An elegant lady turned on the ignition of her car one Sunday at a church I had visited. Chongingingingingingingi! The car refused to start. I rushed to her help. I diagnosed that the car battery was the problem.
Having driven an old car for many years I had learnt everything that could go wrong in a car. I have had punctures in the middle of nowhere and survived. At one time I drove on a square tyre. This was because I had punctured one wheel and the spare wheel had a puncture a few minutes later at a spot that was considered too dangerous to stop. I can confidently inform you that a square tyre does not roll as smoothly as a round one. I have had overheating problems. At one time I even thought that everyone drives around with extra water for cooling the engine. This was until the mechanic finally discovered that the radiator had a problem and replaced it. Needless to add that that diagnosis came after endless visits to the garage for the same problem and after changing gaskets, fans and repairing radiator pipes, etc.
Now back to the lady at the church with battery issues. Using my vast experience of previous battery problems I unleashed my paraphernalia of tricks to revive the vehicle. Should you go to the village look for the fellow with the old pickup whose number plates have only 6 digits. He uses the same tricks.
- Trick 1. I shook the terminals vigorously hoping to get some shift of the contact and hopefully start the vehicle.
Chongingingingingingingi.the car did not start. - Trick 2. I got a piece of metal and hammered the terminals away.
Chongingingingingingingi.’The car did not start. Trick 3. I got water on a piece of cloth to clean the terminals and rubbed the terminals vigorously.Chongingingingingingingi.The car did not start.Trick 4. I decided that it was because the water was not sipping in between the battery and the terminals. So we got more water to run onto the terminals by pouring it from a container.Chongingingingingingingi.` The car did not start.
As I was struggling with my solutions a friend of mine, a surveyor, brought his car next to the stalled vehicle, whipped out the jumper cables, connected them and asked the lady to start her car. Vruuuuuuuuuuuuum vrum vrum. Voila. The car burst to life.
Thank you all said the lady as she drove out of the church compound.
Very often in life we fail to solve our problems by skirting around the real solution. Once the root cause of the problem is found and the correct solution applied the problem is solved instantly. The solution often looks like a miracle yet it is not. This is a scenario often replicated in our public healthcare. It is often reported that public health is failing. All manner of solutions have been suggested ranging from task shifting to public-private partnership. Yet it is very clear that the solution to public healthcare is having the right people, in the right numbers providing the right service.
The most important take-home message from this article is this:
The ability of a country to meet its health goals depends largely on the knowledge skills, motivation and deployment of people organizing and delivering health services” – WHO
Of the six building blocks of WHO Health systems Framework, number 2 i.e. health workforce is the most critical. It is health workforce who can ensure all the other building blocks of the health system function. Without health workforce all other blocks are floaters. The other blocks are:
- Service Delivery,
- Health Information Systems
- Access to Essential Medicines
- Financing
- Leadership / Governance.
That said it is thus imperative for a country to manage health workforce optimally. Health workforce should be treated as a scarce resource. It should be:
- Empowered with knowledge and skills via continuous training
- Motivated with fair pay, good working and social environment and involvement in decisions that affect their life and work.
- Deployed in a way that ensures equitable healthcare to the population.
Indeed the recent panel on human resource development at the Kenya Health Forum agreed that recommended establishment of a central mechanism for managing the specialist workforce that would moderate training and deployment of specialists and subspecialists to ensure equitable distribution of the service across the country. Operationalization of the Kenya Health Human Resource Advisory Council in the Health Act would be a useful start.
Kenya should be actively populating the specialist areas in health with skilled workforce. In this way Kenyans will have the access to the highest standard of healthcare. It is key to note that ACCESS is not only proximity to a health facility or ability to pay but also exposure to the clinicians with the highest level of expertise in that field. This is the case for continuous support for specialist training. Importing expertise is not only unsustainable but is a foreign direct investment in the wrong direction – to the country exporting experts to us. Kenya’s medical institutions have always had exchange programs in medicine to transfer expertise. This has resulted in empowering Kenyan health workers with the necessary sustainable skills that are eventually taught to the next generation of Kenyan health workers.
As a country we thus do not need to go on the roundabout way of fixing small problems as they arise. Just fix the problem. And the problem in healthcare is the management of the health workforce. The solution is establishment of a Health Service Commission.