors.