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Why health professionals exodus curve is not likely to flatten soon

By Steve Umidha
Tuesday, April 20th, 2021
Moderna Covid-19 vaccine has 94 per cent efficacy. Photo/Courtesy
In summary
    • The number of nurses moving to, for instance, UK has been rising steadily in the last decade, making Kenyan nurses the vast majority of those signing up in most of that country’s health facilities.
    • Public healthcare workers in Kenya often work in conditions where they are overloaded and under-resourced, with inadequate remuneration and opportunities for growth.
    • The 2020/21 budget allocation increased by 10.3 per cent compared to the 2019/20 second supplementary budget for 2020 – about Sh1. 59 billion which was lower than the pre-Covid-19 pandemic health budget, which stood at Sh115 billion.
    • At least once in two years the health sector is faced with nurses’ strike mainly as a result of lack of follow up and commitment by the government to implement never-ending negotiations on Collective Bargaining Agreements (CBAs).

Steve Umidha @Umidha

Kenya is experiencing a massive brain drain as medical professionals migrate to foreign countries due to low wages, lack of opportunities and poor working conditions.

The number of nurses moving to, for instance, UK has been rising steadily in the last decade, making Kenyan nurses the vast majority of those signing up in most of Britain’s health facilities.

Also caught up in the mix are doctors who opt out on account of better salaries elsewhere.

It is estimated that surgeons in New Jersey earn on average $216,000 (Sh23.32 million) annually, while their counterparts in Zambia make $24,000 (Sh2.59 million). Kenyan doctors earn on average $6,000 (Sh647,520) per annum.

Compared to the cost of producing a doctor which according to BMC Health Services Research, it comes $65,997 (Sh7.12 million).

The report says tertiary education of a single doctor is approximately $48,169 (Sh5.19 million) while the total cost of secondary education per student is $6,865 (Sh740,870) and that for primary education $10,963 (Sh1.18 million).

It means that for every doctor who opts out, the country loses in excess of Sh7 million, over the years and many have left the country for greener pastures.

But questions abound, that despite a whopping Sh114 billion allocation to the national health budget, the government has failed to prioritise the sector. Worse still, the sector is often rocked by scandals.

The 2020/21 budget allocation increased by 10.3 per cent compared to the 2019/20 second supplementary budget for 2020 – about Sh1. 59 billion which was lower than the pre-Covid-19 pandemic health budget, which stood at Sh115 billion.

At least once in two years the health sector is faced with nurses’ strike mainly as a result of lack of follow up and commitment by the government to implement never-ending negotiations on collective bargaining agreements (CBAs), also aimed at improving medics working conditions and pay.

“Investing in health care has not been a priority for the government. If you fall ill in Kenya you may have no choice but to spend your savings and ask your friends and relatives for money, just to pay the hospital bill,” Elizabeth Gitau, chief executive of Kenya Medical Association, an organisation representing medical practitioners said in a recent interview with Deutsche Welle.

Between 2010 and 2016, there were six nationwide health workers’ strikes across major counties in the country.

But the pain is also in terms of the amount of money that the government invests in medical professionals which is among the highest in training a single Kenyan.

A report by the World Health Organisation rated Kenya, along with 26 other African countries, as having made “insufficient progress” in the last decade in achieving the declaration’s goals.

Struggling health system

As a result of the country’s struggling health system, poor remuneration to nurses, a number of them, especially those in practice, are expected to continue  migrating, according to Stephanie Rose, an International Officer for East Africa Region UCLAN (University of Central Lancashire).

“We are seeing a growing number of nursing students and those practicing moving about to seek better opportunities and this is also being driven by an alarming nursing shortage in the UK,” she says.

An acute shortage of trained nurses in the UK, she adds, has occurred because of several factors including ageing of the nurse population and increasing demand as well as under- investment in nurse education during 1980s.

“Most of those nurses who pass through us tend to remain in the UK for such reasons and we have seen a host of hospitals and nursing facilities in the UK retaining a good number of Kenyan nurses,” Rose says.

It is estimated that the number of registered nurses in the UK dropped by 96 per cent between 2015 and 2017.

As a result, UK employers are offering favourable incentives to attract international registered nurses to fill these positions.

“We have seen an increasing appetite from nursing students willing to further their nursing careers in the UK and that number has been consistent in the last five years.

We are forecasting that the momentum will carry on,” says Omar Mohamed, the Country manager for SI-UK Kenya.

Another reason is the recent changes in Post-study work opportunities in the UK. From July 1, 2021, international students who have successfully completed an undergraduate or master’s degree will be able to benefit from two years’ work experience in the UK upon graduation, through the new Graduate Route.

The new graduate route means that any eligible student who graduates after this date will be able to apply for the route. This includes students who have already started their courses.

It is estimated that from 1999 to 2010, 23,350 students enrolled in nurse training in Kenya. While annual new student enrolment doubled between 1999 (1,493) and 2010 (3,030), training institutions reported challenges in their capacity to accommodate the increased numbers.

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