Health Workforce and the Universal Health Coverage in Kenya

Dr. Oluga delivered this speech at a UHC conference in 2019. It remains relevant today.

‘Good Morning,

Thank you for the invite and the honour to speak to you. I’m deeply humbled.

Kenya has undergone several challenges as pertains HRH. Several strikes are still fresh in our minds. The National Government, Counties, Mission hospitals and even the private sector are yet to find the perfect HRH match for the health systems that they run. As a fact, the one area even private sector cannot boast to be doing better than government is in the management of HRH. The recent cases of Hospitals with Quacks is just but a tip of the iceberg of how trying to cut costs has landed and may continue to land some patients in harm’s way in private hospitals. Public facilities aren’t doing any better. And so are mission hospitals. The many of them.

And so let me highlight just three things that are practical and are important about HRH. These three aren’t complex text book and research publications but ultimately are the guiding truths for HRH.

  1. Health Workforce will never treat patients better than they themselves are treated by the health system. An academician studying the National Health Service in the UK concluded that how patients were treated reflected accurately with how health workers were treated. Think about this deeply. Then think about it again. The take home here is this. It does not matter what you call UHC. What patients remember is the interaction between them and the health workers. If it is bad, your UHC is bad. If that interaction is good then your UHC is a success. That interaction is a reflection of your own interaction with the health workers as managers or employers. The reality is that health workers do not feel critical. They feel unimportant.

  2. UHC campaigns or programs are political. And so they drive demand for health services upwards. In the pilot counties, hospital visits have doubled and some tripped. You cannot meet this demand with the same HRH numbers, same HRH attitudes, same HRH organization and same HRH skills. The tragedy with our UHC models and even the pilot is that health workers were left out completely. Yet they ought to have been the ambassadors. And beyond being sidelined, they bare the brunt of burn out trying to attend to increased numbers with even less support and less motivation. Kindly Match Demand for services with Supply of Health Workers. Both Health Workforce numbers and Health Workforce skills. The index on package of services offered falls directly on the numbers and the skills. And on this I have an important point to make. We cannot be gearing towards UHC when we are not employing doctors and training doctors. The same goes for all categories of health workers. Many people have successfully campaigned for community health workers. And many counties have initiated community health strategies that have driven more and more sick people from home to hospitals. Please match up the demand by employing more doctors and training them with skills that are required for the complexity of the diseases. Let us do what the rest of the successful world has done. If cancer is treated by cancer specialists, let us train and employ cancer specialists to treat cancer. There are no short cuts to quality of professionals. You can’t keep importing. It’s not sustainable. You can’t substitute, it gives you a different quality. Often poorer. And we have lots of evidence in our healthcare system where we prefer to spend Kshs 10 Billion per year to take patients to India rather than train and employ our own doctors and spend 2 Billion per year.

  3. Lastly, health workers aren’t the only thing a health system needs to work efficiently and deliver the services demanded by citizens. Processes, infrastructure, objects (commodities and supplies – drugs, gloves, catheters, etc) are important. In fact, without these the work of doctors and nurses become a burden to them more than even to patients. And they get injured morally when they observe children die because of lack of basic necessities or when they have to choose between transfusing blood to a bleeding mother over a sickle cell teenager. These are difficult choices that injure the soul and once the soul is so injured, it begins to lose empathy. Talking about processes, let health workers do the work for which they are trained. In many hospitals, processes are so broken that a doctor spends 70% of his or her time chasing after a lab result or an X-ray or some other thing that even though is very important for the patient care delivery, spending time doing it is merely a distraction from his or her core professional work. Let’s make processes work within the health system. This is the duty of administrators and politicians. And when processes fail, it is not health workers that have failed. It is the managers.

UHC is achievable but not without a proper roadmap for planning and managing Human Resources for Health.’

Dr. Ouma Oluga, OGW


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