In a recently leaked Cabinet memo, the Ministry of Health signaled its plans to initiate and put in place restrictions to deter unemployed medics from seeking employment opportunities abroad. The major reason cited by the ministry for this approach is the shortage of health workers in the country. The core objective of the policy is to regulate the health sector and ensure that the country’s health system is not destabilized by the cross-border movement of Kenyan doctors.
The yet to be validated policy would result in the passage of regulations that would see the health workers seeking to leave the country for employment opportunities abroad seek the approval of the Ministry of Health. The approval, in the form of a special clearance, would be the only way out for medical doctors and by extension other health workers, if and when they desire to seek employment opportunities outside the country.
This proposal has been vehemently opposed by health workers unions, which have read malice in the intentions of the government with such policies. The umbrella bodies have reiterated that they will work round the clock to protect the interests and welfare of their colleagues. In what is likely to be a long-drawn battle between health workers and the government again, we take an analytical look into the plausibility of the proposed policy.
Health personnel shortage
It is not in doubt that the country currently faces a shortage in its healthcare workforce. A World Health Organization (WHO) study “The health workforce status in the WHO African Region: findings of a cross-sectional study”, published by the British Medical Journal Global Health, revealed the true status of healthcare workforce in Kenya.
The study that was conducted in 47 countries found out that the African continent has a ratio of 1.55 health workers i.e., physicians, nurses and midwives per 1,000 people. Analytically, this was found to be below the WHO recommended threshold of 4.45 workers per 1,000 people, being the requisite for delivery of essential health services and realization of universal health coverage.
Kenya’s situation, based on this index, has a ratio of 13.8 health workers per a population of 10,000. This position is buttressed by the 2022 Policy Brief on Human Resources for Health by the Ministry of Health. The Brief further cited that Kenya has a shortage gap of 3,238 medical officers, with the required number being at least 5,317. There is also a deficit of 2,313 consultants, 1,070 dentists, 4,614 public health officers, 1,020 pharmacists, 4,167 pharmaceutical technologists, 3,970 specialist clinical officers and 9,301 general clinical officers. Other areas with human resources gaps include the cadres of nursing staff that stand at 38,548. Lab technicians and technologists’ deficit stand at 13,309, community health workers at 19,294 and at least 72,000 for other health cadres.
Assessing the plausibility of the proposed policy
Against the backdrop of the above statistics, its brazenly clear that the proposed policy reeks of a knee-jerk reaction. Simply put, the government is unable to assure healthcare workers of employment but wants to control them from seeking employment. Rather than coming up with such a policy under the guise of forestalling destabilization of the country’s healthcare system, the government ought to go to the root of the problem and address it from there.
Kenyan health workers are seeking employment due to the systemic issues around policy dissonance regarding employment. If and when the government addresses these issues around recruitment, payment, working environment, retention and continuous professional development programmes for the Kenyan health worker, then they would feel safe to patriotically serve their country.
Nonetheless, and from a legal standpoint, the policy will be a violation of the rights of health workers. Under contract law, the principle of Freedom of Contract allows one to enter into binding contracts, with preference to the terms, and with protection from interference by third parties. More fundamentally, Articles 39 (1) and (2) of the Constitution of Kenya provide that every person has the right to freedom of movement and the right to leave Kenya.
One cannot fault the proper intentions of the ministry to protect the country’s health care human resource, but the same has to be done in a legal and factual manner. If the ministry addresses the issues bedeviling the healthcare sector, then such policies would be sensible, if applied in the right form and manner, but as things stand, this policy is more of an insult to an already existing injury.
