SOLVING THE DOCTORS STRIKE AND THE NATIONAL HEALTH ERROR:My Take

Currently doctors in public health facilities are on the fourth week of strike with no resolution in sight. At the start of the strike the government was in a much dire situation with doctors, clinical officers and nurses all on strike. With the resumption of duties by nurses and clinical officers the government thinks that it has saved face and gained public confidence that the government hospitals are back in full operation. In reality, only routine services are available to the public. More complex surgical and medical cases requiring the intervention of doctors and immediate cascade of care to specialists for prompt attention is lacking. This has resulted in untold (and sometimes told) suffering of the poor who rely on the government health facilities for all care. It is surprising that coming on the backdrop of festivities of Christmas and New Year no attempt has been made to end the strike and the media has lost its credibility through either churning out one sided propaganda pieces, turning a blind eye or featuring the story as a filler material between political parties news. The impact of the strike will be greater mortality rates and greater healthcare out of pocket spending by the poor who will be forced to seek care in private for-profit facilities. In the short-term the government may think it has won the battle but in the long run it has resulted in many deaths due to lack of diplomacy and arbitration engagement with the doctors.

I do not wish to delve into the ethical dilemma of the actions from both sides. Doctors will insist on the deontological principle of the government honouring its word while the government either through naivety or braggadocio insists there are no funds available and avoids its obligation to meet its commitment. In complex case like this an independent arbitrator with no link to either the employer or the doctors would be important to have. The Ministry of Labour despite the mandate to facilitate is a biased mediator since it draws its budget from The Treasury who is an interested party to the dispute. Therefore I do believe a prompt settlement can only be achieved if the Labour ministry withdraws its patronage of the talks and cedes to an authority agreed upon by both the doctors and the government. This way a foundation of trust can be set to start negotiation on implementation or viability of the collective bargain agreement (CBA).Since the government had already indicated that the CBA is a legitimate document its implementation only would be the most likely bone of contention. The government and doctors union however need to come to the new negotiation table with no preconditions and with an open mind to accept the verdict of the independent arbitrator. This will hopefully save the Kenyan masses compounded suffering. The arbitrator needs to be appointed soonest possible to stop more suffering both to the patients and doctors of Kenya.

All other sideshows of government of union officials commenting on evening news of TV stations with dwindling viewership (even of those with high viewership numbers) should be banned and all statements on the progress of the talks should be through the arbitrator only. In the meantime Kenyans need to start thinking wisely of how their future healthcare system and even leadership system should be governed given the facts of the doctors’ strike, the myriad others problems facing the nation and the lack of attention to problem solving by the current government.

The current healthcare crisis in Kenya has been simmering for years and has not been tackled well and to its conclusion. The evolution of the health system in Kenya has been one of trial and errors and the current one is just another phase of error. From the first Sessional paper No:10 on African socialism in 1965 to the introduction of cost-sharing in public hospitals in early 1990s as part of IMF/WB Structural adjustment programs(SAPs) and finally the devolution of health service provision to the counties in the new constitution systematic errors have been repeated. The situation is so dire and replete with errors that we should just call it the national health error.

I have written several times on this before and maybe it’s time we had a consultative forum of experts on health systems and stake holders to chart the way forward towards a more robust, resilient and responsive health system. But what do I know? I am just a wishful thinker dreaming of a better health system and quality healthcare for all.