1. Executive Summary
I do not support the Bill in its current form.
Kenya Healthcare Professional Oversight Authority (KHPOA) should take up regulation of the proposed cadres. After all KHPOA has recently decided that is their role.
While the intention to strengthen regulation across health professions is acknowledged, the proposed amendments:
* Lack a clearly defined policy problem
* Risk compromising patient safety
* Promote unsafe scope expansion (scope creep)
* Create false equivalence between cadres with vastly different training
* Fail to address quality of training and supervision gaps
International experience—particularly from South Africa—demonstrates that such regulatory consolidation leads to confusion, inefficiency, and weakened clinical governance.
2. The Central Policy Question: What Problem Is Being Solved?
Effective legislation must be grounded in a clearly defined problem.
The Bill:
* Does not identify failures in the current Medical Practitioners and Dentists Act
* Does not present evidence of regulatory gaps affecting patient outcomes
* Does not justify merging multiple cadres under one regulatory framework
My Position:
This reform appears to be structural without being problem-driven, risking unintended consequences.
3. Core Concern: Patient Safety and Quality of Care
3.1 Differences in Training and Competence
Medical doctors:
* Undergraduate training: 5–6 years degree + internship + postgraduate specialization (optional)
Proposed additional cadres:
* Predominantly diploma-level training
* Limited diagnostic and clinical decision-making exposure
These differences are not merely academic— they directly affect patient outcomes.
3.2 Risk of Scope Creep
By placing:
* Community Oral Health Officers
* Dental Technologists
* Optometrists
under the same regulator as doctors and dentists, the Bill:
* Encourages progressive expansion of scope without matching training
* Creates pressure for independent practice
This is a well-documented trajectory in health systems globally.
4. Undermining the Supervision Model
Kenya’s healthcare system is designed as a team-based model with clear leadership:
* Doctors → diagnosis, clinical leadership, complex care
* Dentists → specialized oral health care
* Mid-level cadres → support roles under supervision
The Bill:
* Does not reinforce supervision requirements
* Creates regulatory parity that weakens hierarchical accountability
The Rresult:
Supervision becomes nominal, especially in resource-limited settings.
5. Public Misperception and False Equivalence
Regulatory structures communicate professional status to the public.
Placing all cadres under a single council:
* Creates perceived equivalence in competence
* Confuses patients about who is qualified to provide what level of care
This is particularly dangerous in:
* Rural settings
* Low-health-literacy populations
6. African Comparative Experience
🇿🇦 South Africa (HPCSA Model) – Key Lessons
South Africa regulates multiple cadres under the Health Professions Council of South Africa (HPCSA).
Observed Challenges:
1. Scope Creep
* Clinical associates introduced as support staff
* Increasing pressure for independent practice and prescribing rights
2. Weak Supervision
In rural areas, mid-level cadres often practice without effective oversight
3. Public Confusion
* Patients struggle to distinguish between cadres
* Leads to misplaced trust and delayed escalation of care
4. Regulatory Overload
HPCSA faces:
* Licensing delays
* Disciplinary backlogs
* Administrative inefficiencies
5. Internal Conflict
Different professional boards competing over scope and authority
6. Two-Tier Healthcare System
* Doctor-led care (urban/private)
* Mid-level-led care (rural/public)
The result:
Entrenchment of inequity—different standards of care for different populations
🇬🇭 Ghana
Separate regulatory bodies for:
* Medical and dental practitioners
* Allied health professionals
Outcome:
Clear role definitions and less scope conflict
🇳🇬 Nigeria
Distinct councils:
* Medical and Dental Council of Nigeria (MDCN)
* Separate boards for other cadres
👉 Outcome:
Maintains professional clarity and accountability
🇷🇼 Rwanda
Integrated frameworks exist but with strict scope definition and supervision enforcement
My key takeaway:
Integration without strict scope control leads to system instability.
7. Risk of Entrenching Inequality in Healthcare
The Bill risks formalizing a system where:
* Wealthier populations access doctor-led care
* Lower-income populations receive mid-level-led care
This creates:
“Two standards of medicine within one country”
I strongly opposes any policy direction that institutionalizes “poor care for the poor.”
8. Governance and Policy Integrity Concerns
Legislation must be:
* Evidence-based
* Patient-centered
* Free from perceived or actual conflict of interest
I note that:
* The Bill closely aligns with the interests of specific cadres
* There is insufficient demonstration of broad stakeholder consensus
Parliament must ensure:
* Neutral, system-wide policy formulation
* Avoidance of profession-driven legislative capture
9. My Recommendations
I proposes the following:
1. Maintain Distinct Regulatory Frameworks
* Preserve specialized councils for different cadres
* Strengthen coordination rather than merging structures
2. Strengthen Supervision Laws
Explicit legal requirement for:
* Doctor-led supervision
* Defined delegation frameworks
3. Standardize Training Quality
* National benchmarks for all training institutions
* Independent accreditation mechanisms
4. Define and Protect Scope of Practice
* Clear legal boundaries for each cadre
* Enforcement mechanisms for violations
5. Patient-Centered Reform
* Focus on:
* Quality of care
* Clinical outcomes
* Safety standards
— not administrative restructuring alone
10. Conclusion
The Medical Practitioners and Dentists (Amendment) Bill, 2026:
* Blurs critical distinctions in training and competence
* Encourages unsafe scope expansion
* Weakens supervision structures
* Risks misleading the public
* Lacks a clearly defined policy justification
11. My Position
I respectfully call upon Parliament to:
* Reject the Bill in its current form,
OR
* Subject it to substantial amendments following stakeholder consultation
12. Closing
Healthcare regulation must protect patients first. Any law that blurs competence, weakens supervision, or lowers standards risks institutionalizing inequality in care. Kenya must not adopt a system where the quality of care depends on who you are or where you live.
Download the full bill on:
https://drive.google.com/…/1Tqzx5bdwDqrrgdZjJJP…/view…
Dr Simon Kigondu is an obstetrician gynaecologist at Excella Healthcare and a commentator on Health Policy.