#sickat50 – Health Care Workers should not relent in their strike!

12^th December 2013 marked Kenya’s 50th year as a sovereign nation. As the countdown to the birthday began some minutes before midnight, the healthcare workers (HCWs) strike entered its 3^rd day. This is the third strike instituted by the Kenya Medical Practitioners and Dentist Union and the first time that all cadres of healthcare workers are on strike at the same time.

That means that at nearly all health facilities nationwide at the district level and below there is not a single healthcare practitioner to assist patients. These facilities are completely paralyzed and shut down. I am saying this as a matter of fact, because in the coming days you will see fabricated media reports that certain cadres of workers in some areas are back at work.

The reasons for the nationwide strike are simple. The government breached Collective Bargaining Agreement struck to implement devolution, they also illegally passed the HCWs payroll onto the County Governments without firstly creating the laws and legal framework necessary for devolution of health and they instituted a slashing of healthcare funding across the nation from a recommended 15% of government budget to a miserly 2.7% which subsequently resulted in projected expenditure of only 24-50 kshs per person per year. In totality, what the governors, senators and politicians are calling devolution is actually just an illegal slashing of HCWs salaries, nothing more. 

There is no dedication of more resources so that more people get adequate healthcare.

As expected, the government ignored issues raised by the unions. In fact, this government was given 6 weeks’ notice of industrial action prior to the strike. A day before the strike some governors even threatened to sack HCWs in their counties, of course forgetting that they are not the Public Service Commission and thus did not hire and cannot fire.

Speaking of Commissions, the governments’ response to the legitimate demand to create a Health Service Commission was that it was unconstitutional according to article 234. Well, article 234 simply names other public service sector commissions it does not limit or prevent a Health Service Commission from being formed. Indeed it’s utterly hypocritical for a government that is blatantly ignoring the constitutional implementation process on devolution of healthcare to even talk about the same constitution. They actually claimed that they will devolve salaries’ and then later on create the laws under which salaries would be managed. How absurd!

Of course, such absurdities are a hall mark of government. Once they realized that they cannot use some random quote from the constitution they ran to the high court to get court orders to force the HCWs to end their strike. As if that was not enough, politicians in different counties have stepped up the intimidation and harassment, some even threatening to evict HCWs from government housing if they don’t return to work. As I said, county governments did not hire the HCWs, they cannot fire them and they cannot evict them.

I urge the HCWs to stay resilient and not to relent in their fight for justice. It is unimaginable how horrific the healthcare sector will become under such politicking and selfish leadership especially with such drastically slashed budgets. Surely the death toll will be astronomical, when the hospitals can only afford to spend a miserly 24 ksh on your treatment!

More importantly, as we celebrate Kenya’s Jubilee anniversary, let us not forget that it is those who sacrifice their entire lives and dedicate their work to the service of the people who need to be honored the most in this country. We should not be as shallow and superficial as to call the many roads, parks, hospitals, buildings and airports named after one or two people the achievements of this land. Rather it is the people, who have committed themselves, and are enduring the most deplorable working conditions, who are our greatest achievements.

As we look forward to the next 50 years, I wish to celebrate our Healthcare workers as well as our other civil servants who indeed are heroically doing their best to keep the systems running despite the best efforts of greedy and selfish politicians to plunder the nation. Solidarity!

#sickat50 - Right of Reply: The Health Service Commission IS Constitutional! by Dr. Oduwo Noah Akala

In a written communication dispatched yesterday, December 9th, 2013, hours to the start of the Health Workers Strike, from the Council of Governors working in tandem with the Ministry of Devolution and interested State Commissions, the above named rubbished the primary reason for the strike; the establishment of a Health Service Commission. The position put forward is that the establishment of such a commission is contrary to Article 234 of the Katiba which basically spells out the functions and powers of the PSC establishing it as a Constitutional Commission entrenched in law.What the Governors' Council failed to mention is that this same article establishes several other Constitutional Service Commission such as the Judicial Service Commission, the Teachers Service Commission, the National Police Service Commission and the Parliamentary Service Commission. Therefore, the assertion that the existence of a Service Commission for Healthcare Workers is incompatible with that of the Public Service Commission does not hold water. How come there is no conflict between the PSC and the other Service Commissions?

It is the norm for this government to quote or ignore the constitution whenever it suits them. While the same government actively contravenes article 143 (4) of the constitution which clearly states that the President is not immune to prosecution under any of the treaties that Kenya has signed and domesticated, and pushes for a deferral from trial of suspects of crimes against humanity, they turn around and conveniently quote randomly an article that does not limit or impede them from creating a Health Service Commission. In fact this much needed commission would indeed be service to humanity!

Moreover, a keen eye would observe that the Constitutional Service Commissions are based around services pegged on basic human rights; education (Teachers Service Commission), security (National Police Service Commission), access to justice (Judicial Service Commission) even representation (Parliamentary Service Commission.) What of health? What right could be more basic than this? If the Government is to be taken seriously in its purported commitment to health for all as a Vision 2030 goal, it must take the appropriate steps to establish healthcare as a priority in its national agenda.

At this juncture, I would remind the Council that the Constitution clearly states, in the Bill of Rights, that human rights belong to the individual and are not granted by the State. In adopting the stance they have taken, they violate not only Healthcare Workers' right of fair labor practices but more importantly, the citizens' right to health. The Health Service Commission should not be viewed as a favor to be granted, but as a requirement to preserve the dignity of the Kenyan people.

I quote Article 24 of the Katiba on the limitation of rights:

Limitation of rights and fundamental freedoms
(1) A right or fundamental freedom in the Bill of Rights shall not be limited except by law, and then only to the extent that the limitation is reasonable and justifiable in an open and democratic society based on human dignity, equality and freedom, taking into account all relevant factors, including—
(a) the nature of the right or fundamental freedom;
(b) the importance of the purpose of the limitation;
(c) the nature and extent of the limitation;
(d) the need to ensure that the enjoyment of rights and fundamental freedoms by any individual does not prejudice the rights and fundamental freedoms of others; and
(e) the relation between the limitation and its purpose and whether there are less restrictive means to achieve the purpose.

The question Kenyans must ask themselves is this, is the Governors' Council's position in line with the intention of the framers of our Constitution? Does it seek to abide by the article above? Judge for yourself, below is the article the Council quoted in terming the HSC unconstitutional:

Article 234:
Functions and powers of the Public Service Commission

(1) The functions and powers of the Commission are as set out in this Article.

(2) The Commission shall—

(a) subject to this Constitution and legislation—
(i) establish and abolish offices in the public service; and
(ii) appoint persons to hold or act in those offices, and to confirm appointments;
(b) exercise disciplinary control over and remove persons holding or acting in those offices;
(c) promote the values and principles referred to in Articles 10 and 232 throughout the public service;
(d) investigate, monitor and evaluate the organization, administration and personnel practices of the public service;
(e) ensure that the public service is efficient and effective;
(f) develop human resources in the public service;
(g) review and make recommendations to the national government in respect of conditions of service, code of conduct and qualifications of officers in the public service;
(h) evaluate and report to the President and Parliament on the extent to which the values and principles referred to in Articles 10 and 232 are complied with in the public service;
(i) hear and determine appeals in respect of county governments’ public service; and
(j) perform any other functions and exercise any other powers conferred by national legislation.

(3) Clauses (1) and (2) shall not apply to any of the following offices in the public service—

(a) State offices;
(b) an office of high commissioner, ambassador or other diplomatic or consular representative of the Republic;
(c) an office or position subject to—

(i) the Parliamentary Service Commission;
(ii) the Judicial Service Commission;
(iii) the Teachers Service Commission;
(iv) the National Police Service Commission; or
(d) an office in the service of a county government, except as contemplated in clause (2)(i).

(4) The Commission shall not appoint a person under clause (2) to hold or act in any office on the personal staff of the President or a retired President, except with the consent of the President or retired President.

(5) The Commission may delegate, in writing, with or without conditions, any of its functions and powers under this Article to any one or more of its members, or to any officer, body or authority in the public service.

Dr. Oduwo, Noah Akala (M. B. Ch.

#sickat50 - Government creates a healthcare crisis – AGAIN!

On Tuesday 10^th December, The Kenya Medical Practitioners and Dentist Union will initiate industrial action against the government and go on strike. This is the third nationwide strike in the history of the union, and sadly the issues being raised are exactly the same as the last two times.

For a government that claims to be digital, the healthcare sector under Jubilee is anything but. In the name of devolution of health the most archaic methods and discriminatory tactics are being used to harassed, intimidate and bully Health Care Workers.

Let’s agree and accept one thing – Devolution must occur. The doctors know this. The government knows this. But the government is yet to provide any sort of realistic or even considered strategy that will actually devolve health to the masses and ensure that access to health care is available equitably and across the nation.

Instead, the government has taken devolution to mean that the salaries and resources funding healthcare are devolved to the county level and thereafter the county governments can do with these resources as they deem fit.

It’s absolutely ridiculous to simply move pay rolls to the county level and thus claim that this is devolution of healthcare. What does pay roll have to do with provision of resources? Did the devolution of salaries magically result in more healthcare workers as is needed across the country? Certainly not!

Instead, predictably, the county governments have begun to mistreat the healthcare workers and some have gone so far as to demand that healthcare workers from other tribes return to their tribal counties. This is just the tip of the iceberg on the abuses going on. One governor has even threatened healthcare workers with sacking while claiming that he will hire more workers.

In case this governor has been living inside a deep hole for the last 50 years, let me just point out that not only does Kenya not have enough trained professional health care workers, we have a shortage of doctors by at least 50,000. It’s just a matter of fact that only 2300 (now miserable) doctors cater to 42 million people. That is, each government doctor has to treat 18,260 people. So I don’t know where this governor will find more doctors. By the way, Kenya is not the only country with a massive deficit of health care workers. I suggest he tries to import them from China in line with Jubilee’s new philosophy of looking east.

The sort of unprofessional grandstanding by these governors and their equally arrogant minions the members of county assemblies is typical of the sort of tyrannical leadership Kenyans voted in. Whereas we don’t have enough healthcare workers and should actually hire more, we clearly have too many politicians and should fire most!

At the heart of the dispute causing the strike is the fact that callous leadership and ridiculous politicking has taken over the devolution process and the county governments has all chosen to breach the Collective Bargaining Agreement struck between the national government and the doctors union. Rather than follow the legal policies and structures put into place, these rather tribal politicians instead have come up with an illegal scheme in which the personal emoluments of health care workers are slashed as is the salaries such that the HealthCare worker actually earns less for working more hours under extremely stressful conditions.

The propaganda machinery has been hard at work, doing their best to discredit the intentions and concerns of the doctors.  Jubilee is actually very good at spreading falsehoods in regards to the legitimacy of the doctors concerns. The greatest lie conceived thus far is that doctors are against devolution in totality and wish to contradict the constitution of Kenya.

It is clear to any rational mind that health services and healthcare workers salaries are two entirely different matters. As it is, the governors, senators and members of county government still receive their own salaries from the central government. It is thus simply a total illegality on their part to breach the CBA and thus devolve people’s pay checks to county governments and call that devolution of health services. By the way, so far, other than that, there is no actual plan or strategy to provide actual services to the people. In fact, most county governments have slashed funding to healthcare – the World Health Organization recommends that funding to the healthcare sector to stand at 15% of the government budget. Most county governments have pegged that funding at a miserly 2.7%.  That means depending on the population within the county, the county government has allocated about 24-50 ksh per person per year for their healthcare!

This means that not only will they have to slash healthcare workers salaries in order to fit them within their paltry budget; they will also have to dispense with much of the services and resources because they cannot afford them. You may wonder why these county governments can’t afford suitable healthcare – well they have little money left over after they spent much of the budget on their own allowances, entertainment and retreats and of course to furnish and refurbish governor’s residences even as they bought themselves luxury vehicles. If you go to a hospital and they don’t even have aspirin, don’t despair, your governor looks good in his new Prado!

The healthcare workers are not the enemies of the Kenya constitution; rather it is the politicians who have clearly hijacked the devolution dream of millions of Kenyans for their own selfish benefit while leaving the rest of the country in utter squalor. It is because of this routine hijacking of the process that these doctors keep instituting industrial action.

Their demands are still in line with the CBA that they struck with the government last year. But since the devolution process is being sorely corrupted, the KMPDU has set out to demand that a Health Service Commission is formulated, and that the personal emoluments of the doctors remain untouched as per the CBA. 

Every time the doctors go on strike, the media and politicians are quick to blame them for the mortalities that occur. It never occurs to these politicians that ultimately they are the ones responsible for any mortality that occur due to a deliberate lack of resources and funding in the health sector whether the doctors strike or not. This time, if you want to blame someone for those who died during the Doctors Strike, blame the county governments and their arrogant politicians who in their insidious scheming have managed to allocate to themselves much of the resources that would have saved lives!

#Sickat50 - Right of Reply: A medic's view on devolution By Dr. Samson Mutanda

In a recent publication in the Business Daily, an article written by Dr Edward Omete brought to light all the merits of devolution.it especially captured the apparent benefits awaiting Wanjiku and Onyango as far as healthcare provision is concerned.

Dr Omete arguing from a policy point of view clearly listed the direct benefits that people in far flung areas are set to get from a devolved healthcare and other social amenities.

I couldn't agree with Dr Omete more. That a robust and functional approach health system needs a proactive approach and mentality and not conservatism.

Dr Omete goes ahead to declare that we must endure teething problems for us to achieve a robust and functional health system. I laud him for that, at least it indicates that he is thinking and dreaming of a better healthcare system.

But I must say that Dr Omete's line of thought is entirely skewed. He in fact misses the point altogether! KMPDU and other HCW unions are not opposed to devolution. In fact we highly welcome it. HCW have the best interests of this nation at heart. 

Before devolution kicked in, doctors were already on the streets clamoring for a better healthcare system, singing of the MDGs and quoting the Abuja declaration among other policy papers. HCWs welcome every effort aimed at improving the system; after all they are the custodians of the system. Every ill and rot within the system affects them directly; both as service providers and consumers of the system. The impact that the poor system has had on them; physically, economically, emotionally, and socially is so negative that they would dare not oppose efforts to make the system better.

What Dr Omete fails to note is that the structures needed for the practicability of a devolved healthcare are not in place. He also fails to tell the readers of the direct negative impact that a hurried process would have on this cadre of workers. Dr Omete claims that the reason why the National government and other state organs may be opposed to devolving health is because of an intent to consolidate and wrestle power and control. The reverse is also true: the reason why the counties are are so eager to take over these functions has nothing to do with service delivery but a strong urge to consolidate power and control!

Dr Omete selectively fails to mention that most, if not all counties have put plans to cut down the salaries of these workers,some by almost 50%! If the figures released by Kakamega and Kitui counties are anything to go by, then doctors have every right to oppose these process and are justified to take whatever measures available, including industrial action and civil disobedience if need be. Who on earth would support a process that aims to reduce his "Kenyan peanuts" by half?

What of the widespread harassment of HCW by county officials? HCW are working in chaos, receiving  threats and intimidation from county reps, county executives and anyone affiliated to the county authorities. Are these the teething problems that Dr Omete wants his colleagues to endure?

A government needs and must attract and retain its human resource pool. Its the key to service delivery.What my colleague fails to mention is that the process, hurried as it is, has no plans to attract nor retain its workforce. He also fails to realize that its futile and all vanity to plan a system by antagonizing the very people in the system, the people who run the system, and are in fact the system! Its more like engaging the reverse gear expecting the car to move forward.

Dr Omete is not the only one from a rural county. Its unfair for him to allude that we have no interests of these counties at heart. HCW persevere in some of the most horrid of conditions in poor rural counties to render services to the common mwananchi. Forgive me if I sound personal,and may be I do. Allow me to argue as a medic and as someone who has worked in the "rural counties" for a while. I clearly understand the origin of the current fears and anxiety. All HCWs are justified to resist a process that if not handled properly will subject them to modern day slavery and economic atrophy.

Let me emphasize that HCW are not opposed t devolving health. They are strongly opposed to the way the process is being mishandled, and the dreaded aftermath that affects them at a personal level.

I dare challenge Dr Omete to say how he would react; should he wake up one day to the realization that his employer was being devolved, with the effects being a reduced take home figure, arrogant and intimidating immediate supervisors, with no clearly outlined personal benefits?

Are we telling these workers who offer essential services to accept and move on? To accept that they are a collateral damage in the process of devolution? Have we reduced them to pawns on this chess board?

I dare say that no county should declare it ready to offer essential services. If they cant manage basic things like garbage collection at county markets what makes them think they are ready to oversee healthcare provision?

The whole process of devolution if not properly handled may just turn out to be the worst mistake ever in post-independent Kenya. Its bound to exacerbate corruption, nepotism and tribalism to a very lethal level.

What the government is not telling Kenyans is that it signed a legally binding Collective Bargaining Agreement with the doctors' union, which was to be effected as from July 1st 2013. In collaboration with the Salaries and Remunerations Commission, the government has silently trashed this legal document and instead, under cover of darkness, has gone ahead to publish some measly figures with a significant reduction in salaries and passed them to the counties for adoption. The impending industrial action is very much justified, if not for devolution then for the implementation of the CBA.

Devolution is highly welcome but shouldn't be to the disadvantage of the doctors, physiotherapists,nurses,dentists, pharmacists, clinical officers, lab techs, pharmtechs, plaster technicians and all other HCWs!

Dr Samson A.Mutanda., Medical Practitioner-Kisumu

samwokamutanda@gmail.com

@binmutanda