Nation without doctors

On a cloudy morning at Ihiga community health dispensary in Murang’a county of central Kenya, James Njuguna, the resident nurse, is attending to an elderly patient. The door to his consulting room is slightly open, affording him a peek into the growing queue of patients sitting on the veranda bench that serves as the waiting room. The dispensary that began operations in 2017 and was constructed through community efforts, serves the neighbouring villages of Hura, Ngechu and Karindi, besides Ihiga. The estimated combined population of these villages is 8,000. Njuguna is the only health professional at the dispensary and is assisted by a health records clerk, a cleaner and a watchman.

To cope with the average 48 patients that he sees daily, Njuguna has had to teach his cleaner and watchman basic healthcare tasks such as weighing infants, taking temperature and dispensing prescribed drugs. “It is the only thing to do if I’m to be able to attend to all patients who seek treatment here,” he says in a most emphatic manner.

There is an acute shortage of health personnel in Africa. There are only 168 medical schools in the entire continent, with only one in 24 countries and none in 11 countries, as per a 2017 World Health Organization (WHO) report. Kenya is typically one of the African countries that suffers a shortage of health workers. While it may be doing better than many other African nations, Kenya still has a shortage of 42,800 workers, says the Cabinet Secretary for Health, Cecily Kariuki.

The situation at the Ihuga dispensary typifies health facilities across rural Kenya, and is worse in the more remote parts of the country. The shortage of health workers is more acute at the crucial levels of primary healthcare delivery, including nurses, community health workers and public health officers. These are identified by WHO as the frontline cadres in health sector and are responsible for delivery of preventative health services.

Kenya, according to Kariuki, has 63,000 health personnel. Of these, 21,000 are nurses, 3,200 clinical officers, 2,285 doctors and 1,100 pharmacists. The rest 35,000 are public health technicians, technologists, physiotherapists and records assistants, among others. The country has one doctor for 7,200 people, one clinical officer for 21,000 and one nurse for every 1,600. WHO recommends 23 health professionals for every 10,000 and to meet this ratio, Kenya needs over 0.1 million workers, says Kariuki.

According to the 2016 Kenya Health Workforce Project report, the country not only suffers shortage, but also serious disparities in distribution of health workers. The report found that the ratio of nurses per 10,000 Kenyans varied from as high as 9.7 for every 10,000 people in Nairobi to as low as 0.1 for every 10,000 in remote counties of northern Kenya. The disparity in doctors’ distribution is more pronounced because a majority of them are in urban areas. The ratio of doctors per 10,000 population ranged from as high of 9.5 per 10,000 in Nairobi to a low of 0.8 per 10,000 in the northern Kenya county of Mandera.

Faced with these grim statistics, Kenya has taken a few measures, at least at the national level, to address the problem. It recently “imported” 100 specialist doctors from Cuba. This was the first step in a programme meant to bridge medical officers’ gap in Kenya. The country brought in Cuban doctors and sent Kenyan medics for specialised training to the island country. According to Jeremiah Maina, national secretary of Clinical Nursing Society of Kenya, shortage of health workers in Kenya, especially the “frontline” cadres, can be blamed on low government investment in the health sector, low pay and the high cost of training.

For instance, Maina said, it costs US $10,000 to train as a nurse to degree level, an amount many people interested in enrolling in the programme cannot afford. Similarly, a diploma course in nursing costs $4,500, an amount not affordable to many. “For those parents who can afford, or the health workers who self-sponsor to study the degree course, the compensation in terms of salary is not adequate and they finally seek greener pastures in Europe and North America,” he told Down To Earth.

The government could also lower entry points for admission to the Kenya Medical Training College. The points currently stand almost the same as those for degree courses in universities, yet the college only offers three-year diploma courses, Maina says.

Alternatively, he notes, the government could continually train and upgrade community health workers and volunteers through workshops, seminars and short courses to equip them to offer specialised health services.

“The government must invest more in the right areas of health delivery system, in health promotion and prevention, including measures to ensure that more people are attracted to work in the health sector,” Maina says.

(This article was first published in the 1-15th December issue of Down To Earth. It is part of a series on healthcare in Africa. See previous articles in related stories).

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