Joyce Mulama
NAIROBI, Apr 5 2006 (IPS) – As the international community prepares to commemorate this year s World Health Day (Apr. 7), the issue of poor remuneration for health workers in Kenya is being debated.
The pay for doctors and other health care givers in the public service is so low that many of these people could not devote their full time to public service like I have had to engage in private practice because the money I get from the university is not enough to feed me, Dr Stephen Ochiel, chairman of the Kenya Medical Association (KMA), told IPS. The KMA is a professional body for doctors.
According to health officials, someone in the junior ranks of the medical profession can earn as little as 121 dollars per month.
Those in private hospitals are paid more than ten times above what those in public service earn, said Ochiel.
But it is worse in the rural areas. Doctors here cannot indulge in private practice because the majority of the people here are poor, and cannot afford to pay for services in private institutions.
The result is a particular shortage of health workers in outlying regions a problem highlighted last year after ethnic clashes that took place in Turbi, located in a remote part of northern Kenya. Sixty people died in the violence, while hundreds of others were severely injured and taken to the district hospital, which reportedly had only one doctor to assist them.
Low salaries have prompted medics to look abroad, with the destinations of choice said to include the United States, Canada, the United Kingdom, Australia and countries in Southern Africa, where better terms of service are available.
Even though no official figures have been compiled for the number of medical staff who have left Kenya in search of greener pastures, authorities believe it is substantial.
The turn over is high, but we do not know whether it is from death, retirement or resignation, said Ahmed Ogwell, chairman of the World Health Day organising committee at the health ministry.
To date, a freeze on hiring has complicated efforts to fill vacant posts.
I can tell you that there are 6,000 nurses walking in the street looking for jobs. But the reason we cannot absorb them is because of budgetary constraints, observed Ogwell.
These words were echoed by Assistant Health Minister Enoch Kibunguchy, who told IPS recently that the Ministry of Health was not recruiting because there was an embargo on hiring new health workers, because the wage bill was too high.
Earlier this week, however, President Mwai Kibaki announced that government would recruit 3,200 new medical personnel by the end of June this year to help reduce the current staff shortages in health facilities. A total of 12,000 health workers is needed.
Statistics from the Ministry of Health indicate that there is currently one doctor for every 100,000 people in Kenya, and 49 nurses per 100,000. This is way below the World Health Organisation s recommended ratio of one health professional per 5,000 persons.
The KMA says low salaries do not present the only problem as concerns retaining staff: government also needs to come up with incentives for health workers, particularly those to be deployed in rural areas, it notes.
We are talking about substantive housing and hardship allowances, said Ochiel.
Currently, these are negligible. No-one would want to go to the remote areas because there is nothing to motivate him or her. Besides, medical people are expected to work round the clock, with minimum equipment.
Health officials say they have made proposals about incentives.
We have said that house allowances must be the same for all: those in and out of Nairobi. This will be a huge boost for someone going to a place like Garissa (northern Kenya) because since houses there are cheap; he will be able to save part of this money, said Ogwell.
Again, we have proposed that those workers in the remotest of parts be given a higher hardship allowance because of the tough conditions under which they operate.
An incentive programme that provides for continuous professional development is already being implemented.
Some have pointed out, however, that proper working facilities and adequate supplies of drugs are also crucial for keeping medics properly motivated. Authorities claim that the more than 2,000 public health institutions across the country are stocked with essential medicines.
The theme for World Health Day 2006 is Working together for health . It was chosen to highlight the international shortage of health workers, and how best to attract and retain medical personnel.