QUALITY PUBLIC HEALTHCARE - A TRUMPET

 It has reached such a time that Kenyans must demand for accountability not just from our leaders, but also from workers. For any improvement in quality, there has to be accountability and involvement of specialists and skilled workers in a field.

The demand for quality services in public hospitals will not be successful if everyone is not able to show the gap. The gap must be shown by the rate of unnecessary mortalities and morbidities that are preventable. It reaches a time when constant lamenting and complains from those directly affected and those involved in the care must stop.

Health systems involve human resource, proper amenities and adequate supply of pharmaceuticals and non pharmaceuticals as per the needs. Each arm of the three requirements now has to maintain and create a value of performance improvement.

It is clear from the needs for that for quality care to be achieved in public institutions; the National Government, County Governments, KEMSA and NHIF must be adequately involved.  A weakness or lapse in any of them cripples the others. They are directly involved in financing and provision of necessary requirements.

The biggest question is that who hold this people to account. This should be a role of the citizens that had been given to regulatory bodies. Unfortunately all the regulatory bodies have failed. They have resorted purely on avenues to raise revenues by encouraging private enterprise. We will call them out.

Why the TRUMPET?

Citizens and health workers must take the mantle to demand for quality care in public hospitals. Health workers who operate in conditions that purely abet and oversee unavoidable deaths are also liable for criminal offence. It must be a rule that a health worker must of necessity stop working in an institution that does/has no basic requirements for proper care of patients. A health worker who does this will be taken to a court of law and charged with criminal negligence.

To be safe, a health worker must confirm the availability of essential basic drugs and properly validated equipment's to assist him/her at work. The absence of that gives them the right to stay away. 

We are soon launching this TRUMPET demands through MEDICAL BRIFCASE KENYA. 

KENYAN HEALTH CRISIS SINCE DEVOLUTION

The debate about healthcare is raging on. A misconception is being built by governors that the clamor by unions is that the whole healthcare should be re-centralized. Let me make it clear, unions only want the Human Resource aspect to be re-centralized.  Unions have constantly advocated for a central body to be set up to handle this aspect of healthcare. And this, they have always advocated for with very good reasons. Contrary to what has been said, more than half of doctors have resigned from public service.This has been due to poor working conditions. Both welfare related and improper facilities. For example, doctors had a collective bargaining agreement(CBA) with the government four years ago which was not honored. It is now in court awaiting a ruling. In addition there has been meddling, unprofessional and unqualified supervision from some county bosses. This has raised ethical issues most times and endangered work security for employees.At the end of the day, the person who suffers most in all this is the ordinary Kenyan. And most health indicators continue to deteriorate despite the efforts from the first lady.

 Now, yesterday  a friend of mine took her mother who had a disfigured face to Kenyatta National Hospital for treatment. This was due to previous accidental burns causing ectropion ( hypertrophic scars around both eyes making it impossible to blink). The mother is from Murang'a. There are no plastic and reconstructive surgeons from there, so they had to be referred to Nairobi. This specialized service can only be found in two public institutions in the country, Kenyatta National Hospital and Moi Teaching and Referral Hospital in Eldoret. She was seen and booked to see the surgeon after six months.  This kind of scars caused by burns predispose patients to a risk of cancer or even  permanent eye damage. The number of patients who require surgery are many, so she had no option but to wait.

  No single County Government has the ability to provide this service to the public. There is lack of both the specialists, facilities and requirements for management of such cases. Specialists have to be trained. Hospitals have to be upgraded to necessary standards. And this cuts across all fields, surgery, general medicine, pediatrics, obstetrics, radiology, oncology and pathology. Most counties have been struggling to attract the few said specialists to no avail. This is because they have not accepted that these are professionals who work with standards, unique requirements and need well equipped facilities. They would not waste there skills in places that are not conducive and does not nurture them. In addition they need proper remuneration commensurate with the services they provide.

A specialist aka consultant has to keep learning, he has to keep training and read widely to know the new management options in the market. The same applies to any General Practitioner(Medical doctor, Clinical officer or Nurse) in the market. Otherwise they will practice witch craft and cling to practices that have even been dropped. This are skills and services that have to be nurtured and upgraded accordingly. 

Therefore healthcare human resource needs a consistent, persistent and constant appraisal that cannot be managed by counties. The frustrations and mistreatment meted upon health workers in counties is nothing but an inexcusable and a colossal manifestation of ignorance by county bosses. Lack of knowledge exhibited by some Members of County Assemblies, there executives and a few employees trying to supervise this  profession is a kin to a cow teaching fish how to swim. Its forced mismanagement of both our facilities and patients.

 That is why it is the position of unions and healthcare workers to refuse and oppose any attempt at encroachment into there roles. Any manager understands that professionalism has to be respected. And this sector is a very sensitive one with its own guidelines on supervision and management. The attempt at making mediocre the lives and health of Kenyans by Governors should not be allowed.

The unions in this sector have made it very clear, they don't oppose devolution. Infarct healthcare workers supported devolution at its inception, during the referendum and promulgation. The only voice that was silently being ignored throughout this period was the need for a Health Service Commission. Which the unions have always presented, though it has never seen the light of the day. It is good that now majority are seeing its need. It is important to note that from the above narrative, counties are irreparably mismanaging the gains that were being achieved in this aspect. The counties still have no capacity to handle the various faces and needs in Human Resource. It is clearly more than paying salaries. Its about a constant need of career updating and progression. It is about maintenance of standards and undivided work ethic. County governments cannot provide this.

Let the Governors not trivialize this to a talk about money and salaries. That is a very simplistic way of looking at the issue. And time for blame games need to stop.

 The governors have paid my learned good friend Ahmednasir Abdullahi obscene amount of money to scuttle this noble quest.They should change there minds and be objective.

HEALTHCARE IS A RIGHT NOT BUSINESS

Its not news that healthcare has been mismanaged in this country. No one can blame healthcare workers because they have been at the fore front in lamenting and pointing this out. The blame squarely lies on the historical neglect and lethargic leadership we have had. The same that is being exhibited by the newly elected governors, the Senate Committee on Constitutional Implementation and Commission of Implementation of Constitution( CIC).

Health for a country that is developing and with a majority poor is never a source of revenue, its never for money minting but actually a great expenditure. No country has ever grown with an unhealthy population and poor people can never afford to buy proper health. They have no revenues. With poor Kenyans the governors are terribly mistaken in believing that they will raise money from the hospitals, its an ignorant way that will subject Kenyans to suffering and allow unnecessary deaths from home due to inaccessibility. The little allocation they receive from the central government cannot work.

Secondly the advancement in healthcare and the necessary equipments and tools of trade needed cannot be afforded by counties. CT scanner machines,MRI machines, New automated Chemistry analyzers, Highly Sensitive X-ray and Radiotherapy machines, ICU/HDU beds, proper and necessary cardiac machines cannot be availed by counties. This equipments go for billions of shillings when counties are allocating millions in budget for healthcare management.

Thirdly there is an acute shortage of human resource that cannot be handled by the counties. We still have 1 doctor for >100000 Kenyans against the standard of 1:10000, 1 nursing officer for >40000 Kenyans against against the standard of 1:4000. The work conditions and infrastructure are pathetic, the remuneration terrible, and the motivation at its lowest. Distribution of this workers has been pegged and determined by the national government. This means counties with low education and disadvantaged cannot(will not) attract any qualified health-worker.Its absurd to subject this sensitive sector to such a fate. This will be to the disadvantage of innocent and helpless Kenyans. Therefore before the country acquires adequate number of skilled workers, it is  not feasible/wise to decentralize human resource in this sector to the counties.

 Devolution is not synonymous with payment of salaries, but devolution is almost synonymous with empowerment. Allowing the counties to develop proper infrastructure and environment for health to strive. The handling and distribution of the scarce human resource should be left to the central government. This has to be done within the framework of the constitution. Its has to be a process that does not destabilize or bring disadvantage to the provision of services. That is the spirit of the constitution, it espouses improvement and provision of better services. Its not about paying salaries.Currently, there are no health laws in line with devolution, hospitals will go without even basic drugs, hospitals will lack recurrent expenditure because it is tied with county funds as a consolidated accounts.

CAN SOMEONE AWAKEN THE GOVERNORS, HEALTH IS NOT BUSINESS.

PUBLIC HEALTH WORKERS MUST DEMAND QUALITY

The sadness, emptiness and weakened will of Kenyans to fight for themselves must be addressed. Kenyans must demand for proper services from the government. The tragedy that we see daily cannot be ignored. The dream of every Kenyan is to prosper, to see a day when everyone will have enough food, proper education, shelter and medical treatment.

  To achieve all this we need proper health. We have to hold the view, that the health of Kenyans depends on the skill in the hands of health workers.  That is why first and foremost health-workers should be the best paid in the country. They hold the key to life and death only second to God. They need to be empowered and to have adequate skills to stop our children, mothers, fathers, friends and spouses from dying. Our happiness depends on those who are close to us. We all have to advocate and fight for our health.

  We fight and cry that we are not well attended to in hospitals. When the people who provide this services are looked down upon and paid peanuts. They are not even provided with the basic requirements to do their work. They have to run up and down, looking for other revenues to be able to take care of their loved ones.Its that bad, they are not paid enough even to be able to manage their  basic needs. That's why everyone has to take a role in fighting for improvement of healthcare in Kenya. Today it is me, but tomorrow it will either be you, your best friend or relative in this circumstances with poor amenities and demotivated service providers. They will die before you eyes, with a helpless doctor/nurse consoling you.

 We have to call upon all health workers to rise up against this challenge. They have to set the pace for Kenyans to join them in the clamor for improvement.  They have to stop the downward spiral in healthcare provision. People should not die in hospitals in the name of no facilities, no drugs or the absence of service providers. Health workers must rise up and give direction to healthcare. They must say rightly, and insist on correction of everything that has gone wrong. The state has to address health issues directly and stop hiding behind the face of devolution. As a matter of urgency, the state and parliament should set up a Health Service Commission to streamline service delivery. In addition to that, should re-allocate enough funds to set up proper infrastructure in all counties.

 The pretense at providing  free maternity healthcare must be condemned and rejected. Its not a worthy project but a populist political carrot/idea to delude Kenyans into more trouble. Free maternal healthcare require enough well motivated and remunerated staff in addition to proper infrastructure to make it successful. We lack all this and our leaders lost it by projecting and ratifying a measly budgetary allocation to healthcare. Not one member of parliament had a brain to think straight and ask about this. Our leaders must come back to their senses, in both legislature and government. It will require a hard knock to wake them up from this slumber. A major protest and a bold statement from stake holders will do that. Even in the form of an industrial action.They are surely out of this world and only an accident and a fatal one will bring them to reality.

 The structures in our management cannot bring out this deficiency and advocate for enough funds. Therefore it remains a prerogative of the providers to give direction and to say that this profession is being choked. Yes, medical profession is being choked and is dying. Its only in Kenya where a Councillor( county representative, a section of a constituency) is tipped to earn more than kshs 440000, when a Professor is earning kshs 100 000 and a doctor is earning only kshs 40 000!  Our members of parliament are earning more than Kshs 1 000 000.Its not a soap opera. And believe me, with all these, there is a mother in Jomvu slums, Mombasa who cannot afford insulin. I hope she is still alive. I really hope so.

 Today I was talking with three of my doctor friends who told me categorically that they are now days away from relocating to other countries, there are no prospects in this here.Not as a threat, but a real plan. It does not make sense to study for seven years to work for your country, only to be treated in a manner that does not inspire respect and to be paid like someone who dropped out of primary school. Its better to go where one is respected. Kenya is losing professionals especially in Medicine at alarming rates due to this mediocre tendencies in government. Health workers must be paid well, salaries commensurate with the work they do to stop this.

  The time is ripe for health workers to assert their authority and insist on taking their rightful role in the countries growth, plans and future. This position can only be taken by force, the current dispensation does not recognize professionalism. This is not an incitement, but a true reflection of the redemption in healthcare that this country needs. It is the system that denies healthcare the ability to grow as the other sectors. Because of that, the war of redemption has to be waged. There is no fear in demanding for recognition. A rightful recognition and rewards that come with the roles, obligations and services extended.

Health care workers have to create a niche, a niche for themselves just like workers in other sectors. They have to begin demanding for what is right in this sector. Things must change. Yes, things must change. This is a distinct sector that requires seriousness and decorum.

DO NOT BE AFRAID, IT IS A FIGHT FOR A GOOD COURSE.

DEVOLUTION OF HEALTH CARE IN KENYA SHOULD BE HANDLED RIGHT

Its is a reality that healthcare has been a challenge in this country. With a growing population and greater need for healthcare, the institutions that provide this services has been overstretched. This has been made worse by the slow progress in growth of relevant infrastructure, lack of adequate and well trained staff to work in the few centers available. To make it more clear, the markers of quality healthcare are at its lowest with a child mortality of 115/1000 before 5 years, maternal mortality 546/10000 annually and a lifespan of 46years. All are way below the expected standards. Its worse because the rural and hardship areas are not properly accounted for and go unreported by epidemiologists. Health therefore remains a vital element of the country, it needs a greater input and direct management from the central government.

  Most workers in this sector are terribly demotivated and with good reasons. The working conditions have remained poor, both in terms of staff welfare and equipments. The services provided are essential and need to go on for 24 hours yet this employees are not given overtime allowance, proper rest rooms nor proper security arrangements. Vital equipments that would be needed in the diagnosis and management of patients are not available, the laboratories are poorly equipped and there are no drugs. Patients sometimes die before the eyes of this workers, most who can be treated. This is a song that has been sung a million times and all health workers have tried to drive the point home with no success. Its an issue of both underfunding and mismanagement of the few available funds by those charged with overseeing the work.

 This workers are few and work for long hours. This brings a burnout, lack of time for trainings on new ways of managing patients. Most areas have retained time immemorial practices that should not be used in the current digital world. Its has been encouraged due to lack of inspection, no proper auditing and lack of alternatives. The government has stuck to its system and has no direct followup on its employees. As long as work goes on there is no problem. That's the saying within the ache-lions of management. Low pay has made most of the employees relocate out of the country in search of greener pastures.There are no incentives and opportunities that can stop this. The government has also acted truant by avoiding to directly absorb nurses and registered clinical officers who are out of colleges with claims of no funds. All this happening when Kenya registers more than 1 500 000 births every year.

 The greatest mistake done by the Parliamentary legal committee on constitutional affairs during the fine turning of the new constitution was to scrap the article setting up a Health Service Commission. This would have greatly separated the role of the county and the central government. The county governments have no capacity to handle staffing, not now with this acute deficiency of staff. This role should still remain in central government. The same applies to infrastructure development, this should remain the role of the central government. Off course with assistance by the county governments. This would make it an abdication of duty by the state. It would be very disadvantageous to counties that are not economically endowed. It would end up very discriminative and cannot be fair in both the short and long-term.

   The issue of training specialists is a major one, its not news to say that we lack health specialists and that is why this role has to be left in the central government. At the end of the day, proper allocation of the specialists is important, most will be attracted and remain in economically advantaged counties and leave the other counties to go to waste. With the central governments direct control, they will be equitably distributed in counties. Members of Parliament and Governors have to support the enactment of an amendment in the constitution to support the setting up of a  Health Service Commission if they have the interest of this country at heart. This bill should be tabled in parliament soon.

 Kenyans should support the same, with provision of free maternity services we expect a greater number of deliveries in hospitals and access to maternal healthcare. We should move towards proper and quality healthcare if this goes on well. The role of National Hospital Insurance Fund(NHIF) in all this should be to promote especially infrastructure development in public hospitals. This has the role of cushioning and assisting the poor access to proper services. It can take this opportunity to redeem itself from previous scandals. With time the parliament should also be coming up with amendments to NHIF act to review and redefine its role in providing Universal Healthcare. It needs to be more of a social security scheme.

  It has always been, and its always true that when the public healthcare is removed from its slumber,  properly equipped, human resource well developed and motivated, then we will have a healthy population. AND A HEALTHY POPULATION BECOMES A WEALTHY ONE. 

Our journey...better HEALTH FOR ALL...