EA doctors in another round of strikes

Doctors in Kenya are set for another strike to press for better pay as Tanzania reels from a one-month boycott that ended two weeks ago — a pointer to an ailing health care system that is slowly falling apart.

It is emerging that the Kenya government has reneged on a return to work formula agreed upon with the doctors union last year. Although the doctors were paid a 30 per cent increment on their allowance, the state failed to include senior medical officers in the raise.

Tanzania is battling the effects of a month-long strike as doctors demanded their risk and on call allowances, per diem and increment of eligible payments which the government has not paid since 2008.

Now health experts and economists are calling for a quick dose in fixing the healthcare system in the region.

For something so central to Kenya’s economic well-being, healthcare is still in the doldrums.

“The healthcare system in its current form does not operate efficiently in areas like drugs, personnel, and facility utilisation,” said David Muthaka, an economist at the Kenya Institute for Public Policy Research and Analysis.

Health insurance in the region is taken by only a small minority, and social security mechanisms to cushion the poor against health expenditure are inefficient at best, often, completely non-existent.

Most East Africans are forced to pay for health care out of their own pockets. In 2007, the out-of-pocket expenditure as a percentage of private health care stood at 44 per cent globally. In East Africa, however, the figure stood at 51 per cent in Uganda and 75 per cent in Tanzania. Kenya has the worst — 77.2 per cent of private health expenditure came from the pockets of patients.

For Kenya, which spends nearly 20 per cent of its budget on healthcare, the overall morbidity and mortality remain high particularly among women and children with the maternal mortality estimated to be 414 deaths per 100,000 live births with diseases like malaria, diarrhoea being the biggest killers.

Malaria alone accounts for one-third of all new death cases reported in Kenya for children under the age of five years.

“The increasing level of poverty is a main underlying factor of poor health. Fewer people are dying from immunisable diseases, the focus on immunisation services has reduced, and funding has decreased,” said Shariff Shaanaz, Kenya’s Director for Medical Services
Although all East African countries faced a serious shortage of doctors due to brain drain to countries like South Africa and Europe, Tanzania has the worst deficit.

According to the World Health Organisation, globally, there is an average of 14 physicians per 10,000 people, but Africa is served by just two physicians per 10,000. Even against Africa’s dismal statistics, East Africa still comes up short: There is only one physician per 10,000 people in Kenya and Uganda, and one doctor per over 28,500 people in Tanzania.

“The government has not only failed to recognise the roles of the pharmacists and dental surgeons in emergencies but also that of administrative professionals,” the chairman of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) Victor Ng’ani said.

Among other problems the union wants addressed are registrars not being paid for their overtime and the government not tabling the task force report on doctors working environment.

The Kenyan doctors were initially demanding 300 per cent pay increase. This could have raised the salary of interns from Ksh30,000 ($337) to  Ksh120,000 ($1,348), those of medical officers from Kshs60,000 ($674) to Ksh180,000 ($2,696) and the highest paid doctors — medical specialist II — from Kshs130,000 ($1,460) to Ksh520,000 ($5,842). However the government offered to increase their extraneous allowances of $300 to $400 per month to be implemented in three phases.