Society / Health & Science
Friday, 09 Dec 2016 14:00 EATskenana@kenyafreepress.com
The ongoing strike by medical workers has once again revealed the neglect of Kenya’s healthcare system and its workers. At the commencement of the strike on Monday, dozens of patients escaped from Mathari Mental Hospital, signifying the important security role the professionals play in containing the patients. The strike has paralysed health operations in all counties except one and affected autonomous national agencies like the Kenyatta National Hospital, Moi Teaching and Referral Hospital and Mathari Mental Hospital.
More than 20 Kenyans have died in public health facilities, whereas the government continues to treat the strike casually as if it is not a big crisis. The cabinet secretary for health Dr Cleopa Mailu has so far failed to address the matter at the core of the strike: a collective bargaining agreement (CBA). Two days ago, President Kenyatta appeared to make the government’s indifference worse by asking the striking doctors to be “humane” and resume work. In an atmosphere of rampant corruption and wastage in government, the appeal for doctors’ humaneness was dismissed by many as ludicrous.
This strike, however, has also helped clarify to Kenyans some underreported facts about inequality in health service provision, the relative performance of various county governments (which provide the bulk of health services) and the growing disconnect between devolution and concentration of funds at the national level. This article examines the transformation of healthcare in Bomet County, which is the only one where health services are going on normally despite the nationwide strike.
A spot check in facilities in Bomet indicates that medical services are continuing as usual in all the 133 health facilities in the county. All nurses and doctors are attending to patients as per schedules. As the news has spread in the media, facilities in Bomet have received an influx of patient from the neighbouring counties of Narok, Kisii, Nyamira, Kericho and Nakuru. Local officials conducted journalists on a check throughout the county yesterday to confirm that services were indeed going on. A local official told the Kenya Free Press about the case of a family from Mai Mahiu that travelled the 150km to Bomet for treatment. Bomet has ordered emergency medical supplies to deal with the upsurge in patient numbers.
Unbeknown to many Kenyans, Bomet County has been a leader in healthcare transformation for four years. This newspaper has previously reported about the county’s acquisition of capacity for total knee replacement, which is available in only three other public hospitals in Kenya (KNH, MTRH and Nakuru General Hospital). We contacted Dr Sowek Bernard, the Chief Officer for Medical Services in Bomet, to discuss the general state of healthcare in the county in light of the national coverage of the county’s success in keeping doctors at work.
According to Dr Sowek, immediately the Kenya Medical Practitioners and Dentists Union and other unions representing health workers issued the strike notice to the Government to implement their CBAs on or before December 5, Governor Isaac Ruto convened a meeting with local unionists representing doctors, clinical officers, nurses and all health workers in Bomet to start an engagement.
At the meeting on November 30, which included chief officers, the governor expressed his sympathy with the grievances expressed by the unions and his readiness to engage them in a conducive atmosphere free of strike or threats. Sensing goodwill from the administration, the workers said they would give dialogue a chance by boycotting the nationwide strike.
On Monday December 5, as the strike took effect nationwide, workers in Bomet reported to work normally as their leaders started negotiations with the county administration on the basis of the 2013 CBA that is at the heart of the stalemate. The two sides agreed that the first course of action was to draw a recognition agreement, which has been signed today December 9. No county government had signed a recognition agreement with the unions which have operated at the national level. The parties have committed themselves to sign a collective bargaining agreement which will ready within one month.
Dr Sowek, who was appointed in December 2013, said that Governor Ruto has shown his recognition for the work of health workers since he came to office. He said in 2013, healthcare services at the region’s 90 facilities, from dispensaries to the largest, Longisa District Hospital, were on the verge of collapse. Longisa Hospital had no running water. Casual workers washed patients linen by hand. As the health sector had been highly centralized, staff were poorly equipped and not well supervised.
These circumstances were in no way limited to Bomet. The push for decentralization of healthcare was intended to cure the burdens of infrastructural challenges, lack of personnel and poor management systems that had deprived Kenyans of quality healthcare for decades. To succeed, the counties had to create health value by improving health outcomes, access to health services, and the way patient care is delivered.
The Isaac Ruto government embarked on a programme to improve physical infrastructure, personnel and systems. The first action for the governor was to install piped water at Longisa Hospital, Dr Sowek said. It was an obvious way to reduce chances of infection and promote quality of care. The county bought automatic laundry machines and ensured the staff were appointed under regular contracts.
Second to that was the purchase of equipment. Bomet was among the first counties to buy a dialysis unit, also installed at Longisa. This cut back the long travels patients always made to MTRH in Eldoret and KNH. The machine is used for chemo dialysis and has had a huge impact on patient care. The county government built a six-bed intensive care unit and an oxygen plant at the hospital as well.
According to Dr Sowek, the whole region had only six doctors. Now they have employed 54 doctors in four years, bringing the total to 60. There were no consultants. Now the county has four surgeons, one obstetrician/gynecologist, one pediatrician, one physician, and one orthopedic surgeon, who conducts the total knee replacement reported about in September.
Over the four years, Bomet has also built 43 new health facilities and established 23 maternity wings in its hospitals as part of its contribution to First Lady Margaret Kenyatta’s Beyond Zero Campaign, Dr Sowek informed us. On staff employment, he says Bomet was the first county to absorb on permanent terms all the 114 nurses that were employed by the government on contract terms under the 2008 Economic Stimulus Programme. Other counties followed suit, and some have not employed the workers on permanent basis until now.
"There is no denying that these changes have improved the lives of the residents, but even more important is that few other counties have experienced such a change during the last four years," said a resident of Bomet.