Is it time to change tack over the public health crisis?

By Irũngũ Houghton

First published Sunday Standard, January 15, 2017. Kindly reproduced here with permission from Standard Group 

This past week, the public health crisis just took an even dangerous turn. Judge Hellen Wasilwa’s emotionally delivered judgement this week effectively criminalized the national executive of the Kenya Medical Practitioners, Pharmacists and Dentist Union for representing the 5,000 strong membership. Regrettably describing the leadership as “having hands that are stained with blood, dirt and stinking of sewage,” the Employment and Labor Relations Court Judge sentenced them to one-month suspended jail time if the strike was not concluded in two weeks.

The tragedy was not lost on some of us. Call any leadership weak and effectual and then ask them to go back and negotiate with their members usually produces either of two results. One, fearing their judgement may be clouded by the prospects of jail, the membership replaces them or two, the current leadership becomes even more defiant and intransigent. Both doesn’t serve the stated intention to bring an end to the strike. I hope the Doctors look for a third alternative.

Coupled with the very real and present danger for the tens of millions that have been unable to access life-saving medical services, the forty-one day’s crisis deepens. While the real cost is yet to be counted, out-patient and special clinics attendance have dropped to an all-time low. Safe deliveries, inpatient and emergency care denial and numerous deaths have been recorded. While major referral hospitals, including Kenyatta National Hospital are operating below capacity for the first time in decades. Many of you reading this column, will have seen your savings depleted to keep loved ones alive while some of you will have buried others. This strike has hit us hard.

This acute crisis like the many before it has left some Kenyans publicly debating. Did the National and County Governments have to wait for KMPDU strike notice before returning to the Collective Bargaining Agreement signed in 2013? Should the right to association be limited for public workers in essential services? Should public health be privatised? While valid questions given the crisis, we need to look elsewhere for raising the level of leadership on all sides.

Kenya’s case is not unique. Doctors and nurses from Burkina Faso, South Africa, England and the North America went on strike for better working conditions and salaries over 2016. What distinguishes Kenya from these others is the fact that public health procurement theft has framed our crisis. Until we as citizens and State Officers act to restore integrity, transparency and demand accountability in the health procurement system, public health will continue to be dysfunctional.

There are seeds of ideas we could introduce into the dialogue on the way forward.

Minimal service agreements with County Governments could enshrine agreements on industrial action that ring-fence and protect emergency services. It would be important to ensure that this does not tie the hands of right to association and labor in the case of a non-responsive state.

Parliamentary oversight and mediation has been missing from this strike. Perhaps the agreement reached between the health-workers, National and County Governments should be subjected to annual parliamentary budgetary and policy oversight as they do in the United Kingdom and North America.

Finally, more effective standing mechanisms would allow for continuous policy dialogue between all the stakeholders in the health sector. Organized health-workers and patient associations must increase their vigilance and public action on wastage and corruption in future. To ignore the pillage in our sector is to undermine the future capacity of the state to pay health-workers decent and competitive salaries and the very public health sector itself.

The clocks in all our public health centers and the Labor Court are ticking. The President seemed to have rebuilt confidence in the negotiations. These negotiations should resume immediately in the presence of the Council of Governors. The secrecy shrouding the Collective Bargaining Agreement and the negotiations to date should also be lifted to allow for more public scrutiny. Keeping the negotiations in the public eye ensures public accountability and as my neighbor would say, reduces possibility for “funny business”.

For those harboring unconstitutional thoughts of a future without unions and a purely private health system, it is worth considering that the current pain and suffering would be the new future. The only difference is, it would be big business and the new normal. That is a future no-one should not wish for.

Irũngũ Houghton writes in a personal capacity. He is the Society for International Development Associate Director. You can engage him at katiba@sidint.org or @irunguhoughton

Post-script: Following this post, Senators Mutula Kilonzo and Omar Hassan strategically offered to mediate between KMPDU and the state.

 

 

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