By Chrispory Juma and Camlus Odhus
Public Health as a profession has been
existence for a long time. Some authors have dated the founding age of public
health to around 400 BC when the Hippocrates published his book titled Airs, Waters
and Places. Since then, Public Health Officers have been involved in disease
control, health promotion, epidemic preparedness and investigation, and health
education. In Kenya, Public Health Officers and Technicians are tasked with
safeguarding the health of the public, including ensuring food safety, promoting
basic sanitation and hygiene, educating the public on various health risks,
planning diverse population health interventions, and enforcing a vast array of
public health laws. To do this, health officers must adopt multidisciplinary
and collaborative approaches, work with integrity and professionalism, and
emphasize equity and prevention for a healthy population.
Thus in 2013, the Ministry of Health
saw through a law known as the Public Health Officers (Training, Registration
and Licensing) Act, which made provision for the professionalization, training,
registration and licensing of Public Health Officers (PHOs) and Public Health
Technicians (PHTs) in Kenya. The Act established the Public Health Officers and
Technicians Council (PHOTC), whose purpose is to exercise general supervision
and control over the training, practice and employment of public health
officers and technicians in Kenya, and to advice the government and Ministry of
Health on matters of public health governance. Over the past two years, the Council has done its level best to put its house in
order, including setting up training regulations and curriculum for Kenyan institutions
that train the Public Health workforce including Universities and other
colleges; putting up measures for internship and registration of graduates; setting
up an online information portal, among other achievements.
In
line with its mandate to ensuring that all public health professionals within
its jurisdiction meet an acceptable level of competence before they begin to
practice, the PHOTC has gazette a raft of guidelines. This level of competence
is measured by assessing the applicant’s knowledge, skills and professionalism.
It is in this regard that the Council has decided on annual examinations, where
graduates who have successfully completed their internships undergo written and
oral interviews before being issued with a License to Practice. The Council set
registration examination fees at Kshs. 20,000 and Kshs. 15,000 for degree and
diploma graduates, respectively. The seemingly high fees have created a raging
controversy among the graduate fraternity with them calling for the fees to be
revised to reasonable levels, and streamlined with other professional bodies’
fees. Others have called for the scheduled exams to be called off all together
until the grievances are addressed, in line with sound stakeholder engagement
mechanisms.
Graduate
PHOs go through a mandatory one-year unpaid internships without any allowances
or benefits, at times even without any supportive supervision from the national
government. As if that is not enough, interns are expected to pay Kshs. 1000
for the internship. Even after this, their absorption into the Public Service
is not guaranteed, at both the County and National levels even as the Higher
Education Loans Board expect many of these graduates to start repaying
university loans, amidst the tough economic times. The graduates are, therefore,
asking where the council expects them to get the exorbitant Kshs. 20,000 to pay
up for the examinations. They would also like to know the criteria which used
to arrive at the figures, yet other profession’s examinations are much
affordable. Doctors undergo paid internships and for those in public service,
have to part with Ksh. 8,000 for Board registration. Nurses pay up less than
Kshs. 5,000 for their professional examinations to the Nursing Council. While
PHOTC have a mandate to set fees among other regulatory roles, the decision
processes need to be open, fair, objective, participative and reasonable.
Public
health professionals across Kenya have also questioned the list of graduates who
have already been lined up for the test. Core to this discussion is the
question regarding how holistic a professional’s training should be. While
board examinations have been used the world over as filters, societies are
increasingly weary of prohibitions, and regulators should instead adopt
facilitative processes in for holistic development of any profession. Needless
to say, Kenyans will pass exams through hook or crook but passing a
first-past-the-post exam is neither indicative of a qualified professional nor
should it assure members of the public regarding integrity and professionalism.
The PHOTC is well advices to enlarge its focus beyond exams and unreasonable
fees, and to train their lenses on institutions that are non-compliant with
admission and training standards.
Until a proper system is put in place to monitor and
enforce training standards, administering entry exams does not assure the
public that quacks and half-baked officers will not be the ones tasked with
promoting and safeguarding their health. And in a country that suffers from
gross inequality, questions must be asked regarding whether profession of
Public Health is now on sale to the highest bidder? We must guard against a
culture that dishes out opportunities to those that can afford irrespective of
their competence and qualifications, at the expense of many that could be
deserving, yet cannot afford. Are the right candidates selected to join the
right institutions? What is the quality of training at the respective
institutions? Is there enough effective oversight on the training of health
officers? What procedures are in place to go beyond an exam-based filter to a
competency-based professional grounding?
How is PHOTC going to systematize continuing professional development,
given that public health has one of the largest specialization options of any
career? Employers, although not specifically about public health, have
continued to note the poor quality and employability of job-seekers from local
institutions of higher learning, despite such applicants holding impressive
academic qualifications. The challenge is for PHOTC to find a balance between
evolving employers’ needs, the country’s health aspirations, and current socio-economic
realities, and to feed these back into the training standards and ongoing
initiatives for professional development.
These are weighty issues that many do not expect the
regulator to have sorted out in its brief existence. But public health
professionals are watching to see that a solid foundation is set for the
sustainable development of the profession in the country. Most importantly, and
as anticipated by the Constitution, what public consultative mechanisms have
PHOTC put in place to ensure effective stakeholder engagement? It would be
important for the regulator to put in place effective stakeholder engagement
strategies, backed by a sound communications plan to ensure ongoing exchange of
information in a non-confrontational manner. Sadly, on this facet, the
regulator is found wanting. Although backed up by an Act of Parliament and
having the benefit of a fully constituted board, PHOTC should seek to gain the
confidence of her stakeholders, and work collaboratively with genuine
member-driven associations rather than wave statutes at the slightest
interrogation. Unless the regulator has a thousand-strong secretariat and
adequate finances to police the profession, it is well advised to forge cooperative
alliances while remaining above board. As we have witnessed with other
regulators, laws are not enough to maintain sanity, and public participation
and support for policy actions are key ingredients for success. We want the
Council to succeed wildly, for we, the members of the public health profession
and the public - whose health we are here to safeguard - will be the ultimate
beneficiaries of such a success, but we are also ready to scrutinize how it conducts
business because we have a legitimate right to do so, both as citizens and
as corporate members.
A strong council would need all PHOs and PHTs of all
calibers to move along with it, regardless of their stature in the society. It
would be in naïve, in bad faith, unjust and arrogant to go ahead with the
planned examinations without properly responding to concerns raised. We expect
it to have a special sitting to deliberate on the exorbitant examination
charges, because if this is not done, professionals will need a rethink. The
Council must be fully supported in its efforts to restore integrity in the
Public Health sector, but that support can only be effective with participatory
decision making on its governance roles. Kenya needs strong institutions to
move towards national, regional and global development goals, including the new
Sustainable Development Goals related to public health, and PHOTC must not
disappoint.
Disclaimer: The writers are Kenyan Public
Health Practitioners. Views in this article do not necessarily reflect those of
their affiliate organizations. Chrispory Juma is a MPH Student and Community Mobilization Expert (chrispory.juma@gmail.com); Camlus
Odhus is a post-graduate Commonwealth Public Health Scholar (codhus20@gmail.com)
