INTRODUCTION
#STATEOFHEALTH has been a popular and trending topic on Kenyan social media platforms recently. Being a healthcare worker I know a thing or two about what is ailing the health sector in the country. Indulge me as I share some few thoughts with you.
THE POLITICS OF IGNORANCE AND SELF INTEREST
A few years ago, Kenyan healthcare workers took to the street to protest the poor state of the health sector. They warned that a darkness had been slowly gathering. Decades of under investment in health had finally caught up with the nation and threatened to undermine our collective resolve towards development.
The issues at stake were deplorable working conditions, under staffing, poor pay, specialist training and broken down health infrastructure. We were then treated to the poor spectacle of strikes and unnecessary patient suffering. All along the political class promised they have prioritized healthcare and soon things would be better.
In the most recent of industrial action, doctors and nurses said that they were opposed to the hurried devolution of health services. They said they want structures and policies in place that would ensure the smooth transition from national to county level. I remember my troubles when explaining to some interested Kenyans how the strike is not about money but about principles.
Both the politicians and the public criticized the action, reminding us that we took an oath to protect lives. Nobody cared to listen to the numerous union officials explain the logic and rationale behind the strike. Some said 'We would understand if you downed tools for salaries like teachers of this country.... 'The governors promise to handle heath better than the national government ever did....'the structures you desire will be legislated by the real experts of the constitution and the law. And so the government moved quickly to devolve health. Perhaps central government wanted to wash its hands of the burden of negotiating with a unified doctors union( kmpdu). They must have reckoned that it would be harder for devolved workers to unionize and strike whenever calls for dialogue were ignored.
THE DARKNESS FINALLY ARRIVES
After two years of the health devolution experiment, it is safe to say that the country's healthcare system has been turned into a complete mess. We all know what the problems are, and how they they can be solved, but in typical Kenyan style, we are too distracted with politically rooted headlines to notice.
A quick glance at the news making stories in healthcare makes me weep. GOVERNORS OPPOSED TO 38BILLION MEDICAL EQUIPMENT LEASING!! BEYOND ZERO!!! FIRST LADIES FIGHTING CANCER!! DEADLY INJECTION LEAVES CHILDREN LIMPING!!! ARVS IN DUMP SITE!!! YOUNG MEN DIE OF ALCOHOL WITHDRAWAL etc.
The real issues facing ordinary Kenyans are never brought to the fore. Not the many children who die of easily treatable diarrhea and vomiting, nor the many whose kidneys are failing because of the thriving unregulated quacks and herbal medicine men who claim to cure chronic illnesses like AIDS, diabetes and cancer.
What irks me the most is though, is how the counties have handled health. For obvious reasons, County governments were quick to take over the budgeting and procurement roles. The immediately bought pick up trucks and painted the word AMBULANCE' on them. This they said, would ensure the people with various health emergencies were promptly rushed to the hospital.
A closer look at this noble idea reveals the folly of letting Governors and MCAs control health budgets.
First the vehicles do not have basic life saving equipment required in an ambulance. No emergency lifesaving drugs, no oxygen, no staff. Secondly, in my county at least, the vehicles don't even have fuel and maintenance budgets. Did they purchase easily serviceable vehicles like Toyota? Nope. Counties have style. They do American Ford rangers....Vehicles with no easily available after sale services. When they break down, repairing them is expensive and time consuming since you have to wait for spares from dealerships. All this added cost to taxpayers, for no value whatsoever!
These ambulances are regularly seen in funeral ceremonies, usually aiding in transport logistics. Usually the local MCA is in attendance to point out how helpful he has been. Eti..hii ambulance no yenu! Free!' Interesting to see how the shepherd always try to persuade the sheep that their interest and their own are the same.
The counties also took up the purchasing of medical drugs. All good, but as we all know, they don't consult health care workers on the ground. The result has been delayed supply, wastage due to stocking drugs with complete disregard for demand and consumption data. Indeed, many hospital pharmacies regularly overstock on drugs they don't need, and quickly run out of essential drugs.
EQUATING DEVELOPMENT WITH CONCRETE
In my county, there are over 90 government run health facilities. Majority of these are dispensaries and health centers manned (or more appropriately, womaned) by few nurses. This situation is replicated throughout the country; in some cases, a single nurse runs the facility. With no clinicians or medical laboratory technicians available, the nurses usually have a short list of diagnoses to choose from. The most popular is malaria of course.
Recently a story of limping children in Teso hit national headlines. The nurse had wrongly administered quinine and injured the sciatic nerves of over 30 children. Images of children dragging their feet with foot drop were broadcast allover. Kenyans were outraged.....How could she? Where was the nurse trained?.. She should be suspended pending disciplinary action.
A media house even interviews the director of medical services, who had nothing but tough speak about how he would demand answers from the nursing council. I guess by now somebody is out of a job that ideally shouldn't have been theirs in the first place.
Does a government that has commissions nurses to play doctors, lab techs and pharmacists.....(heck even accountants and hospital administrators)....have the moral authority to prescribe punishment to same nurses when they err? Kenyans would rather see that nurse fired than wonder why government has posted her without any support to offer services that meet standard of care.
Its shameful for a politician and county executive to stand and criticize a single individual, to walk away with cheap political capital while at the same time do nothing to address the real issues. County governments it would seem, are happy to have health money devolved, but when questions about service delivery are asked, of course it is the health workers at fault. After all, remember the expensive ambulances we have procured?
Take the example of Embu county. Its one of the geographically smaller ones, with slightly over 500,000 residents. It has over 133 health facilities, about 90 of which are government run. The various ward MCAs have taken to building maternity wards in even the smallest centers near each other. Was this based on need or catchment population needs? Of course not. Such lofty details that concern the professionals pale in comparison with the political mileage one stands to gain by erecting an empty concrete structure. Some now record less than one delivery a week. Midwives there are bored to death. So instead of waiting for the rare delivery, they would rather leave clear instructions about how they can get the ambulance to rush the laboring mothers to the main hospital, for free of course. Thanks Mr governor... Mr MCA. This is not a frivolous referral either, because the maternities were built but not equipped.
This is how to play tennis without the net. Simple Kenyans voters are happy with the politicians for their hard work. The politicians are happy too because any further failures in this arrangement can be blamed on a poor nurse who just can't seem to do her job right.
Meanwhile, middle class Kenyans who can spare a few coins aren't bothered. If they want health services, they just go to private hospitals.....where the more they pay, the better they think their health gets.
No comments:
Post a Comment