Over the past weeks there have been reports of disquiet at Moi Teaching and Referral Hospital (MTRH), the second largest health facility in the country. This followed the removal of the long serving Director-Prof. Haron Mengech after his term expired. Mengech’s tenure at the hospital has seen the health facility expand both in infrastructure and the services it offers to the populace in Western and Rift Valley regions of Kenya. That Prof. Mengech turned around the Hospital is not in question. He was a no- nonsense administrator and an aggressive resource mobilizer.
But lost in the arguments as to the merit or demerit of the move by the Minister of Medical Services-Prof Anyang Nyong’o not to renew the directors term was a statement he made last week in Kisumu that in future , administrators of government hospitals will not necessarily be medical doctors. This is a welcome move and should be followed to policy levels. I have written about this in the past. Our health system cannot continue to afford the wastage and maldistribution of human resources, especially of high qualification as doctors, through archaic practices as one that public hospital administrators be medical doctors. Further exacerbating the maldistribution of healthcare workers by service delivery level is the fact that just two hospitals, Kenyatta National Hospital and Moi Teaching and Referral hospital, employ 42 percent of Kenya’s doctors and 13 percent of all nurses.
Effective management and administration of hospitals only requires the officers charged with this responsibility to bring together human and material resources in a manner that achieves favourable health-related outcomes consistent with the objectives of the organization. Healthcare management is a unique discipline in management and as such, calls for a slightly different management applications. It then follows that not all doctors are effective managers and that we can have a non-medic but a professional manager ably run our health care institutions. In deed the core component of the training for our medics is the provision of clinical care, and management or administration only constitute a small proportion of the curriculum if any.
Such a move as proposed by the minister, will relieve the many doctors we have handling administrative duties of these roles and grant them the opportunity to serve in areas where their services are badly needed i.e. to provide clinical care to patients, especially at a time when the doctor to population ratio in Kenya is as low as 18 per 100,000 people.
Since the establishment of this coalition government in 2008 and the creation of 2 health ministries, there has been the creation of parallel positions and the duplication of duties of officers from the 2 ministries of Public Health and Sanitation (MoPHS) and that of Medical Services(MoMS). The worst scenario is that most of the occupiers of these created positions are senior specialist doctors who are badly needed to provide clinical services in the wards and theatres of our ailing hospitals.
Indeed a preview of the legal notices creating the 2 referral hospitals –KNH and MTRH doesn’t require the CEOs of the facilities to be necessarily medical doctors.
It is my considered opinion that the minister for medical services should go on with his proposal to strip the management of our hospitals of this bureaucratic practice of insisting that the chief executive officers be medical doctors and allow potential and qualified Kenyans to apply for these positions based on their past performances in public policy and administration.
Mr Onyando is a Public Health specialist working in Uganda. [email protected]