This article first appeared in my weekly column with the Business Daily on January 22, 2017
Doctors in Kenya went on strike in December 2016 due to on-going concerns with regards to numerous issues including remuneration, working conditions, promotion and transfer policies, doctor occupational safety issues and inadequate health staff and facilities.
Both the press and national government have given Kenyans the impression that the main demand being made by doctors is focused on a 300 percent pay increase. However, a public announcement released by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) stated concerns that, ‘in all its offers the government has addressed itself solely on a non-existent 300 percent pay increase demand and has refused to give its position on the non-monetary issues’. Thus while there are requests by doctors to improve compensation, there are other demands that would benefit the greater health of Kenyans including a call to hire more doctors and better equip hospitals.
However, it must be said that although the CBA the doctors seek to have honoured is not solely on remuneration issues, their demands would have financial implications. For example, there is a demand to hire 1,200 doctors per year for four years, making a total of 4,800 new doctors. It cannot be denied that honouring this request in addition to meeting the demands of increased compensation and better equipping medical facilities would be an expensive endeavour; and that is likely why national government has yet to broker an agreement with the doctors.
The reality is that Kenya’s fiscal space is narrowing and the ability of national government to take on added costs is becoming increasingly limited. Last year the government overshot its fiscal year debt target having borrowed KES 147.1 billion against a target of KES 106.0 billion. The public debt to GDP ratio stands at about 52.8 percent, well above Treasury’s 45 percent ceiling; and the fiscal deficit is at 8 percent, well above the 5 percent target. Indeed, the country has acquired public debt to the extent that a fifth of the budget is committed to repaying loans. The national government seems to have acquired the habit of chronic over-spending. And while debt levels are still thought to be sustainable, bodies such as the IMF and World Bank have issued warnings about the trend of government borrowing with concerns that it may lead to the country being over-leveraged, probably in a shorter time span than anticipated. So there is reason for national government to be concerned about the financial implications of the demands being made by doctors.
However, there are is a clear flaw in the case being made by government attempting to use finance and economics to deny doctors their requests. Just as the government seems stuck on chronic over-spending, it also seems stuck in chronic financial mismanagement. Kenyans will simply not believe that the government does not have enough money to meet doctors’ demands given the sheer volume of allegations of colossal corruption housed in national government bodies such as the Ministry of Devolution and Ministry of Health; allegations of graft in these bodies alone are estimated to stand at about KES 8.5 billion. Last year Member of Parliament (MPs) negotiated a deal that effectively made Parliament’s wage bill rise by more than KES 2 billion in a year. Please note that by 2013 reports indicated that Kenyan legislators are the second-highest paid lawmakers in the world, beating their counterparts in USA, Britain and Japan. Ergo, the issue is not a lack of money, the issue is what priorities are absorbing public finances.
Thus, while there are financial and economic implications to the demands being made by doctors, I fundamentally agree with their demands. This is not only because the country can only develop on the foundation of a healthy and productive population, fiscal policy is wanting. It is wanting not only in terms of fiscal mismanagement but also through the prioritisation of wages for some while failing to better equip hospitals and ensure the adequate compensation of doctors and other health staff.
Anzetse Were is a development economist; email@example.com