The guest blog post comes from Mark Pointer, group leader of the Norwich RESULTS group. Mark recently met with two colleagues from Kenya to discuss how Kenya’s health service provision differs from the UK and what needs to be done to address the global shortage of health workers.

Single Lab coat

I work at the Norfolk & Norwich University Hospital Microbiology Laboratory and in recent weeks we have employed additional temporary staff to help out with extra workload.  Two of those locum staff, Aaliyah and Bititi had come up from London, but originate from Kenya – where they were trained through the WellcomeTrust – which is a global charitable foundation dedicated to achieving improvements in health by supporting public engagement, education and the application of research to improve health.

After becoming fully qualified laboratory staff in Kenya, their opportunities were limited. I talked to them about the work of RESULTS and about a recent monthly Action regarding the role and need for more health care workers.  Both Aailyah and Bititi checked out our website and thought the action was very important issue.  I asked them whether they I could ask them a few questions about Health Care workers in Kenya. What follows is their replies.

What is healthcare like in Kenya?  Medical standards have massive differences between the various levels of the population. There are very few doctors for the population. Well-to-do Kenyans may not feel these health issues as they can access private hospitals which are good and continually improving. The private hospitals in Nairobi, Mombasa and Kisumu (the big cities) have very good healthcare but are very expensive. Again, the living conditions among well-off Kenyans hardly expose them to the kind of health problems that poorer Kenyans suffer from. The healthcare provision and implementation infrastructure includes the national teaching hospitals, provincial hospitals, district and sub-district hospitals, health centres and dispensaries. There are also private clinics run mainly by Clinical Officers and nurses, NGO and traditional health providers. Availability of healthcare facilities does not guarantee utilization as cost remains a great impediment. There are those that report being ill but never sought treatment citing healthcare costs and distance to health facility. Hospitalization rates are higher in the urban than rural areas because there is a higher number of inpatient facilities and doctors in the urban areas. Also the demand for inpatient services increases with income. Insurance provided by the National Hospital Insurance Fund (NHIF) cushions some of the inpatient healthcare costs but very few Kenyans (about 10% of the total population) have insurance – 88% of people who have insurance are insured by NHIF.

Why did you leave? We are very ambitious people and wanted to pursue our education. We approached our then line manager and he wouldn’t hear of it so we started looking for ways we could do an MSc and probably a PhD. We looked at enrolling in various universities abroad and the fees were staggering and there was no way we were going to manage to pay that – not from what we were earning anyway. By then we were very unhappy and just wanted to leave. We attempted to get jobs in Canada, USA and Australia but they all had some form of “road-block”. We tried UK and it was perfect. The advantage is that the training in Kenya is recognized by the UK because Kenya adapted the UK system of training. We had our papers checked by the UK NARIC and we were certified but had to get registered as a Biomedical Scientist in order to practice in the UK. The pay in Kenya is meagre but because we were working with Wellcome Trust, the pay was way above my colleagues who were working with the government (until now) – almost 5 times higher.

What is the difference in UK? Order! Everything is so organised. Laboratories have the necessary equipment and reagents and training is really good. There is nothing as frustrating as going to work and there are no reagents so one ends up sitting and doing nothing literally the whole day. It was different at Wellcome Trust but in government hospital laboratories it is dismal. Professionalism is another big point in UK. There are standards that are followed by everyone in the UK so all hospital laboratories tend to do similar things/procedures.

What do you think needs to happen in Kenya? Laboratory work should be standardised and all the private laboratories need to be monitored fairly. There is also too much corruption and that is the biggest problem as you will find  that laboratories that are not up to per are still open and testing samples! This is because someone has not done their job and just ended up taking a bribe. Corruption is the biggest evil in the Kenyan society and Africa in general. All the colleges/ universities training laboratory technologists or medical personnel in general need to be accredited and in the present time there are a lot of these that are mushrooming and not meeting the required standards. So you find that “half-baked” medical personnel are entering into the system and not having a clue of what is required of them. It is a vicious cycle really!

What are the long-term consequences of other trained staff leaving Kenya? The country has lost so many well-trained medical personnel and it’s mostly due to frustration. What has resulted is poor quality of healthcare to those who cannot afford private hospitals. This will go on and on as long as the working conditions of the healthcare personnel is not good. There are people dying from diseases that can be treated from a single dose of antibiotics, for example. Life expectancy will reduce in the low income earners and the unemployed / poor population – it is already very low at about 63yrs.

Would you go back if the pay and conditions were better? Yes, we would. But they would have to meet my expectations. Having experienced what proper healthcare is in the UK we think we would expect to be paid much better and also to have good working conditions. The weather and food is fantastic and with the right conditions it would be just the perfect place to be. We know so many British citizens who are working in Kenya as expatriates and have not been back to UK for years or some just come to visit and go back. It is because they know what they are enjoying in Kenya is hard to come by in the UK.

I would to thank Aaliyah and Bititi for their openness and honesty regarding this issue.  Both felt very strongly about the lack of prospects for healthcare workers in Kenya and how their country had suffered as a result.  Let`s hope RESULTS UK can bring this to the issue greater attention of our Government and start the ball rolling.