The inaugural Health Workforce Conference 2022 was a major milestone towards realization of health care reforms aimed at strengthening technical and soft skill competencies. The conference whose theme was ‘Repositioning today’s health workforce for the future’ focused on strengthening the technical and soft skill competencies and enhancing the global competitiveness and future job readiness of health professionals. It also focused on ensuring adequate response to the Country’s changing healthcare needs and strengthening capability and technical support from health professionals for the Universal Health Coverage (UHC) agenda.

KMPDC played a key role as the secretariat to the conference with its Chair Dr Eva Njenga serving as the conference Co-Chair and CEO Daniel Yumbya as the head of the Secretariat. The conference which ran from the 7th to 9th of February 2022 attracted over 1,000 local and international delegates. After three-days of deliberations, the following resolutions which are expected bring transformative change to the health sector were made:

• The need to revise curricular of training the health workforce with a view to enrich it with skills based training and other competencies including specialist training to enhance patient centered care.

• Better harmonization in training amongst training institutions and promotion of affordable training through establishment of a training fund and medical education fund for teaching hospitals to fund trainees.

• Development of a comprehensive integrated health workforce information system and institutionalization of HRH tools such as Workload Indicators of Staffing Need (WISN) and Health Labour Market Analysis (HLMA). This will enable evidence decision making so as to effectively manage the human resource for health labour market.

• Streamlining the supply and demand of health workforce in the labour market for quality healthcare through guidelines on absorption, specialist training, retention of medical graduates and migration of health workers.

• The need for collaboration between universities and tertiary hospitals which are uniquely placed to support and prioritize research and implement research findings to improve patient outcomes.

• Development of a regulatory framework and standards to guide task sharing and common learner based curricular.

• Standardization and harmonization of scopes of practice for all cadres of health workers to match health professional competencies aligned to career progression pathways.

To ensure implementation of the conference resolutions, it was recommended that a Standing Implementation Oversight Committee (SIOC) be established.

Kenya Medical Practitioners and Dentists Council has developed the first ever scope of practice for general specialist and sub-specialist medical practitioners: general specialist and sub-specialist dental practitioners and diploma community oral health officers practicing. The new policy was adopted during the 132nd Full Council Meeting held on the Friday 25th March, 2022.

Application of the scope of practice is an important milestone in ensuring provision of quality healthcare. The scopes of practice provide the procedures, actions and processes that a medical/dental and community oral health officers is lawfully permitted to undertake in the course of discharging their duties. According to Dr Margret Mbugua the KMPDC Director, Standards and Professional Practice the scope of practice will also enhance the governments agenda towards the achievement of Universal Health Coverage one of the major developmental pillars of the country.

The general expectations of all medical practitioners as per the guidelines include: the need to take appropriate and adequate clinical history, undertake appropriate physical examination, ensure accurate and up to date documentation in a manner that facilitates continued and safe patient care and advocate effectively for patients among others.

By providing these guidelines the scopes among other benefits works to protect practitioners from taking actions that may result in concerns of medical malpractice Development of the scope of practice was done through an inclusive and consultative process. Various healthcare stakeholders including medical/dental practitioners, community oral health officers, medical facilities, training institutions and various cadres and specialties represented by their respective medical associations were involved in the process. The Council will continue to periodically collect feedback regarding the scopes for the various cadres to ensure that they remain relevant and effective at all times.

The new health facilities categorization rules Gazetted on 31st of December 2021, aim at streamlining services offered by health facilities in the country. The rules which clearly stipulate the services a facility can offer vis a vis the infrastructural and human resource quality and capacity will affect over 15,000 registered health facilities. In the new categorization, there are 12 levels of health institutions with the primary unit being a Community Health Unit run by a community health extension worker. This facility offers preventive as well as promotive healthcare including early identificationcation and screening of health problems at community level. This is unlike the previous categorization which had seven (7) levels whose basic unit was a clinic. The clinic was categorized at level 2, the human Resource quality and capacity notwithstanding.

The basic level of any facility run by a medical or dental officer is now classified as level 3B, which constitutes of the general practice medical clinic and the general dental practice clinic respectively. According to John Kariuki, the Deputy Director, Licensing and Accreditation, the new guidelines are to the ultimate benefit of the general public who will now be able to identify where to get specific services. Health facilities and practitioners are now expected to familiarize themselves with the new rules available at https://kmpdc.go.ke/

In February 2021, a team from the Kenya Medical Practitioners and Dentists Council (KMPDC) together with its associates conducted an inspection exercise of College of Surgeons of East & Central Africa (COSECSA) training institutions in Kenya, as part of KMPDC’s monitoring and evaluation framework.

The inspections, which took place between the 22^nd and the 26^th of February 2021, marked the second such exercise conducted by KMPDC, and was in line with the Council’s mandate to regulate the training of all medical and dental practitioners and community oral health officers (COHOs).

The team, appointed by the Council’s Chief Executive Officer Mr. Daniel Yumbya, also visited existing and proposed COSECSA training sites in order to ascertain whether or not they meet the minimum requirements to train residents in general surgery.

The week-long exercise targeted 24 sites and was aimed at advancing education, training, standards, research and practice in surgical care in the country. This will in turn, help increase the number of surgeons in Kenya which still remains very low.  

According to our data, there are only 581 licensed surgeons in the country. The COSECSA program therefore aims to bridge this gap through a unique in-service training, where the surgeons are taught within their countries of origin and in their respective counties. This not only reduces costs incurred by trainees if they were to study abroad, but also helps in surgeon retention post qualification at the place of study.

With most surgeons based in urban areas, this unique training program also aids in the distribution of the specialists across the country as most surgeons are retained in the specific counties where they studied.

Some of the COSECSA training sites that were inspected include the Kenyatta National Hospital, Moi Teaching and Referral Hospital, PCEA Kikuyu Hospital, AIC Kijabe Mission Hospital among others.

One of my favorite philosophers Mahatma Gandhi once said “It is health which is real wealth, and not pieces of gold and silver”.

His sentiments ring true to this day and might explain why patients are always seeking better health services and if they can afford, are willing to spend millions by traveling abroad to seek treatment if promised favorable outcomes when their health is on the line

This could be one of the reasons why medical tourism is a multi-billion industry.

The Ministry of Health (MoH) estimates that Kenyans spend $15 million on medical expenses abroad.

In any given year, hundreds of Kenyans troop to hospitals abroad in search of treatment. Between January and December 2019, more than 400 patients were cleared by the Ministry of Health and the Kenya Medical Practitioners and Dentists Council (KMPDC) to travel abroad for treatment. The numbers recorded in 2020 are slightly lower due to the lockdown imposed to mitigate the spread of Covid-19.

The few patients who seek clearance from KMPDC are those who need the National Health Insurance Fund (NHIF) to help with their medical bills abroad. Hundreds of other people, especially those with private insurance, go directly without authorization from the Council.

According to our data, the most common referrals are those to do with oncology, heart disease and organ transplants. Although some, if not all of these services are available in health facilities in Kenya, a number of patients genuinely travel for services unavailable in the country.

While going abroad for treatment is no guarantee for better health care, it has been sold as the ultimate option for medical care. This is not always true.

Whereas the treatment expenses overseas in some cases may appear pocket friendlier than the costs in Kenyan hospitals, many patients travel oblivious of a myriad of added costs resulting from travel. Besides the hospital fees, patients pay for accommodation, air ticket and food as separate bills. In most cases, family members accompany the patients adding onto the costs.

Such costs make treatment abroad extremely expensive and many patients, unable to meet these expenses, end up detained in foreign hospitals for unpaid medical bills. This only adds more suffering to families already strained by medical bills and anxiety over the health of their members.

A patient also needs to plan for any needed aftercare upon returning home. One must talk to their doctor to plan for medication and other post-operative needs that may arise from treatment to ensure that the treatment received is indeed working well. It would be quite difficult for a practitioner abroad to physically follow up on a patient who sought treatment from them.

For reasons elucidated above and several others, the Kenya Medical Practitioners and Dentists Council in 2017 developed rules for referral of patients abroad. Under these rules, a medical or dental practitioner may refer a patient for medical or dental management abroad where; there is evidence of inadequate expertise or medical facilities to handle the condition locally; when referral is the most cost-effective option available for the patient; and when the patient opts to pay for medical intervention abroad.

The rules determine the procedure for referrals and eliminate sporadic or unwarranted referrals that fleece Kenyans. This means that Kenyans who want to seek treatment abroad must inform the Ministry of Health and KMPDC about their intent.

This is important because it will help reduce unnecessary referrals when the services can be received in the country at a lower cost and, in the unfortunate event a patient loses their life while receiving treatment abroad, the Kenyan Embassy at the country which one is seeking treatment is in the know of such an eventuality, making it easier to help in the transfer of a body from a foreign country.

In recognition of fissures in the current regulations, the National Assembly is seeking to amend the Health Act by introducing a new section in the law that will establish policy guidelines in the regulation of oversees medical referrals.

Sponsored by Kesses MP Dr. Swarup Mishra, the amendments make the referral of a patient abroad a multi-agency affair. KMPDC, NHIF, Association of Private Health Institutions, Kenyan Embassies and consulates will play a part in vetting the referrals.

The rules, as proposed, stand to benefit the people but nobody should mistake them for a panacea to the menace. KMPDC is committed to ensure that Kenyans get quality healthcare available in the country and in the event that they are referred abroad, their safety and healthcare concerns are well taken care of.

Patients must however commit to play their part and seek advice from the Ministry of Health and the Kenya Medical Practitioners and Dentists Council before travel. The forms and other requirements are on KMPDC’s website www.kmpdc.go.ke.

The editorial has been written by Daniel M. Yumbya, MBS, the Chief Executive Officer of the Kenya Medical Practitioners and Dentists Council and Management Committee Member, International Association of Medical Regulatory Authorities (IAMRA)

When the first case of Covid-19 was reported in the country on the 12th of March last year, many Kenyans were terrified. The dreaded coronavirus that had killed people in thousands in developed countries that had the latest medical technologies and infected hundreds of thousands, was now in Kenya.

Following the discovery of the first case, the president would then issue a number of directives including travel bans to and from countries with confirmed Covid-19 cases,14 days of quarantine for all incoming passengers and an immediate suspension of learning and encouraged people to work from home. A 6am to 7pm curfew was further effected.

People’s lives were inevitably affected, socially, economically and psychologically. And for the first time in the history of this country, the luxury of traveling to other countries for leisure, escape or to seek treatment, was no longer there.

There was a period of doom and gloom for thousands of Kenyans, and for a moment, many never thought we could get through it. But as the proverbial phrase goes, every cloud has a silver lining; and rising like a phoenix from the ashes, we slowly, but ably proved that we could make it as a people in a pandemic.

Analyzing how the country has performed in the past ten months since the coronavirus was first reported in Kenya shows a lot of improvement, especially in healthcare. For instance, with the travel bans, no one could seek treatment abroad and all focus shifted towards strengthening the country’s healthcare system. The president instructed each county to have at least 300 isolation beds to address the increasing demand, in preparation for a surge in Covid-19 positive numbers. As a result, the national and county governments supported our hospitals and institutions to the point of enabling them deal with the virus at their levels. County governments were able to equip their respective health facilities to ensure that should there be a peak, the facilities would not be overwhelmed.

Another key activity undertaken by the government was an assessment of the availability and reliable supply of high-quality oxygen whether by gas cylinders, liquid oxygen tanks through central oxygen piping system, concentrators or liquid oxygen plants. The findings necessitated the formation of a task force to formulate policy and strategic mechanisms to enhance adequate availability and reliable supply of oxygen, a critical PANDEMIC has been a blessing in disguise component in the treatment of pandemic cases. Post the pandemic, these will still be used for patients who come with other communicable/non-communicable diseases.

Healthcare has also shifted towards telemedicine following fears of contracting the virus in health facilities. The Kenya Medical Practitioners and Dentists Council has been approving Electronic Health certificates which have helped health professionals engage their patients virtually, allowing diagnosis, treatment and prescription of drugs online, without having to physically go to a hospital.

Alongside other state agencies, the Council has also been providing technical assistance to strengthen the county capacity to handle pandemic situations. Some of our key findings reflected high level of county awareness and efforts to contain the pandemic, albeit constrained by resources and infrastructure.

Another improvement witnessed in the past 10 or so months is the critical role played by doctors, community health workers, nurses, clinical officers and other cadre of health workers who are critical in Primary Health Care (PHC) at the community/grass roots level.

Through them, communities learnt about the importance of hygiene and social distancing. In many counties, more than 1,000 Community Health Volunteers were trained to handle the pandemic to support the health care worker efforts. These efforts went a long way in not only reducing the number of Covid-19 infections, but also infectious diseases like colds and flus, diarrhea, cholera among others. Looking forward and noting the critical role health workers play in any society, the government should look into boosting its support for this group in all cadres and implementing Universal Health Coverage to ensure that we are ready and capable to deal with any future pandemic. This can be done through the training of more specialist doctors, investing in specialized treatment and capitalizing in primary/preventive healthcare at levels 2 and 3. There is also need to enhance partnerships with Faith Based Organizations and private sector in health, seeing the critical role the private sector played in the pandemic.

The most important lesson that none of us should forget after this pandemic is that health is not domiciled in the Ministry of Health; it is everyone’s responsibility. We should all continue to be involved as players to enhance positive impact on health outcomes.