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Politics,Policies,Agents and Parties: Activists,Lobbyists and Unions-A cure for healthcare

We have amorphous proposals being chanted: Babacare v Rutocare and Others et al. What does it mean to all of us as leaders and countrymen? Is it time to cause fine-tuning of conversations towards our favour as a people and for the betterment of our society.

Healthcare agents, activists,lobbyists and unions exist for a purpose and from their vantage position they get to advocate for the change they desire, for the good of a people or against a people. Advancement and realization of the right to healthcare is that socioeconomic benefit that our country,Kenya, owes its citizens as per the constitutional edict of 2010. How much progress in healthcare would we be comfortable with in the next administration? Do we have a realistic score matrix of how the outgoing administration has performed in matters healthcare? From brick and mortar structures, management of human resources for healthcare and planning of future developments in healthcare.

Our votes and voices as a people is the currency to acquire a permanent and progressive mark in the country’s healthcare. Questions are many and the answers are wanted and wanting. Who among the political agents has the best, feasible, practical and realistic healthcare reform proposal? Would one dare follow a cure to their ills and suffering or would one rather be comfortable with the warts and all?

My wish from August 2022 is Healthy Healthcare and a Healthy Nation. What is your wish? Tick-tock, tick-tock, tick-tock, bleeeep.

COUNTIES: We have ENOUGH problems, we DO NOT need to plan and train SPECIALIST DOCTORS

Did you know that we have less than 40 Oral and Maxillofacial Surgeons in Kenya?

This small number of specialists are distributed in 10 counties ONLY:
Nakuru,Nairobi,Mombasa,Kitui,
Embu,Nyeri,Kiambu, Uasin Gishu, Makueni and Meru.

Close to 50 Million citizens get to be served by the specialist doctors.

Some of the conditions dealt with by the specialists include the high cases of oral cancer, tongue cancer,jaw cancer, all road traffic injuries of the face and head, all major dental disease conditions, all cases of congenital defects of the face such as cleft lip/palate and many other varied diseases and disorders of the head and neck area.

Did you also know that the rest of the citizens in the larger country have to keep up with intercounty transfers and referrals on a daily basis to seek specialists services care? Isn’t it exhausting and expensive enough ? The Ministry of Health has a cure.

Let’s make a toast to the Council of Governors for the progressive specialist training reforms-“We have enough problems!”

Proceedings on Health Laws Amendments Bill No 2 of 2021

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) champions for the rights of health workers in the country and the progressive realization of the right to healthcare.

Pursuant to requirements of public participation as stipulated by the Constitution of Kenya,2010, Article 10 on principles of good governance, and following requests for submission of memoranda as guided by National Assembly standing orders, as a union, we have several times submitted memoranda to the National Assembly Health committee since March 2021 on the proposed HealthLaws Ammendment bill no 2 of 2021. On the proposals made, none of our proposals have been factored in the laws and we are concerned on the kind of inclusive and participatory governance being adopted into the regulatory boards.

The objective of the bill is reported to be the need to align board leadership in health regulatory bodies in accordance with Mwongozo Code of Governance, 2015.

As a union, we have made a general note of the following inconsistencies in the proposed amendment laws:

*The proposed laws do not provide qualifications of chairpersons relevant to the field being regulated

*The proposed laws do not provide qualifications of board members relevant to the field being regulated

*Multiple government agents have infiltrated and ousted key stakeholders in the boards in a move that demonstrates major conflict of interest. These proposals will stifle board efficiency, operations and entrench bureaucracy and corruption. This demonstrated over representation of government agents in the professional regulatory affairs ought to be checked majorly through self-regulation by the professionals themselves.

*There is demonstrated lack of rationality, proportionality and independence from the appointing authorities who seek to reward non-professionals with board positions in regulatory authorities meant for professional self-regulation. This hijack of professional autonomy and duties is discriminatory, exploitative and retrogressively unbalanced if we are to ever plan to attain universal healthcare as country. We cannot attain much desired progress by relegating healthcare workers in their day to day professional regulatory affairs.

*Further we make reference to recent court precedents on the need to have appointing authorities (President, CS and PSC) become harmonized as per the existing statutory laws.

It is our hope that Members of the National Assembly will return the proposed laws to the Health Committee and cause amendment to the proposed laws to cure them of the raised inconsistencies, demonstrated conflict of interest and over-infiltration of multiple government agencies into professional regulatory affairs.

How To Make Doctors Pay To Deliver Universal Healthcare

Doctors are the richest persons in our society. They get rich through their calling, coins and a tough touch of passion juice.

The National and County Governments, Ministry of Health and University of Nairobi have decided. They have decided that we have enough doctors in the country. Enough doctors and specialist doctors who aspire everyday to fill the demand and need for healthcare services.

Doctors are ailing. Ailing for being spoilt for choice over the years. Ailing for being left without a choice but a headache for a career. Who shall treat yourselves and themselves in the near future?

Our national leadership has decided to import doctors and specialists to provide the much needed healthcare services, handholding and mentorship of the jobless doctors. Our public taxes must be utilized to cater for our realization of progressive right to healthcare.

The Ministry of Health and Associates has also decided to reduce the number of doctors going for training and intending to serve our country people. To add salt to injury, targeted and on narrow spectrum strategies, fees for a healthcare degree must rise. A potent regimen for the society’s illnesses. As a people are we going to take this kneeling or lying down, choiceless and in need of our own home-made cures? We keep to queue. Wound dressings, dry gauze and a sticky strapping.

A calling through calling letters. From 2021, to train as a doctor will now be considered entrenched social inequity, a preserve for the well endowed,those without the tarmacking passion and those ready to go through the enriching strenuous specialization route.

Universal Healthcare here we come. We come with our young doctors remaining hopeful as our country disease burden remains unchecked. We remain watchful as the cost of accessing quality healthcare rises from general inflationary costs,limp and myopic social development plans. Is it band-aids we need? Band-aids for our bloated, boastful, mischievous and prideful doctors or band-aids for our state of healthcare.

It’s time. It’s time when we as a society looked at the cost of production of healthcare providers towards reducing health inequalities for the much needed social and economic progress of our country.

Vision 20/30.

Vehicle with deflating wheels: BBI Omnibus

Regulating Omnibus Bills

An omnibus bill seeks to amend, repeal or enact several laws, and is characterized by the fact that it is made up of a number of related but separate initiatives.

A reason cited for introducing an omnibus bill is to bring together in a single bill all of the legislative amendments arising from a single policy decision in order to facilitate parliamentary debate. A question arises, is this practice of legislative drafting an intelligible and reasonable strategy as guided by principles enshrined in Constitution of Kenya 2010, Article 10 on good governance?

In the case of Commonwealth v Barnett, with reference to American parliamentary law in 1901, the Court used these words: “Bills, popularly called omnibus bills, became a crying evil, not only from the confusion and distraction of the legislative mind by the jumbling together of incongruous subjects, but still more by the facility they afforded to corrupt combinations of minorities with different interests to force the passage of bills with provisions which could never succeed if they stood on their separate merits. So common was this practice that it got a popular name, universally understood, as logrolling. Could we be having logrolling happening in our 12th parliament without our knowledge?

Omnibus legislative drafting practice has been growing. It is my considered view that perhaps it’s time we had the practice regulated for it’s curtailing of rights on effective public participation on governance and policy proposals. Legal frameworks should not grossly entertain Omnibus Bills. A guiding law ought to issue to prescribe that no bill shall contain more than one substantive subject matter, and which subject shall be clearly expressed in the title. This is to allow for intelligible and orderly, reasonable and undistracted debate on legislative proposals.

The Menace of Underemployment, Salary Discrimination and A Cure for Obnoxious Employment Arguments

Contracts, PnP, UHC engagements, Locums and all other atypical worker engagements; doctors SHOULD and MUST not suffer illegally low pay, and dangerously long hours in the name of a contract of employment that is substandard in comparison to mutually agreed on CBAs.

In the case of Solo Nzuki v Salaries and Remuneration Commission & 2 Others [2019] eKLR, Judge G.V Odunga outlawed the JSC mode of employment of judges, where he cited the judges appointments as DISCRIMINATORY, UNCONSTITUTIONAL and a VIOLATION of the Judges’ Labour Rights.

Judges appointed to serve in the High Court as Judges are all entitled to similar starting remuneration and benefits.

From this case, all affected judges got awarded an order for arrears payment based on differences in pay packages from their dates of respective appointments.

Should our doctors keep to tolerate unequal remuneration where they perform work of equal value at entry level?

From our Constitution of Kenya of 2010, Article 27(1) provides that every person is equal before the law and has
the right to equal protection and equal benefit of the law.

It is also good to note that Article 41(1), (2) and (5) provides that all persons have a constitutional right to fair
labour relations.

Section 5 and 26 of the Employment Act of 2007 are also express on this and posit:

“Section 5(4)
Discrimination in employment.

An employer shall pay his employees equal
remuneration for work of equal value.”

And

“Section 26. Rights and Duties in Employment.

(1) The provisions of this part
constitute basic minimum terms and conditions of contract of
service.

(2) Where the terms and conditions of a contract of
service are regulated by any regulations, as agreed in any
collective agreement or contract between the parties or
enacted by any other written law, decreed by any judgment
award or order of the Industrial Court are more favourable to
an employee than the terms provided in this Part and Part VI,
then such favourable terms and conditions of service shall
apply.”

Section 12 of the Salary and Remuneration Commission(SRC) Act 2011 also provide that
equal remuneration to persons for work of equal value.

Discrimination on equal work and equal pay for union members is DISGRACEFULLY UNACCEPTABLE.

All above cited Legal Provisions underscore that NO ONE should be discriminated against by being
underpaid or provided with unfavourable terms of employment.

Equal
remuneration should match work of equal value.

I say NO to employers promoting salary discrimination and entrenching underemployment.

Kahura Mundia

Aspirant For The Office of ViceChairperson, KMPDU

Salus populi suprema lex ✊

Summary of Issues in Healthcare Bill 2021 Amendment

  1. Composition of all healthcare professionals regulatory bodies being changed to include 4 government officers( Non exec director,PS-Health,PS-Finance,AG) and 4 other persons, three of whom are not to be public officers and are to be in the primary professions under regulator.

Board will have 9persons;9th being CEO.

The regulatory bodies to have their boards reconstitute d-Pharmacists, Medics and Dentists,Nurses,MedLab, Nutritionists, Public Health Officers,Counsellors and Psychologists, Physiotherapists and Clinical Officers.

  1. Proposal to legislate UHC into the NHIF legal framework.
  2. Health Act of 2017 amendments in

a) Change in the board structure compositions of bodies established under the act

b) Change in management of all levels of healthcare facilities

Draft views of Dr Kahura Mundia
26.2.2021

VARIED MEANINGS OF GOOD STANDING


This year we mark the KMPDU 10th anniversary and I can proudly say that I am glad to be associated with the union in all the gains, losses and experiences we have acquired as a membership.


As a union, we are driven by aspirations of uniting all doctors of all cadres for quality service delivery, socioeconomic improvement, professional advancement, strengthening of collective bargaining power, and the promotion of quality health care delivery in the Country.


In a few months, the current leadership will pass the mantle for the next phase of growth to deal with union busting, a rugged labour environment and regressive bargaining dynamics. As bonafide members we have a duty to fulfill, and that is to not forsake the union when it needs us most. We ought to make our union self-reliant and effective. This we shall do by rising up when called to action and electing-in accountability, competence, execution, integrity and transparency in the next leadership. A perfect leader is one who holds the interests of the union both at their heart and mind. He/She is impartial and objective when it comes to leadership and politics of ethnic origin, cadre identity, gender differentiation, county of work, union branch, and even region of hailing.


The following are the provisions that give color to the meaning of good standing as per the KMPDU Constitution of 2017 and Labour Relations Act of 2007. They also elaborate on some of the election requirements:

  1. Members of the union not in arrears in their subscription shall be eligible for elections as National officers of the union. Article IV(4)


2. Members of the Independent Electoral Committee should also be of good standing and must have paid union dues for at least in the last 12months. Article IX(1).


3. Elections are meant to be supervised and managed by Labour Officers from the Ministry of Labour, Article XIV, and an Independent Elections Committee, Article IX. This committee is to be appointed by the electoral committee selection panel.


4. There should be published a certified register of members eligible to vote. This should be published immediately the independent electoral committee is confirmed and at least one month before the union elections at branch and national levels as per the provisos of Article IX(1)


5. Planned elections schedule at Branch and National level should be submitted to the Ministry of Labour officials at least 60 days before the election. This information shall also be published on Ministry of Labour website and other public media vide directive REF: ML&SP/TU/Election/2021 of 25th Sept 2020


6. If Physical Elections are to be held, the venue of the elections is to be communicated accordingly to the Ministry of Labour and Registrar of Trade Unions at least 30days before the elections vide directive REF: ML&SP/TU/Election/2021 of 25th Sept 2020


7. Elections are to be by secret ballot, Article XIV(2). The meaning of this can be expanded to provide for E-Voting owing to the current prevailing public health circumstances.


8. Voting is to be between 6am and 6pm on election day vide directive REF: ML&SP/TU/Election/2021 of 25th Sept 2020


9. Labour Relations Act 2007, section 33(c) provides that no person shall be a voting member of a registered trade union if that person’s subscriptions are more than thirteen weeks in arrears (3months arrears, Kshs 12000). Non-Members who pay agency fees will not vote vide directive REF: ML&SP/TU/Election/2021 of 25th Sept 2020


10. After elections, the Labour Relations Act in section 34(3) provides that the notice of the election of officials results shall be given to the Registrar within fourteen days.


In conclusion, in the quest for progress and a better tomorrow, I will reiterate this fact; the labour movement and rights cannot and will never suffer abrogation.


“We live in and by the law. It makes us what we are: citizens and employees, doctors and spouses, and people who own things. It is a sword, shield, and a menace. We insist on our emoluments, or refuse to pay our rents. We are forced to forfeit penalties, or get locked up in jail. It is all in the name of what the law has decreed…” Ronald Dworkin (Theory of Integrity, 1986)

Union now and forever!
Unio nunc et usque in aeternum!

POSITION STATEMENT: STOPPAGE OF KMPDU DEDUCTIONS, DEC 2020.

CS directive on union deductions stoppage is VOID ab initio. He has NO mandate to vary,revoke or suspend what is provided under established legal principles and labour organization statutory requirements.

Labour organization rights are codified in national and international labour laws that cannot be arbitrarily limited to disadvantage employees in any form of negotiations.

Labour legal instruments and sources of law that are available in Kenya: International Labor Organization Declarations and Guidelines, UDHR, ICESR, African Charter on Human and Peoples’ Rights. All these instruments are ratified by Kenya and our 2010 constitution enshrines them sacredly.

The guiding statute,Labour Relations Act 2007, sections 48,49 and 50 provides for the process of management of union deductions.

CS/Minister of Labour has to issue an order to allow for union deductions. Order is served to employers. Last order was made in June 2018. It has not been varied,revoked or suspended.

CS Health has no mandate to direct PSC,county governments or even the CS Labour to stop deductions of union dues.

Further,for the CS Labour to vary, revoke or suspend union deductions as per the law, the rules of natural justice must prevail.

The governments and the CS Health have acted in bad faith during a time when social dialogue should be prevailing to end employer and employees conflicts.

All concerned parties ought to reverse their illegal union busting activities since the law as posited today cannot be allowed to have personalized creases and kinks.

Finally, let it be known that labor organization exists for the sole purpose of protecting employers, employees and workers rights.

Labour rights principles are imprescriptible.

Union now and forever!

Blunting Professionalism: Health Laws Amendments 2020

I hold opposing views on the recent proposal to amend health laws barely less than 13months since their last amendment.

On Mwongozo code of governance,this is a good policy document which brings a lot insight about good governance practices. However in my view I don’t think it can apply to all entities with the same level of precision in guidance.The document was mostly intended for use by SAGAs(semi autonomous government agencies) owing to their lack of efficiency,effectiveness and poor governance from citations in the past years. The application of this code verbatim to professional societies governance is a form of misplaced regulation. It is important to also note that the Mwongozo code has not been anchored in any law as a form of reference for good governance practices.

That professional societies are best served by persons with technical skills and on meritocracy is a given. Not to forget that professional societies have some of the most democratic and open forms of governance. Lack of independence and lack of perspective in professional societies in our set-up has been cured by having non-executive professional board members, to wit, inclusion of representative persons from the Law Society of Kenya, Kenya Commission on Human Rights, Consumer Federation of Kenya, and even the larger public.

The mandate of professional regulator bodies is to register,licence and provide quasi judicial disciplinary functions to inconstant professional members. This mandate doesn’t require or need the attention of full government machinery. Further, all mandates of professional regulators have and are always carried out in liaison with the different government agencies in charge of health as is required.Furthermore, the roles of AG representative as advisor to the government,PS Health,PS Finance and other authorities have always been played through regular consultations with the professional regulators. The occupancy of professional regulator board positions by government officers beats the logic of corporate bodies and governmental offices separation of powers.The application of checks and balances in an impartial way will be lost.

Where a professional regulatory board seeks the services of an independent auditor, economist,financial manager, forensics expert, legal expert etc, this has always been on an outsourced basis as need arises because there are limits to the size of a board and its planned utilization of all existing variations of professional competencies .

Since time immemorial professionals have always sought to do good for the advancement of society.This calling of duty does not stop today.It is therefore absurd and repugnant for the government and AG to plan to reduce professionals to spectators in the management of their professions.

The proposed professional boards regulatory changes is a textbook form of autocracy. And critical to note is that the reasons raised for the boards reorganization can be effectively handled by the Kenya Health Professionals Oversight Authority as established in the Health Act,2017, s46,47,48.

Professionals and their professional regulator bodies need to assert themselves.There should be no room to provide reasons for the constant encroachment,and the unending attempts at emasculation of any good form of professional self regulation.