KENYA MEDICAL ASSOCIATION’S (KMA) POSITION ON MEDICAL OFFICERS INTERNS EMPLOYMENT I. PREAMBLE The Kenya Medical Association (KMA) received a copy of a petition to the Minister for Health from its members who have been on internship. KMA is also aware of the contents of an “Offer of Employment” on a Ministry of Health letter head signed for the PS issued to each medical officer intern during the time of appointment dated 30th December 2005, stating additional terms of employment for these officers. We are also aware of a circular to all the Provincial Medical Officers and Medical Superintendents signed by the PS Ministry of Health stating that the current medical officer interns should be advised to exit the service to create room for the incoming ones. The immediate consequence to this is that the concerned doctors will have their salaries stopped and asked to vacate their stations as they wait for the positions of medical officers to be advertised. We at KMA fully support the petition by the medical officer interns and further wish to state the following: • The letter of offer of employment and the circular to the PMOs and Med Sups originates from the PS Ministry of Health who is not the employer of the said doctors. We therefore question the legitimacy of the additional terms of employment and therefore the purported sacking. • The action by the PS notwithstanding, KMA maintains that the services of these officers are required in the public health sector. • The supposed policy change seems to have been hurriedly done since it is now emerging that it was not discussed extensively and the key stakeholders were not consulted. • The implementation of this supposed policy has been carried out without any due regard to the implications to the concerned officers. This move is unfair and unjust given that it is unprecedented. II. ASSERTIONS BY THE MINISTRY OF HEALTH The Ministry of Health has put forward the following assertions: a) That there are enough medical officers in public health sector b) That the government can not afford to pay medical officers The following facts are arguments against these assertions a) There are enough medical officers in public health sector: • The Doctor to patient ratio is still over 1:20,000 assuming equitable distribution based on population. The recommended WHO ratio is 1:1000. • Distribution is skewed with majority of doctors being in Nairobi and a few larger towns. Given this fact, you find some instances where the ratio may be as high as 1:200,000 especially in the underserved areas. • This therefore means that the medical officers, let alone specialists, are not enough even if all the government was to absorb all the 5000 registered doctors into the public sector. b) The government can not afford to pay new medical officers • This is also not correct and there is need to prioritize the needs of the country. At independence, the founding fathers were out to eliminate Poverty, Ignorance and Disease. The government needs to do more in addressing the problem of disease. • The government should instead increase the allocation to the Ministry of Health to 15% of its total annual budget as per the Abuja Declaration. III CHALLENGES FACING THE HEALTH SECTOR a) The Disease Burden • The high burden of infectious diseases: HIV/AIDS, Malaria and Tuberculosis together with the increasing burden of chronic diseases including injuries related to road traffic accidents (RTA) • Though the prevalence of HIV is reported to be decreasing, new infections still occur and provision of treatment for the various types of opportunistic infections remains imperative. In addition, the government has an ambitious plan of rolling out an ARV program to cover the country. • Malaria is still the number one killer disease in Kenya, especially among children under five years and pregnant mothers. This has been worsened by the growing resistance to various anti-malarial drugs and now ACTs are being introduced. • TB incidence on the other hand is on the increase due to HIV and AIDS. This is coupled with the increase in resistance to the anti-TB therapy. These challenges will not be addressed without the government increasing the number of skilled personnel to tackle them. The most skilled personnel in the health sector are doctors whom the government is rendering jobless. b) Distribution of Doctors • There are slightly over 5000 doctors (including all types of specialists) registered by the MP&DB • Over half are in the urban areas mainly in private practice and the few public hospitals in these urban areas. • Those in government employment are less than 1500 distributed over the national referral, provincial, district and sub-district hospitals country wide. • The majority of the sick and needy members of our population are found in the rural areas where they have no access to doctors. They therefore resort to obtaining health care services from all manner of practitioners including quacks. KMA will support the Ministry if it comes up with a policy that will ensure equitable distribution of doctors to reach the underserved populations. KMA is therefore strongly opposed to the intended release of Medical Officer Interns after 31st December 2006. We support this position for the reasons that: • There will be a gap left by these interns since the process for recruiting the medical officers as stated by the Ministry’s Permanent Secretary has not started • The new interns from the University of Nairobi and Moi University, who will take up the vacancies left behind, have not yet been released for internship • Some of the medical officers working in various government health facilities are moving on for postgraduate training or to other sectors, creating more vacancies that are unfilled. • If this process is not handled with care and diligence, it will worsen the already bad situation of doctors moving out of the country. IV WAY FORWARD KMA therefore wishes to state as follow: • The medical officer Interns should be cleared as usual by the various internship hospitals/centres • Once cleared, they should be retained in their stations as they await the newly graduated interns. • Once replaced, they should be posted to the needy areas as has been happening before. • Any departure from this should be discussed by all stakeholders that include KMA and MP&DB among others. Dr. Stephen Ochiel Hon. National Chairman __________________ Dr. Samson K. Ndege Hon. National Secretary __________________