A responsibility of every African country is to improve the living conditions of its citizens. Effective and efficient public health institutions are part and parcel of that better life. African health problems need African solutions, and they must be lasting ones.
In 2013, a few months after being elected as the fourth President of Kenya, Uhuru Muigai Kenyatta signed the Collective Bargaining Agreement (CBA) which today has come to be a major reason for the strike which has crippled Public Health facilities. Kenya is under a nationwide strike championed by public sector doctors and nurses. This has also left many patients with no medical attention. Of interest is how negotiations seems to have staled with leaders of the Kenya Medical Practitioners and Dentists Union (KMPDU) insisting that the strike must continue. Samuel Oroko, KMPDU secretary-general insists that they are tired of dialogue and diplomacy by government.
In his recent response President Kenyatta said: “For the last two weeks, the governors and the unions have been engaging. Why should we have lost over 14 and close to 20 people already? Good faith requires that we do not put the lives of our fellow Kenyans at risk; let us not allow innocent Kenyans to suffer.” This, in his response, advances a question of a moral responsibility given the type of service health workers provide. It also reminds leaders of KMPU that negotiations must continue in good faith. The deaths are unfortunate and should not have become apparent.
But what does the collective agreement which Kenyatta agreed to comprise of? In the main it speaks to salary increases over a period of time. It stipulates that doctors must only work for 40 hours a week or be paid overtime; that government would employ an additional 1,200doctors yearly; it promised to fill vacant posts and improve the working conditions in state hospitals and clinics. These surely are reasonable demands. It is worrying that the government of the day has failed to live up to this promise.
What Kenya is facing is not new; in most African countries this problem has remained and African leaders seem to have no proper plans to improve our public health institutions. In Malawi and South Africa, Public Health institutions hugely rely on foreign doctors with the production of local doctors slow and more friendly to the elite. The South African Minister of Health, Dr Aaron Motsoaledi recently had to re-emphasise the need for community service by health workers, especially pharmacists. This was after the Pharmaceutical Society of South Africa said that if government could not afford to offer pharmacists community service posts‚ then it had no legal or moral basis to enforce community service and it should end the practice.
This statement by the society was after 75 pharmacists experienced glitches over placement in public hospitals. The notion conceded by the minister is that health workers must be patriotic because without enforced community service, Public Health Institutions would collapse. Community service must be compulsory beyond health workers and the minister remains correct. The problems in placement are in no way reason enough to scrap compulsory community service.
When the Kenyan government agreed to the production of 1,200 doctors a year, was this in line with their strategic plans as a country or they had relied on importing doctors from countries like China and Cuba? This we must ask because for Africa to be able to respond to the needs of its children, we must collectively produce more doctors, more specialists and improve our public health institutions. Are there plans in line to build more health universities? A responsibility of every African country is to improve the living conditions of its citizens. Effective and efficient public health institutions are part and parcel of that better life. African health problems need African solutions and its own knowledge production. We hope the people of Kenya will find each other, we hope they will continue to negotiate and find a lasting solution. DM
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