DN article

​The Daily Nation is today exposing the insincerity, backtracking and outright arm-twisting that have been blamed for the long-drawn doctors’s strike that enters the second month this week.

In doing so, it hopes that the parties to the dispute — the doctors and the government — will come to their senses and end the suffering of hundreds of thousands of Kenyans who have gone without medical care since the beginning of December last year.

Our report is based on two things: a secret return-to-work formula drawn by the doctors’ union on January 28 this year, and which was to be signed between them and the national and county governments as a way to end the strike; and the negotiators’ inflexibility.

Dr Mailu, the soft-spoken geneticist who became CS Health in January last year, now finds himself fighting the biggest battle of his life yet. Apart from the loss of lives, a lot is at stake for his ministry, such as medical training that is hosted in referral hospitals, and collection of data for disease surveillance.

The four-page document, which we obtained from an official of the union, has glaring irregularities that were either honest mistakes or deliberately aimed at hoodwinking the government to pay more than was actually captured in the agreement.

The Ministry of Health late last month refused to sign the document, to the chagrin of the striking doctors.

To begin with, the 15-point agreement states that all medical practitioners, pharmacists, and dental officers, including specialists in the public service, shall be moved one job group higher effective July 2016.

A table in the appendix of this agreement quotes job group ‘M’ as earning a minimum basic salary of Sh54,532 and a maximum of Sh68,165. At this group, medical interns will also get a house allowance of Sh28,000, a doctor’s allowance of Sh72,000, a commuter allowance of Sh8,000, and a non-practice allowance of Sh19,000. The take-home package for interns in the pay structure proposed by the doctors’ union totals to about Sh221,000, inclusive of risk and extraneous allowances.

But the salary of job group ‘M’ as stipulated in government records is different from what the doctors are demanding. The minimum basic salary is fixed at Sh44,989 and a maximum of Sh56,236. The house allowance is Sh28,000, the doctors allowance is Sh66,000, a commuter allowance of Sh6,000, and a non-practice allowance of Sh12,000. When the risk and extraneous allowances are tallied, the intern’s take-home is Sh196,989.

These are consistent with what the Salaries and Remuneration Commission (SRC) provided on December 6, 2016 as the salary structure for public officers.

What the doctors are asking for, therefore, is Sh24,543 more than what is provided for, for job group ‘M’.

CLOSE SCRUTINY

A close scrutiny of the document shows that the benefits of job group ‘M’ have been replaced with figures from ‘N’, and from there the inconsistencies cascade all the way to ‘T’.

Further scrutiny in the appendix shows that doctors have also created a new job group ‘T’ which does not exist in any available government pay structure.

Surprisingly, at this job group — which is the pay scale for specialists — doctors are asking for a minimum basic salary of Sh192,060 and a maximum of Sh302,980, a difference of Sh110,920, which is the highest margin across all job groups in the country.

What is even more suspicious is that a specialist junior, in job group ‘S’, will take home a minimum salary of Sh221,058, which is Sh28,998 more than their seniors.

And there is more. The agreement states that the entry level for medical interns shall be ‘C5’ effective July 1, 2017, despite earlier documents placing interns at ‘M’.

If interns are paid on ‘C5’ terms, their minimum salary will move from Sh54,532 to Sh64,919 and a maximum of Sh81,148, which are the SRC guidelines.

When asked to explain these inconsistencies, a source within the union was lost for words and offered to send us another document with “better edits”.

As a result of these inconsistencies, the Ministry of Health has started questioning the mandate of the negotiating team, asking whether it has the clout to reach any agreement on behalf of doctors.

Health Cabinet Secretary Cleopa Mailu, who was not available for comment on the new document, has previously said that the doctors have “constantly changed” their decisions, adding that “when a union agrees to a position and changes in the next minute, it becomes very difficult to negotiate and reach an agreement”.

But the doctors say they walked out of the last meeting because the government “gave them a new Collective Bargaining Agreement” and not what they had agreed to earlier.

BACK-AND-FORTH GAME

As the back-and-forth game plays out, the strike — and all the passionate discussions around it — has taken a life of its own.

The abhorrence against it has moved from the plight of patients to political undertones, such as politicians waiting for an opportune time to play the God syndrome for campaign mileage.

So testy has the subject become that even those authorised to speak on behalf of those directly affected by the strike want anonymity when talking to the press as they claim to have insider information on who does not want the strike solved, and why.

Dr Mailu, the soft-spoken geneticist who became CS Health in January last year, now finds himself fighting the biggest battle of his life yet. Apart from the loss of lives, a lot is at stake for his ministry, such as medical training that is hosted in referral hospitals, and collection of data for disease surveillance.

Initially, at the centre of all the hubris was a document that the doctors wanted registered and the demands therein fulfilled: the collective bargaining agreement between them and the government, signed in 2013.

In it, doctors asked for, among many other things, salary increments that range from as low as 75 per cent to as high as 180 per cent, facilitation for post-graduate studies, better working conditions, and better relations with their employers.

And they have a reason to ask for better terms. Data from the Ministry of Health shows that there were only 9,734 registered doctors to attend to the 44-million-plus Kenyans as at 2015.

Not all of these practise, but assuming they do, that would mean every doctor takes care of about 4,500 people, against the WHO recommended ratio of 1:600. A Kenyan doctor, therefore, carries out the duties of eight professionals in countries that have met the recommended threshold.

SENATE COMPLICATED MATTERS

Last week, the Senate complicated matters even more when it asked doctors to stop insisting on a salary agreement that has already been declared illegal by the courts.

The Senate Health Committee observed that the CBA the doctors are pushing for has been overtaken by events and will derail efforts to end the strike.

“They can’t hang on an illegal document,” said the committee chairman Dr Wilfred Machage. “Nobody has prevented doctors from coming up with another legal document.”

The Labour Relations Act requires that such agreements be registered with the Industrial Court, something that had not been done by either the government or the Kenya Medical Practitioners and Dentists Union (KMPDU) when they entered into the agreement in 2013.

And, in its strike notice to the Head of Public Service, Mr Joseph Kinyua, the union stated that it wanted the CBA “signed on June 27, 2013 registered and implemented”.

It is, however, an offence to implement a CBA before it is registered by the Industrial Court, but once registered it binds parties to comply with the commitments therein.

And so goes the story of Kenya’s worst industrial dispute in recent history. The doctors are hanging on the promises of a document that the Executive, the Legislature and the Judiciary say is illegal, but they insist that a promise is a promise, and it should be kept.

While there was hope at the start of the strike two months ago, there is none now. Only despair, death, and a growing thick skin.

Additional reporting by Verah Okeyo

***

That is what we can afford. But if you tell me that we pay doctors because they have gone on strike, and if we pay everyone who goes on strike what they demand, then we can’t go on living in this country. It is our duty to inform striking personnel that our economy can only afford this. Henry Rotich, Treasury Cabinet Secretary, on why striking doctors should accept the 40 per cent pay rise offered to them by government

***

We hope government agrees to mediation. We want the process to be open, in front of the press, so that the public can get to know what is happening. Dr Ouma Oluga, Kenya Medical Practictioners, Pharmacists and Dentists Union Secretary-General

***

When a union agrees to a position and changes in the next minute, it becomes very difficult to negotiate and reach an agreement and that is what we have been subjected to as a ministry… as a government… for the last 52 days. Health Cabinet Secretary Cleopa Mailu on why the doctors strike has dragged on for over 50 days.

***

The ongoing doctors’ strike is a very unfortunate occurrence. The government is prepared to sit with doctors to resolve the matter before the year’s (2016) end. Eric Kiraithe, Government Spokesman, adding that the union was offered a good package but refused it.

***

This is beyond the ability of any single ministry in the national or county government to handle effectively. How can the government import doctors if they cannot pay their own? Prof Lukoye Atwoli, Kenya Medical Association secretary, in an appeal to the World Health Organisation and the International Labour Organisation to help end strike.

***

Our striking doctors need to consider the package the government is offering them. Our neighbouring countries pay much less than the salaries our medics are currently receiving. Peter Munya, Council of Governors chairman, after asking county bosses to issue sacking letters to striking doctors if they fail to resume work.

***

A timeline of death, pain, and despair

November 2016

November 18: Doctors meet with Ministry of Health to avert looming strike, set for December 5, 2016.

Nov 30: CS Mailu urges doctors to drop strike threat, seeks dialogue, but doctors announce nationwide strike demanding the recognition, registration and implementation of the 2013 Collective Bargaining Agreement.

***

December 2016

Dec 2: Court stops doctors’, nurses’ strike following a case filed by the Council of Governors.

Dec 4: Doctors start strike in defiance of court order, colleagues from coast asked to travel to Nairobi for demos.

Dec 5: Poor patients suffer as health workers’ strike begins, affecting 2,700 public health facilities, forcing families to transfer ailing kin to private hospitals; polio vaccination drive postponed, CS Mailu urges medics to resume work as negotiations continue.

Strike enters fifth day, doctors’ strike gets worse as KNH consultants down tools.

Dec 9: KDF doctors step in to handle emergency cases at KNH, counties announce plans to hire temporary medical staff to alleviate suffering, leaders as government to revert health services to national management, State says it is displeased with protracted talks.

Dec 10: Governors fault government for signing 2013 CBA with doctors

Dec 11: Strike by nurses called off after the Ministry of Health and the union sign a Sh7 billion agreement as doctors union says it will evaluate government’s offer.

Dec 14: Nurses union officially calls off strike and signs pact with governors.

Dec 20: Medical associations call on international organisations to help end doctors’ strike, union officials found guilty of disobeying Labour Court order

Dec 22: As striking doctors fear the government might sack them to force them to resume work, resident doctors at Aga Khan Hospital show support for striking counterparts

Dec 27: Counties announce they will not pay the thousands of doctors their December salaries

Dec 28: National government challenged to take over the responsibility of paying salaries of the striking doctors from the counties, Bomet Governor Isaac Ruto, accompanied by a group of rowdy youth, storm a doctor’s union meeting at Fair Hill Hotel and allegedly rough up the officials, bringing the meeting to disarray.

***

January 2017

Jan 3: Seven counties withhold December salaries of more than 300 striking doctors

Jan 4: President Uhuru Kenyatta meets doctors in Mombasa over strike at State House, offers a 40 per cent pay rise.

Jan 6: Doctors meet to assess State’s pay deal but reject the offer and maintain they only want the 2013 CBA.

Jan 8: State House trashes CBA, calls doctors for negotiations even as the health sector crisis deepens, doctors and ministers exchange barbs.

Jan 10: Doctors warm up for a bruising legal battle with the government after a court orders arrest of union officials for contempt of court, Nairobi County government threatens to sack striking doctors if they do not return to work.

Jan 11: Police fail to arrest Kenya Medical Practitioners’, Pharmacists’ and Dentists’ Union officials as ordered by a court.

***

Jan 12: Council of Governors (CoG) chairman Peter Munya urges county bosses to issue sacking letters to striking doctors if they fail to resume work, the Employment and Labour Relations Court sentences six officials of the doctors’ union to a one-month suspended sentence on condition that they continue with negotiations with government to end strike.

Jan 13: Ministry of Health announces raft of measures to cushion desperate Kenyans from the impact of the doctors’ strike, including partnering with faith-based hospitals, Health CS Cleopa Mailu directs that medicines in public health facilities be redistributed to faith-based hospitals, government in a paid advert appears to revise its offer to doctors to end their strike by extending the time for resolving labour issues from 60 to 90 days.

Jan 14: Kenyans says they have resorted to nursing the sick at home as strike enters 42nd day.

Jan 15: Senators say President Uhuru Kenyatta and governors to blame for deaths due to doctors’ strike.

***

Jan 16: The Archbishop of the Anglican Church of Kenya, Jackson ole Sapit, calls on doctors to call off their strike to save the country from witnessing more deaths and agony.

***

Jan 17: The end of strike seems imminent following talks between the government and the medical practitioners’ union in Nairobi, clinical officers also demand a pay increase and issue a one-week strike notice.

Jan 19: Doctors take to Twitter in a bid to explain why they will not budge and why they refused a 40-per cent pay rise offer, medical students demonstrate and urge government to meet demands of doctors, medics talks continue as doctors’ strike enters 46th day.

***

Jan 22: As medics away from the hospital, clinical officers forced to take on extra work.

Jan 23: Government announces nearly 4,000 dismissal letters to be issued to striking doctors.

Jan 24: Doctors, through their union officials, move to the Employment and Labour Relations Court seeking an extension of the negotiation period with the Ministry of Health.

Jan 25: Fresh bid to end doctors’ strike collapses as CS Mailu accuses union leaders of indecision.

Jan 26: The Labour Court extends the suspension of a jail sentence it granted doctors’ union officials on the condition that they end their job boycott in five days, county governments begin the process of firing doctors who are on strike as Council of Governors Chairman Peter Munya explains that the termination process started as soon as the dismissal letters were issued to the doctors, nurses threaten to go on strike again on February 1 because their pay slips do not reflect the allowances their employers promised late last year.

Jan 29: Council of Governors Chairman Peter Munya tells nurses not to boycott work again as counties are processing their allowances.

Jan 30: Governors say they will henceforth hire doctors on three-year renewable contract as opposed to the current permanent work terms.

Jan 31: The National Assembly is prompted into joining the Executive and the Judiciary in seeking an end to the strike after the doctors’ union submits their petition to the House.

***

Medics take war to Twitter, share sad stories from in-the-red wards

By the time the doctors’ strike comes to an end, whether the doctors get their demands or not, their voices will remain etched in history.

Their voices and words, like digital footprints, will forever be etched on social networking sites, where in their numbers they have aired, shared and re-shared their grievances. They have in unison explained why they will not be going to work unless drastic changes are seen not only on their pay slips, but also in their work environments.

Their rallying call throughout the strike has been the hashtag #LipaKamaTender, through which they have kept asking the government to pay them as quickly and easily as a tender is handled in government projects.

But there have been more hashtags in the past two months, such as #MyBadDoctorExperience, through which medics recounted experiences of being forced to work without drugs, gloves or electricity, and under severe staff shortages that left many on the verge of collapse.

One Twitter user, a doctor identified as Anthony, told of how he had to light up the theatre after lights went out in the middle of a Caesarean section. “The back-up generator was out of fuel. We ended up using a Nokia phone flashlight (as the) torch available had expired batteries.”

“Waiting all day to perform an emergency surgery because there are few theatre rooms and multiple emergencies in wait,” said Joyce Omuok.

“Got pricked in casualty, patient HIV+, no post-exposure prophylaxis (PEP). Had to travel to Nairobi at 1am to get it,” narrated Nasirumbi Magero.

Then the stories got serious and ridiculous.

“Watching a patient die because the ambulance had been given to the MCA to pick his tomatoes from market,” wrote Jeff Kims.

“My bad doctor experience is transporting an intensive care unit (ICU) patient from Garissa to Kenyatta National Hospital (KNH) by road. They (sic) died at Thika,” tweeted one doctor, who only identified herself as Njeri.

“Consoling a mother who lost her baby because the only available anaesthetist was in main theatre with another patient,” wrote Wambugu Justus.

While Beldina Gikundi shared how she had to donate her own blood for a bleeding mother because there was no blood in the hospital’s blood bank.

Robert Simiyu could not administer an emergency drug to a patient because “syringes were out of stock.”

Wambui Munjua shared: “Watching the nutritionist mix cow milk with water as hospital could not afford formula for the babies in the nursery.”

“Losing an eight-year-old girl to leukemia because there was no blood or ambulance,” a user only identified as Munyoki tweeted.

But there have been divergent voices, counter-narratives, who questioned the doctors “calling”, hard stance to negotiate, why they are not bounded by the Hippocratic Oath, accept the government offer and go back to work.

But even then, the doctors have not backed down from their Twitter accounts.

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