If you are familiar with Isaac Newton’s 3rd Law of Motion, you will understand that for every action, there is an equal and opposite reaction. So when the government fails to compensate its work force, there will be consequences. In light of the recent doctors’ strike, several matters have come to light.
First off is the fact that the protests are being spear-headed by post-graduate interns from the medical fraternity, otherwise known as registrars. They represent other post-graduates working in the public healthcare sector including the Kenyatta National Hospital (KNH). Most of these interns were government sponsored until the Ministry of Health was forced to stop their funding due to government budget cuts.
What’s the Problem?
According to Moses Masika, a doctor at the Nakuru Provincial General Hospital, medical interns had been earning salaries until their funding was withdrawn in 2009. Speaking during an open forum at Caribea, Dr Masika said that registrars had been promised a house and travel allowance to compensate them for their services. The government has since failed to release the money for these provisions and the interns have not taken it lightly.
A report by the Ministry of Medical Services and the Ministry of Public Health and Sanitation states that Kenya currently has 1 doctor per 6250 potential patients. This barely meets the World Health Organisation (WHO) minimum requirements which recommend 1 doctor for every 1000 people.
The document, otherwise known as the Musiyimi Report, notes that instead of the KES 386.7 million needed to develop staff competency, the Ministry is currently receiving only KES 88 million per year.
There are 3674 health facilities in the country. The Report argues that more than half of them are worse for wear with public facilities taking the brunt of the budget cuts. To make matters worse, post-graduate doctors were initially earning about KES 40,000 per month when they could get 10 times as much elsewhere. According to Dr Ahmed Omari, Botswana pays between KES 400,000 and KES 500,000 plus accommodation for the same service.
What do they Want?
Much like any other protest in Kenya, this all boils down to money. The interns, however, don’t just want salaries. They want funding for the entire sector. Aside from the recent protests, the medical community has been pushing for better health facilities. In light of their own demands, registrars have adopted the Musiyimi Report. The report, which was published earlier this year, outlines the following recommendations:
(a) Treasury to allocate additional funds for the two Ministries to implement a three year health stimulus package amounting to approximately KES 217 billion.
(b) The treasury to increase progressively, at 2% per annum, the budgetary provision to the Ministries of health until we achieve the Abuja Target of 15%.
(c) For sustainable and affordable health care in the country, the Ministries of health to fast track implementation of the recently developed health financing strategy
(d) That 1% of the total health budget is allocated to Health Research.
(e) Enact a national social insurance (NSHIF) to minimize the risk of financial catastrophe due to health spending and improve access within the next one year.
(f) Phase out cost-sharing as a financing mechanism over the next three years.
(g) Improve governance & regulatory framework to avoid wastage and increase performance.
Why should they get paid?
The report was drafted shortly after the December 2011 Doctors’ protest. The recommendations are all solid arguments but the current strike emphasizes the need to compensate interns.
When was the last time an intern was paid for their services?
Post-graduate Law students earn nothing after they apply for internships, despite the fact that they can practice law. Even graduates with a Bachelor’s Degree in Business Administration have to work for free before they can branch out into the world of employment.
At most, interns earn a small allowance to cater for their lunch and transport needs. In fact, they took the job so that they could gain some experience, not a steady income.
Besides, some Kenyans are getting by just fine without them. With low-cost health insurance schemes taking flight, private health care is slowly becoming more commonplace than it was a few years ago. With as little as KES 7 a day, anyone can get a medical cover.
So when interns protest, why should anyone else care?
Putting a few things into perspective, post-graduate medical interns are actually working in a hospital. They aren’t just cleaning bedpans and checking pulses. They are saving lives. A post-graduate doctor can perform a kidney transplant in the theater while Law graduates may not appear in court until after they take the bar exam at the Kenya School of Law.
“Public sector medical interns work for free but they have to deliver a service that the hospital will charge the patient for,” said Dr Masika.
Maybe if more Kenyans felt that their personal medical care was threatened they would be more sympathetic towards doctors. “What if a registrar walked out in the middle of a surgery because their work day was over?” asked Dr Wambui Waithaka, who was also at the forum.
Most internships don’t have that much at stake. How many trainees can boast that they prescribed the right treatment and medication for a diabetic who would otherwise die without it? How many interns can claim that they got rid of a life-threatening blood clot or inflated a collapsed lung?
Some may argue that training is not a service but a chance to learn more from more experienced people in the field. Others may say that as a trainee learns, they eventually develop skills that have value. It therefore reaches a point where the line between intern and professional is blurred.
Which begs the question; should every single sector compensate its interns? It seems unlikely. Maybe the best that can be done is to prioritise the fields that carry the most valuable services. If so, why not start with Medicine?