In medicine—particularly in surgical disciplines—skill is not theoretical. It is built through practice, repetition, and exposure. A surgeon becomes better the more procedures they perform. Experience sharpens judgment, improves technique, and ultimately determines patient outcomes.
Doctors therefore must seek opportunities to practice wherever those opportunities exist: public hospitals, private hospitals, and faith-based facilities. Every patient treated adds to a doctor’s competence, and that competence benefits the entire health system.
It is therefore deeply concerning that the Cabinet Secretary for Health has recently issued threats suggesting that doctors working in public hospitals should not pre-authorize care in private hospitals under the Social Health Authority (SHA). The suggestion that doctors should be confined to a single institutional environment betrays a fundamental misunderstanding of how medical expertise develops.
The truth is simple: most of Kenya’s best clinicians have trained and practiced across both public and private systems. In fact, nearly 80% of public hospital doctors also consult in private facilities. This is not abuse of public resources—it is how skills are maintained and improved.
Ask any doctor which surgeon they would prefer to operate on them or their family. More often than not, the preferred surgeon is one who practices across both systems, constantly refining their craft.
I speak from personal experience.
For the last 25 years I have worked in both public and private sectors. I attribute much of my clinical growth to this partnership between the two systems.
When I was a medical intern at @Machakos District Hospital between 2000 and 2001—and later a medical officer there—I performed a large number of Caesarean sections. At that time many inductions were done using Cytotec, a drug known to produce very strong uterine contractions.
Later, when I began doing locums at Nairobi Women’s Hospital, I encountered a different approach: a gentler prostaglandin protocol used at carefully calibrated doses, achieving successful inductions with fewer complications. I carried that knowledge back to Machakos and applied it to improve care for patients there.
This is how medical systems evolve: through cross-pollination of experience.
Doctors who do locums and cross-sector work have historically been among the most industrious clinicians in the public service. They bring back new techniques, new protocols, and new standards of care. They remain intellectually engaged and professionally motivated.
Indeed, it has often been observed that doctors who maintain active clinical practice outside the public facility tend to be more productive and less prone to burnout. Telling a doctor to sit idle after finishing their duties is neither realistic nor healthy—for the doctor or for the system.
The measure of a surgeon is not the number of hours they spend sitting in a public facility.
The measure of a surgeon is how many operations they have performed and what their outcomes are.
Medicine is both science and art. Outcomes improve with experience. A surgeon who has performed hundreds or thousands of procedures inevitably develops superior judgment and technical mastery.
This is why the recent directive from the Cabinet Secretary—threatening that Social Health Authority may refuse payment for procedures pre-authorized by doctors who also work in public hospitals—is misguided and ultimately harmful to Kenyan patients.
Yes, public funds must be protected. But protecting public funds cannot come at the expense of developing skilled doctors.
Let me give another example.
For my postgraduate thesis at the University of Nairobi School of Medicine, I studied the utilization of laparoscopy—minimal access surgery—in gynaecology at The Nairobi Women’s Hospital
Shortly thereafter, when I was posted to Isiolo District Hospital as a consultant gynaecologist, my very first patient was a woman with primary infertility who required laparoscopy. Isiolo had never performed such a procedure. Because of my exposure to the technique in the private sector, I was able to refer her appropriately to Nairobi Women’s Hospital where we performed laparoscopic surgery.
The following month she conceived.
Had we attempted an open procedure in her severely scarred abdomen, we might have permanently condemned her to infertility.
That outcome was possible only because of exposure across institutions.
Unfortunately, whenever systemic failures occur in Kenya’s health sector, the The Ministry of Health often falls back on the familiar narrative of doctor absenteeism. Historically, this narrative has even been reinforced through regulatory mechanisms such as the old “part-time private practice license” issued by the Kenya Medical Practitioners and Dentists Council.
The Kenya Medical Association fought to have that license abolished because it misrepresented how medical practice works. Doctors are licensed to practice medicine, not to serve as employees of a particular institution. A license reflects competence in a field—whether as a general practitioner, specialist, registrar, or non-clinical expert—not a restriction to a particular hospital.
Regulatory bodies must regulate competence and ethics—not function as the human resource department of the Ministry of Health.
Another uncomfortable truth is the chronic underutilization of consultants in county hospitals. Many young consultants arrive enthusiastic and eager to serve. They begin with energy and commitment, performing surgeries and building services.
But over time they encounter familiar obstacles:
• Lack of theatre space
• Missing equipment
• Shortage of staff
• Administrative bureaucracy
• Political interference
Gradually frustration sets in. When consultants seek additional work elsewhere to maintain their skills, the system turns around and accuses them of absenteeism.
That is intellectually dishonest.
Even more troubling is the attempt to justify these threats under the banner of protecting public funds through SHA.
This is the same Social Health Authority that is currently rejecting legitimate claims, including cases where consultants have performed authorized procedures such as elective Caesarean sections only for payments to be denied over minor clerical issues.
So one must ask: who exactly is protecting public money?
There are far more constructive ways to maximize the utilization of doctors’ time.
Research being undertaken by Strathmore University for KHHRAC is exploring consultant sharing across counties—a promising model that allows specialists to serve multiple facilities efficiently.
Murang’a County Government has already taken a progressive step by allowing consultants to provide services across hospitals within the county.
Another promising concept is the development of amenity wings and Doctors’ Plazas in public hospitals. These facilities allow both public and private doctors to consult and operate within public hospital infrastructure, improving facility utilization and expanding access to specialized services.
At Kigumo Sub-County Hospital, we are working toward exactly such a model. When a Doctors’ Plaza and amenity wing become operational, any qualified doctor—public or private—can use the facilities.
The result is simple:
• Facilities are better utilized
• Doctors perform more procedures
• Skills improve
• Hospital revenues increase
• Patients receive better care
Attempting to control doctors through IT monitoring systems or administrative directives will never substitute for measuring quality through outcomes.
The future of professional regulation lies in competency-based systems. The Kenya Medical Association is currently working with the Kenya Medical Practitioners and Dentists’ Council to develop competency-based CPD frameworks that assess real improvement in clinical skills—not simply attendance at webinars.
The principle is straightforward.
The more a doctor works, the better that doctor becomes.
There is no such thing as a “public doctor” or a “private doctor.” There are only doctors—professionals trained to provide care wherever patients need them.
Doctors are already effectively on call most of their lives. If the government wishes to restrict their ability to practice elsewhere, then it must also be prepared to compensate them for that time fully—something no public system in the world realistically does.
The Cabinet Secretary for Health should therefore reconsider the threats being directed at doctors regarding SHA preauthorization.
Such threats appear less like genuine reform and more like an attempt to justify claim rejections within a system already struggling to pay legitimate bills.
The real challenge before us is not controlling doctors.
The real challenge is ensuring that SHA is adequately funded and capable of paying for the care that doctors provide.
Instead of antagonizing clinicians, the Ministry of Health should embrace public–private collaboration, support innovations like Doctors’ Plazas and amenity wings, and focus on expanding the financial capacity of the health insurance system.
Because in the end, the goal is not administrative control.
The goal is better doctors, better hospitals, and better outcomes for Kenyan patients.
Maybe we now need to recall the calls for a HEALTH SERVICE COMMISSION.
Dr Simon Kigondu is a Gynaecologist and the President of Kenya Medical Association