Preventive
health care has gained a lot of traction in government as well as in the NGOs
sector. However, financing it has never gained the same tracking and most
activities geared towards prevention are under-resourced (mortalities due to
preventable deaths still high). Only
recently, the government began putting some efforts to support prevention
through the community strategy by employing CHEWs (Community Health Extension
Workers). However, the CHEWs (lab tech, pharmacy technicians, etc) employed
through the ESP program were not directly relevant to Community strategy and
had to be reassigned in most districts. To date the biggest undoing of
community strategy is lack of funds as it is still donor-funded with many
donors having their own priorities.
This brings to
fore the whole question of how adequate Public Health Professionals,
particularly PHOs, are for the Kenyan Public. The number of PHOs in Kenya is
approximately 20,000, with those in government at around 10,000. Majority of
those in Government are diploma and certificate holders and only about 200 are
graduate degree holders. We are talking of a ratio of 1 PHO for every 2,000
Kenyans.
A cadre of PHOs
which seems to be forgotten in this Public Health Human Resource circus is the
Graduate PHOs Group, which just like any other health cadre, is required to undergo
a mandatory 1 year internship to be considered for absorption by the
government. The interesting thing about the health care system in Kenya is that
it is very much in the hands of the government thus opportunities for health
professionals largely depend on government provisions.
Internship is
undoubtedly a good professional development platform, more so for those with
health backgrounds. But how convenient and motivating is the PHO Graduate
Internship? Is there anything that can be done better? Upon completion of
studies, graduate PHOs interested in future MOH job considerations are required
to choose an internship station of their choice, apply and volunteer there for
one year, without any motivation or stipend.
Upon completing
this, absorption is not guaranteed. Frustrated graduate PHOs have had to wait
for more than 3 years now for a word from the MOH. The most affected are the
Environmental Health Graduates. The last time MOH did a meaningful absorption of
PHOs was in 2009, where more than 150 PHOs were employed. Many PHO graduates have
had to run to NGOs which have Public Health Programs, and have found their
skills and experiences relevant and hugely in demand. Others have had to
diversify their career paths into unlikely fields such as banking and
insurance.
As one of the
creamiest professions for university entrants, many people always have huge
expectations when they enroll for it. But the loud silence from MOH on the fate
of PHO interns, with many of them graduating from Universities each year, always
makes them wonder if academic investment in Public Health is worth it, in the
absence of many NGOs which have absorbed a number of them.
While we are
talking of laws to introduce stipends for unemployed graduates or stipends for
best performing form four leavers, what has made it difficult to have stipends
for PHO graduates? Is it about our laws, now that the Public Health Act Cap 242
and Public Health Officers/Technicians Act do not mention PHO interns? Can’t we
include PHO interns in the PHOs’ Schemes of Service (SOS)?
With health care
largely devolved, any hopeful PHO is looking up to the county governments to
create more opportunities. This being a service delivery profession, the
government continues to be our sole bread-winner and the silence has even wider
effects on the growth of the Public Health Profession in the Country. The Constitution of Kenya, in the Bills of
Rights, expressly provides not only the right to health for every Kenyan but
also the need for everyone to be treated equally, with an equal right to
employment and related benefits. When the government selectively targets one
cadre of health workers to be compensated during internship and not the other
one, it is a violation of the other’s human rights and propagating professional
discrimination in the health sector. As such, by the PHO Interns asking the
government to look better into their welfare, it is not a request for a favour
but a demand for what is justifiably right.
(The writer is a
PHO working as a Program Officer for Water and Livelihoods Network (WALINET).
He is the convener of Public Health Officer Interns-Kenya, E-mail:
chrispory@walinet.org)
