Call for Truce and Dialogue in Doctors Strike

The last 24 hours has seen a change in the plot of the script in the doctors strike action movie. The momentum and control of the conversation has shifted to the county governors. They have weighed in heavily on the issue and given an ultimatum to doctors to resume work or else. This grandstanding is a measure of the hard line stance taken by all parties in the industrial action and it portends for a tough time ahead for health service delivery in the counties and the country in general.

For a matter as serious as life and death to be taken to be a time of political gamesmanship and oneuppance is a sign that the script seems to be a Quentin Tarantino thriller instead of a Disney feel-good fairy tale. So I hereby call for ceasefire in the hostilities from the county governors, national government and the doctors. This health crisis is getting messy and only the intervention of voices of sanity can a catastrophe be averted. It is not in the best interest of Kenyans that we see the scenario unfold in front of our eyes and I can only hope the parties above will read this plea. I call on dialogue by an impartial party as I had earlier suggested to resolve the problem amicably.

Let us all realize that at the centre of the whole dispute is the fate of the Kenyan public healthcare system which could face an uncertain future if the actions of the governors are to be taken seriously.The mass exit of doctors from the public healthcare system and taking over of their roles by clinical officers involved in primary healthcare and referrals will result an initial reduction in payroll expense for the counties and a relief for their budget. But the gain will be transient and illusory as the greater markers of clinical outcomes i.e. infant mortality, morbidity and maternal deaths will eventually increase due to the limitation in both capacity and knowledge gaps of the staff in the new county systems. As it stands there is an inequitable distribution of skilled healthcare workforce in the country and the sack order will further aggravate the situation. Some of the affected counties could be where the doctors are most needed, but due to political expedience of the  rash decision made on 9^th January 2017 lives will be lost unnecessarily and greater suffering visited on the poor of this country.

Doctors are not beggars and a firing from the public sector will not mean destitution or misery for them .Most doctors will set up private clinics almost all near the gate of the former county hospitals. So, next time a patient goes to the county facility and is not attended to by a specialist or a doctor with greater skills, they will cross the road to those private clinic to be attended to by the doctors, of course at a fee. External brain drain to more developed countries may also pull some doctors to seek alternatives.A majorb problem though is the organized private healthcare provision promise of greater rewards to the doctors may sway them to opt for bondage in chains of hospitals.Already others like Wandia Njoya,the Oxfam report on IFC investments in healthcare   and other media sources have highlighted the folly of this trend.There will also be proliferation of quack clinics with a profit motive and without adequate supervision, a greater problem of reduce quality of services will be evident. Eventually the cost of healthcare for the poor will keep on growing while the private clinics of the doctors continue to flourish and doctors will rightfully gain their deserved pay increase. But at what cost? The cost will be an increase in out of pocket healthcare expenditure for the poor as the insurance penetration rate among them is low, earlier mentioned clinical outcomes deterioration and finally demise of the public healthcare system.

The poor of this nation do not have a voice to tell their governors that what is needed is dialogue and compromise and visionary leadership. They do not have the power to stop the cascade of events and to convince the doctors to come up with another strategy that would ensure implementation of the CBA and thus better equipped and manned health facilities. They do not have the power to access the media outlets to tell their stories of suffering as the healthcare system collapses. But what they can count on is that I will be with them to highlight their aspiration for a vibrant, affordable healthcare system with efficiency motive rather than profit motive.

Currently there is loud silence from many quarters like the NGOs and international donor funded programs. It’s not because they do not see the dangers in the above scenario, but they are also fighting for their existence and cannot openly come out to issue a statement that might be seen by one or the other party in the conflict to be interference. But impartiality at a time of suffering is being complicit to the acts and I call for a little more bravery and even behind the scenes maneuvers to ensure the impasse is broken and the siege on our healthcare system lifted.

Lack of action will only result in greater suffering and collapse and it’s my earnest plea that we witness leadership and dialogue on the issue before we write the obituary of the public healthcare system.