POSTING OF MEDICAL INTERNS
Following many days of protests at the Ministry of health in a campaign dubbed #OccupyMOH, medical interms were finally deployed to their various stations of work. They received what is called at termless contract, termless because the exact amounts of pay was not put in the contract, pending determination in September 2024 of a court case that was lodged to challenge the advisory from SRC that the immediate past cabinet secretary of health had proposed to pay medical interns a stipend of KES 70,000 in place of the court-sanctioned terms as per the 2017 – 2021 CBA which placed the medial interns in Job group L with negotiated allowances of medical interns. In that scheme of service, once medical intern complete their internship and are employed as medical officer, they are immediately elevated to Job group M with their attendant benefits by virtue of their qualifications.
KMA SACCO INTERNSHIP LOAN
The Medical Interns have now reported to the various internship centers across the country. They have encountered several challenges. Their key challenge was getting adequate resources to enable them settle in their respective stations. Some of the interns have had to travel and work far from their home support. Without home support, the interns have struggled financially to settle in their new stations. KMA SACCO had offered internship loans to help the interns start. The prerequirements to gAn intern who needs a KMA SACCO intensive loan should enroll as a member of the circle and get a garage to guarantee them that loan as per the rules have aged my fellow KMA SACCO senior members to le No problem nd a helping hand to our younger brothers and sisters in need of guarantors, by guaranteeing them. I urge beneficiaries of yhr SACCO loans to repay back yheir loans as soon as thr court awards thrm their fair pay.
WHY WE PUSH FOR A HEALTH SERVICE COMMISSION
Now that the medical interns have settled in their various stations their initial experiences will shed some light on the various aspects of the health service delivery we have been discussing in the era of devolution of human resources for health. Their experiences will demonstrate some of the reason we medics ask for various changes across the medical sector, including the push for a health service commission for the management of HRH, and also on the need for self regulation in the health sector.
MURANG’A RECEIVES ITS MEDICAL INTERNS
In Murang’a county, in Murang’a County Referral Hospital, the medical interns were welcomed with an thorough induction session organized by the Medical Superintendent Dr Florence Kagwaini. During this induction session, all departments within the hospital made presentations incliding physiotherapy and laboratory. The consultants also weighed in and encouraged the interns to learn as much and as quickly as possible. The neurosurgeon for instance asked the medical interns to ensure that they are able to ‘open and close’ someones head safely by the end of their surgical rotation and vowed to show those interested.
The medical interns were informed of the rules, were shown what was needed of them and were allocated to the various rotations of surgery, medicine, paediatrics, gynaecology, psychiatry and community rotation. The neurosurgeon Dr John Kibe was nominated as the new internship coordinator taking over from Dr Cliff Muturi the ophthalmologist who has done a splendid job of internship coordinationover the last several years. Dr Edwin Mogere, the fantastic Murang’a surgeon, was nominated to deputize Dr Kibe. Dr Mogere and Dr Kibe were medical interns when I was a gynaecologist at Murang’a County Referral Hospital. They worked dilligently as medical interns and later as medical officers. The County sponsored them to specialize and they returned to continue serving the people of Murang’a. Additionally they are now mentorimg the next generation of doctors, the Gen Z.
KAKAMEGA MEDICAL INTERNS YET TO START INTERNSHIP
On the other side of the country, the medical interns in Kakamega county were in for a rude shock.They are yet to commence the internship. After staying out for close to two years, the interns who have spent a lot of money settling down, the Kakamega interns were informed that there were no Medical Consultants at Kakamega County Refereal Hospital (CRH). Among other complaints the medical consultants in Kakamega CRH are protesting the failure of deserved career progression. Some of the medical consultants remain in their original job group M, where they started off as medical officers. Remember that the medical interns that the medical consultants are suppose to suppervise are in job group L. This means that in exactly one year the medical interns, who will kow be medical officers, will be in the same job group as those who are suppose to supervise them.
KAKAMEGA GOVERNOR RECALL STRIKES OF MEDICAL PERSONNEL
In his interview for Cabinet Secretary, the immediate past Governor for Kakamega Wycliffe Ombetsa Oparanya indeed reportrd that he has had to handle many strikes of health workforce. One of the memorandums against him even said that he did not pay health workers who had gone on strike. Last year the Kakamega County Referral Hospital obstetrics and gynaecology team closed their maternity for lack of health products including blood products. When this was highlighted this on social media thr best the County Government of Kakanega could do was to put up posters in the same social media calling the posts that were calling them out fake. Sasa Kimewaramba.
ENOUGH IS ENOUGH
Medical consultants have said enough is enough. Some have left the county. Others are taking the fight for better management of Health to the ground. The County Assembly of Kakamega was shocked by revelations made by the gynaecology team back then on the state of health at the hospital.
WIDENING HEALTH INEQUITIES IN THE COUNTIES
In the long run the health inequities accross the couty health facilities will continue to widen. Health will be dependent on who the governor is and whether priorities are given to health in general, and human resources for health in particular. A good case study and example is Laikipia County, where the treatment of health workforce changed from ‘night’ in the previous regime to ‘light’ in the current regime. A big-up to Governor Joshua Irungu for prioritizing health workforce.
CURRENT SITUATION
As we wait to see what nane nene has in store for us we know that the previous governor of Kakamega is on his way to State House to take up the office as CS Cooperatives. Kakamega medical consultants are on strike. Medical interns in Kakamega have not began their internship. Murang’a consultants have inducted thr medical interns who have been sent to them.
47 COUNTY PUBLIC SERVICE BOARDS AND MINISTRY OF HEALTH
Where then is the problem? In the current state where health is a shared function, health workforce in the public sector has to deal with 47 County Public Service boards and Ministry of Health. Currently those dealing with Murang’a County Public Service Board are happy. Those medical consultants dealing with Kakamega Public Service Board are very annoyed.
KENYA HEALTH HUMAN RESOURCES ADVISORY COUNCIL
The recurrent theme here therefore is the push for equality of treatment of health workforce. How can this be achieved? As we speak the role of advising that health workforce are properly managed has been charged to the Kenya Health Human Resources Advisory Council. (KHHRAC). As healthcworkforce on the ground our concern of the advisory nature of KHHRAC has come to pass. The medical interns had to #OccupyMOH and rope in all doctors into a 56-day national strike for their grievances to be listened to. KHHRAC was quiet.
PRESIDENTIAL TASKFORCE ON HUMAN RESOURCES FOR HEALTH
A Presidential taskforce was then set up and termed a Human Resources for Health taskforce which has even been given a budgetary allocation of KES 250 Million in the proposed budgetary allocation. Even worse the Chairman of KHHRAC has been made a member of this taskforce. Essentially saying that he and his KHHRAC team have failed even after hosting a flamboyant event dubbed the Kericho Declaration. The duplication of roles on HRH is unacceptable in our opinion. KHHRAC should be strengthened, assigned a location, a secretariat and budgetary allocations. The Preaidential HRH Taskforce has indeed elicited a court case as it should, and we hope the court will help save tax payer money by annuling it.
WISHING MEDICAL INTERNS WELL
As President of the Kenya Medical Associatiin I wish all the medical interns well as the start their journey in the noble profession. I urge them to remain focussed and not let the hurdles coning their way distract them from their goal, completing medical internship and getting licenced. I urge the Council of Governors to check on those counties that that are a hurdle to quality healthcare by mistreatment of health workforce. Benchmarking on HRH can be done in Murang’a and Laikipia.
Dr Kigondu Simon is a consultant obstetrician Gynarcologist and the President of the Kenya Medical Association
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