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STRAIGHT TALK EP 7 - DR DAVJI ATELLAH - HEALTH ON THE EDGE
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00:00We have issues that made the doctors to go on strike and then be dismissed.
00:05In our negotiation that we've had in this framework, all those issues have been resolved.
00:10Again, because it's always an issue of give and take, we have looked at the period and the budgeting and the goodwill of the county
00:16and also discussed with these doctors. It's always not about money only. It's always about the need to serve the people.
00:23Welcome to Straight Talk, where we engage Kenya's brightest minds in the issues facing our nation.
00:36This episode, we are privileged to be joined by Dr. Devji Atela. He's the Secretary General and CEO of KMPDU.
00:46Thank you so much for joining us.
00:48Thank you everyone for having me today.
00:50Tell us, how did you find yourself in the position in which you are today?
00:56I found myself as the Secretary General and the CEO of KMPDU through service.
01:03When I was done with my internship after my undergraduate, I was working in Nakulu County.
01:09We have a union, KMPDU, which has been in existence since 1971, but was registered in 2010.
01:17And therefore, in 2013, 2014, when I was in Nakulu, we had issues.
01:22The recurrent problems that were occurring in the county, where the county would pay salaries late, almost two months late.
01:29The issues of promotions were not being done. The issues of welfare were neglected.
01:32And therefore, in all our forums of discussions, we could voice out with courage to force the county government to get their things done.
01:41And it is that process that the doctors in Nakulu County, in 2015, asked me to represent them as their branch secretary,
01:49which then I was elected to represent the region, South Rift, which has about 60 counties.
01:54And later, I think in 2018, I was doing South Rift and also helping my colleagues in the North Rift region.
02:01It is out of the work of about five years, that is 2015 to 2021, where there was results and impact for each and every doctors in South Rift.
02:13And also in North Rift region, that made the doctors see the need to actually ask me to vote for the position of the secretary general.
02:26And it is the drive of the work that you are doing that led me to be elected in 2021, April, as the secretary general.
02:34In our union, we have what we call universal suffrage.
02:38You move across in all the 47 counties to ask each and every doctor to vote for you.
02:44So it means that we get mandate from the doctors of voting to be represented.
02:48That's how I became a secretary general now for almost four years.
02:52And again, the CEO aspect of this is because as a secretary general in the Labor Relations Act,
02:57you are the executive executor of the decisions of the National Executive Council.
03:03The day-to-day running of the union.
03:06So it means you have to be on a full-time basis to make these things done.
03:10We represent the welfare of doctors across the country, in both the public sector, in the private sector,
03:15and those also working in the universities, to see to it that in the hospitals where they work,
03:20they're able to be facilitated, supported, and to see that patients actually are served as expected.
03:26You have a background then in bachelor's in clinical pharmacy.
03:32And a master's then in medical law and ethics.
03:36How does this help in how you approach leadership at KMPDU?
03:42You know, the KMPDU represents three cadres.
03:46That is the medical officers, the pharmacists, and the dentists.
03:50And in the day-to-day running of operations of the workers, in the engagements with the governors,
03:56in the engagements with the government, you cannot just do it out of ignorance.
04:00In fact, in many situations, it is out of not knowing that people are aversely suspended from work.
04:10That is out of not knowing that counties will delay your salaries, statutory deductions are not limited,
04:16that collective beginnings are not implemented.
04:18So for you to actually be equipped to do the work that protects justice and ensures that the right of workers are protected,
04:25the right of workers, which doctors in this case, are protected, we must be well-equipped as a union.
04:30We must have this aspect of capacity building.
04:32So that is the essence why we need to have the matter of the law and ethics.
04:36And we have a number of our leaders that have also been trained or capacitated in this matter of industrial relations.
04:43This is to enable the leaders within this sector that whenever you go to engage on collective bargaining,
04:49you know what you're talking about.
04:50When you say that an employer has contravened the collective bargaining argument like we went on strike last year,
04:55we have to follow up the particular actions.
04:57When you are in court like today, where the matter of social authority is ongoing,
05:02and as those who won the case in last year are not part of their appeal,
05:07we have to be able to actually move the court to allow to join the union.
05:12So all this requires us to be well-educated, requires us to actually know the social aspect of life,
05:18know the critical aspect of it, and actually know how to relate to all the matters.
05:22So that's why we as a union do not really go the traditional movement of being on the streets only.
05:28We are also capable to ensure that in our advocacy process or in the pursuit to ensure justice,
05:36we go by the book.
05:38Now, you have a very unique position in that you've served under two presidents,
05:44President Uhuru and President Truto.
05:46And within that time, there's been the transition to universal health care.
05:51From your perspective as Secretary General of KMPDU, how has that transition been?
05:57You know, universal health care conversation is not new.
06:00It is something that has been in the country for now the last government rise to the gym for 10 years,
06:08and now this one.
06:08And I think last year was the fourth, 2023, October,
06:15was the fourth time that universal health care was being launched.
06:18And we came to realize that...
06:20The fourth time.
06:21The fourth time that it was being launched, because it has been launched...
06:23The piloting was done in four counties.
06:26And after the piloting, then there was a rollout in 2022 that captured every country.
06:32Then again, in 2023, there's another relaunch.
06:35And in fact, this is now when now the country was coming to have the social health authority.
06:39So really, when seeing the actual implementation of what universal health care was envisioned to be currently...
06:48Yeah, that's what we are seeing now.
06:49But as I say, the dream of universal health care started much with the former government.
06:56And if you look at the tenets of it, it is a very...
06:59It's a key that anybody who will support, any individual of a country will support the idea, ideology of universal health care.
07:07Because it just means that any person in the country should be able to access health care devoid of their socioeconomic status.
07:16That is, if you wake up today and you are a Kenyan, you are sick,
07:19whatever ailments you have, you need to go to the hospital and get the care.
07:22But then for that to be achieved, it means that there has to be financial investments to ensure that there is health care.
07:30There needs to be investment on the human resource.
07:33There needs to be investment in the infrastructure that actually provides those services within the hospitals.
07:39There needs to be investment in the equipment.
07:41There needs to be investment in governance and leadership.
07:45So in case any of this is not done, and the biggest one, the investment in human resource,
07:51in case these ones are not done, then we end up having immediate reactions.
07:55We end up trying and not reaching where we are.
07:58And that's why there's a big of a difference in last trial and the current trial.
08:02As much as we are seeing a bigger conversation on social health authority where there is a plan to have everybody able to access health care
08:14without necessarily having to contribute, because now they're above that part of the primary health care,
08:21which the government taxes actually contribute to.
08:24Then they have the part where people are contributing, and then the part of the chronic health care.
08:27But because the money is still not enough, that's why we still have, yes, people are getting the care.
08:33You go to hospital, and social health authority approves.
08:36We have a bigger population that has been approved for.
08:39But on the flip side, we have hospitals that have provided this care, but they've not been paid.
08:45They still owe the money.
08:46So from what I'm hearing, then, you've highlighted five key areas in which must go along with the implementation of universal health care.
08:58And from, again, what I'm hearing from you, there are teething problems, absolutely.
09:03But at least there is implementation of SHA or universal health care as we know it.
09:10Yes, there is implementation, and we must give credit where it's due.
09:15Where we have come from, the social authority now, is different from where it was in 2023 when we went to court
09:21and object so many of its articles.
09:24Because, for example, now we, at that time, the chronic health cancers were about 300,000.
09:31But I see now it's been 550, and now it's been proposed to 800,000.
09:35These are improvements that are coming in because of a responsive cabinet secretary who then take the inputs of stakeholders to improve this.
09:44But I can say that social health authority is just one component of universal health care in the sense that it ensures that people can access the care.
09:53But for it to work and be more effective, there has to be more funds to it.
09:57So that when people have accessed care, the authority does not struggle to pay the services that have been provided by both national government hospitals and the private hospitals.
10:07Because, Yvonne, health care cannot be free.
10:10For health care to be realized or to be attained in any hospital, somebody has to pay.
10:15When you go to a hospital that is privately owned, there are drugs there in those hospitals, there are equipment, there are reagents, and there are human resources that have to be paid for one service that has been offered.
10:28So this has to be paid by either that person who is seeking the care as a patient or by the insurance.
10:34The same happens in the public facilities.
10:36To the extent that if it is not paid, then you will access the care, but the next person who will come after you will not access the care.
10:43That is why insurance is very key to help people actually access this particular care.
10:48And in the event that you do not have the insurance, then there is a lot of out-of-pocket expenditures.
10:54That is why people will go and buy land and sell their lands.
10:57They will go to different mchangos.
10:58You will sell all your property.
11:01And that is what will give us the insurance care, the increased investment.
11:04The other component which is very key is the human resource.
11:07The human resource is what makes it possible.
11:09In those hospitals that have been built in different counties, that when you go there, you access care.
11:16It is like if you have an hospital where there are no human resource, it's just like a school where there are no teachers.
11:23You can't explore where to learn.
11:25Or it is an hotel.
11:27It's more like an hotel because there's no services you can get.
11:30So the reality is that there is need to have human resource in those particular hospitals.
11:33And that's where we have not really done well.
11:36Because the health is devolved.
11:40That for seven counties then have to do the annual recruitment or recruitment of health care workers.
11:45And what have they done in the last 10 years?
11:48Before devolution, up to 2023, there was annual recruitment of health care workers, including doctors.
11:55You graduate, you have your appointment at us to the hospitals.
11:58And the numbers were subsequently increasing.
12:00But after 2016, when the county government said that they have reached the ceiling of the PFM Act, and they cannot, that is the Public Finance Act, and they cannot hire any more.
12:13It means that there is need in this hospital.
12:15There is a shortage of health care workers, a shortage of doctors, but they can't hire.
12:19And therefore, what can happen is that there may be a vision by government to have people access health care in the public facilities, but unless health care workers are employed there, it becomes difficult.
12:30That's why unions like NPDU have been mobilizing and advocating that we need to have a plan like that of teachers, where there's annual employment, annual budgeting, or that of the police and the military, where we have annual recruitment like that.
12:46We also hear issues of cartels within the UHC system, and we've also seen ghost hospitals as well.
13:00So when you talk about medical institutions registering to be part of the UHC, there has been implications of corruption within the system.
13:11How do we tackle that?
13:14You know, corruption has been part of the personal society that we live in.
13:19It's a problem to the givers and the receivers of that regular bribe, whatever situation it is.
13:24But corruption in health care is a worse situation, because whenever anyone tries to do corruptions or the drugs, the livelihood of the people who depend on these drugs, all the patients, is at stake.
13:38Or medical institutions that are registered that don't offer any services and don't exist.
13:44How do we tackle that?
13:45Even that, even the medical institutions that then are acting to defraud the medical insurance are in all the way immoral in its nature of action.
13:55Because you know that this money is pulled together with one aim to alleviate people from suffering, that they may get this particular care.
14:02So the moment there are particular, any elements of frowdy in an hospital where you say you're offering services that you don't offer, there's a problem.
14:11And that's why I'm trying to put it that any matters that relate to the health corruption should not be treated like any other corruption.
14:18Because you may do corruption anywhere else, maybe in schools or anywhere else, and people will still be alive.
14:25But when you do corruption, whatever manner of it in health sector, be it in drugs, be it in the one we saw in Kemsah, be it the one that relates to stealing drugs, stealing medications,
14:36or finances that are meant for medical insurance, or whatever form of it, is in a way affect the access of care to the people.
14:44And that's why we must, as a country, look for ways to eliminate it in all possible ways.
14:50So like, for example, what was being brought by the social health authority, or what has been always a communication that there was a big defrauding effect in NHIF,
15:00which was involving both the members of NHIF and the hospitals and the operators in it.
15:05The same way they brought social health authority to actually eliminate that particular aspect of corrupting what was existing.
15:14The plan that I have, that the government has had, that we have seen them communicating, was that if there was suspicion in any hospital, then they will stop the payments.
15:22In one way, that is good.
15:23But on the other way, there has to be timelines to investigate whether whatever alleged corruptions is real, or just a misunderstanding between the authority and the hospitals.
15:34Because otherwise, there are some hospitals that may suffer when, in essence, they are actually offering a great procedure.
15:40But when any hospitals or any individual is found culpable with criminality of defrauding social health authority, or defrauding in any other way any organizations,
15:50the law needs to be very severe on these particular persons.
15:53Because that is what has made it possible in developed countries to actually eliminate corruption.
15:58Because when you are found that you are actually trying to mess up with the system of health care to benefit you,
16:05while the rest of the patients or the community are suffering, you need to be dead to it.
16:09Is there any justification then for medical institutions to keep patients against their will when they fail to honor their medical bills?
16:24It is a matter of ethics, and it is a matter that has been conversed in very many forums.
16:29I think the courts have really pronounced themselves on this matter in several instances.
16:34For example, the time that a patient was detained at Nairobi Women's, and the court made it very clear that the freedom of association,
16:42freedom of movement should not be detained because of the cost, or because of inability to pay the cost.
16:48And I think in that judgment, the court, Nairobi Hospital having contravened this particular act,
16:55were told to pay cost.
16:57And from that cost, it covered the medical cost and paid this particular patient.
17:01We have seen other judgments in this regard also.
17:04Even as a union, you've gone to court against Nairobi Hospital when one of the senior professor doctors was detained in the hospital.
17:11Why?
17:12Because during the COVID, he was a psychiatrist, he was sick, and he passed on, and the bills could not be paid.
17:19And the court ordered for the cops to be released for burial.
17:22So ethically, it's not right to detain a patient or anybody.
17:26So do the hospitals have a justification in doing that?
17:29As Secretary General, what do you think?
17:31I'm going there.
17:32But ethically, it is not right, it is not justifiable to actually detain a patient or the body in any of the hospitals in the country.
17:41But as I have explained to you, that the operation costs that are there for hospitals, that are there for both public and private hospitals,
17:51and therefore, when they offer services and you cannot pay and they have no means to get to pay, to get to have you pay,
17:59it means that we are denying services for the next level of patients.
18:03And that's why there is need urgently for this aspect of indigents to work, so that those who can't pay are actually paid for.
18:12There is need for social aid authority, there is components of chronic care to work, so that the public are able to get the services.
18:19There is need for emergency and critical care, because this was not there before.
18:24And you realize that the Constitution provides that every Kenyan has a right to access health care, and even the emergency health care.
18:31That's Article 43.
18:33That then leads back to the conversation then again about funding into universal health care.
18:40There needs to be funding, and also there needs to be a provision that allows these hospitals, the private public,
18:48that when you go there and you get this particular care, and you're not able to pay these insurance at prices,
18:54there needs to be a provision that when you have emergency care, and you are like unknown from anywhere,
19:00you get services, but then the hospitals also get compensated.
19:02Because, yes, the ethic and morality of being detained is wrong, but we have to get a mechanism that hospitals are also compensated for the services they have offered.
19:11There are some people who say, well, yes, I had SHA, and I registered, and I've been paying, and I've been deducted,
19:16and yet somehow my bills aren't covered.
19:20How do you explain that to them?
19:24You know, there are several matrices in social aid authority that have been explained in very many forums.
19:30One thing that I know for sure, the difference in NHF now, and as it was, as a social aid authority,
19:37that in social aid authority, SHARP, immediately you register, you have access to primary health care,
19:45that is level one, two, three, that you will go to any private or public and get a care.
19:49And that's why majority of the populations have gotten the care in those hospitals,
19:53and some of the hospitals are still waiting to be paid.
19:57The other component of it is that in now the SHIFT, Social Health Insurance Fund, which is contributory,
20:05then there's now packages of access to package and benefit,
20:09that you go to the hospitals, and it depends on which hospital you've gone to also.
20:14Because if you go to, like, Nairobi Hospital, for let's say a serial section,
20:20and you go to Nakuru Level 5, or to Kenya National Hospital, the package that's been put there is like $30,000.
20:29So you realize that if you are in Nakuru Level 5, that will serve, will cover.
20:34There's a price discrepancy between the two institutions.
20:37When you go to Nairobi Hospital, they will desire to charge you $100,000.
20:41So the Act provides what's called a co-payment.
20:44Or for 30,000 shillings.
20:46So when you go to that hospital, like Nairobi Hospital, they'll pay that.
20:49But it's now you to top up that, the difference.
20:54That's why if it were that the public hospitals are working effectively as is envisioned,
20:59I don't think there's anybody who will be able to pay any extra in public facilities.
21:04And therefore, that comes to the fact that for a real functional universal health care in any setting that you have seen,
21:11it has robust functional public health facilities.
21:15Because these are geared toward public good.
21:18They're not geared so much into profit margins.
21:21But when you look into Level 4, Level 6, Level 7 status private facilities,
21:27then the costs tend to be much higher.
21:29And that's where that aspect of co-payment comes in.
21:33So from your perspective then, CEO, Secretary General of KMPDU,
21:37you believe in universal health care and SHA and SHIF and the direction in which it's going.
21:44What recommendations or what would you like to see going forward?
21:49We as a union, we would say that we believe in universal health care
21:53and we want it to work into the greater extent that every Kenyan is able to access health care
21:57without really need to worry about finances.
21:59We know that the social health authority has had its challenges,
22:04which we as a union has come out in all different situations to discuss them.
22:10But as now we can see that it's also had its gains and benefits that can be seen
22:15based on the leadership that has there in the ministry
22:18that now is allowing the inputs and the conversations to actually include these changes.
22:23What gaps would you like to see filled?
22:25For example, it is very proper that this matter of chronic health care,
22:30I know they have increased it now to 800,000,
22:32but it is still very crucial that when somebody has oncology or has cancers
22:37and is getting their oncology care, they need to be covered fully beyond the 800,000.
22:43Because I know that some of the costs go beyond that.
22:47That's one thing that is very critical.
22:50I also look into it at some of the packages that there are.
22:54And I am happy that there is Professor Jaoko, who is the chairman of the benefit packages,
23:00that there is need to ensure that these packages are increased to the point that there is almost elimination
23:06of the co-payments in most of the facilities.
23:09But the reality is that that cannot work if majority of the Kenyans are not contributing.
23:17Because, as I told you, health care is not free.
23:20But when we have 30 million or 27 million registered,
23:23and we only have those working, those who are in wages or salary,
23:30about 5 million Kenyans.
23:30It becomes almost an impossibility for these 5 million to carry the 30 million on the back.
23:38So, as a responsible citizens, we also have to look for mechanisms to contribute.
23:43Because when we come out, we just criticize this particular social authority
23:46and saying it is not paying after we go to the services to the providers.
23:50And we are not paying into it.
23:51There is a problem.
23:52And therefore, it cannot work.
23:54And we will be contributing for it not to work.
23:56So, there is also responsibility for us, for Kenyans,
24:00to actually ensure that when we want these pooling funds to work,
24:05then we must be able to contribute.
24:06If you have registered 26 million, then we need to contribute.
24:09Because then that makes it easy for unions.
24:12It makes it easy for civil society, for different bodies to lobby this package
24:17so that it can actually benefit everybody.
24:19That is for the Social Health Insurance Fund.
24:22But on the other side, the primary health care, which is also free,
24:25there is also, which is free, there is need to increase the package,
24:30the money for it, so that once they give the services in these facilities,
24:36the payment is done promptly.
24:37So, I believe those are some of the things that need to be done by us
24:41and by the government and even by the providers,
24:45so that it becomes a joint action to make it work.
24:47But when we have this aspect of only pointing fingers,
24:51then we become part of the problem.
24:53Why?
24:53Because we have here, as we speak, we have the Social Health Authority as the only insurance.
24:58So, we must look into it.
25:00How do we make the government or the authority to increase the packages so that people are covered?
25:05So, there's a responsibility on us to own universal health coverage and embrace it.
25:12Otherwise, it doesn't work.
25:14It doesn't work.
25:14And when it doesn't work, it's a bigger danger.
25:17Because when it doesn't work, it means that the doctors can't work.
25:20Because when you have patients who cannot pay,
25:23then there's no provision of health care that can take place.
25:25Yes, the politicians that, the members of parliament, members of the Senate,
25:30they have a bullet in their hands.
25:32They have the biggest stake in this matter because they make the law.
25:35And also, they have the provisions on the budget.
25:39It's therefore, we coin upon them as the representative of the people to ensure
25:43that there's enough funds in this particular body and there's enough benefit package
25:50that Canadians can actually access the care.
25:52Yeah.
25:52Okay.
25:53You've had, during your time, lots of strikes happen,
25:57in turn striking, and a lot of uncertainty within the healthcare industry.
26:07What is the motivation behind this?
26:10You know, an injustice is something that can never be tolerated.
26:16And arguments that are done by employers, with employers and employees,
26:21must always be respected.
26:23But we are in a country for a long time where you will have arguments,
26:28you will have collective bargaining arguments,
26:31you will have return-to-work formulas,
26:33you will have all the promises that remain very nice and rosy,
26:37but then they cannot be implemented.
26:39So our responsibility as a union is to see to it that every benefit that we have been documented
26:47is implemented.
26:48Like, for example, we had a strike last year that went for two months.
26:53It was on two issues.
26:54We have a collective bargaining agreement that had gone for seven years,
26:58where our salary increment, which was then given 2016, has not been paid.
27:03So to us, it was like, we are seeing many taxes coming up, reducing our payroll in our take-home.
27:12But then we are seeing that we are owed money that has not been paid.
27:16So we came out strongly demanding for that implementation.
27:19I am happy that in December, we got 50% of those arrears,
27:23and in September this year, we also got paid.
27:24We only have a balance of about one and a half years to go,
27:28and we are having engagement on that.
27:30The other thing was on interns.
27:33We have agreed on intern wages, which was slightly higher than what they were earning in 2009.
27:40Yes, $206,000.
27:41$206,000.
27:42Yes.
27:42Which was higher than what they were earning in 2009, which was 2009 earning about $150,000.
27:48And here comes government, with a former minister,
27:51stating that interns do not deserve to earn such wages.
27:54And without consultation, reducing the wages by over 70%.
27:58And that calls for war.
28:00It doesn't call for any reasoning or any discussions,
28:03because even the action of injustice that is being perpetrated did not have any consultation.
28:09And that's why we were on that particular strike.
28:11And most of the time, we go on this strike to ensure that we protect what we have gained,
28:16and we're able to be supported to offer the best care to the patients.
28:22Because when your salary is delayed, when you are not promoted,
28:25when you are overworked without employment of more doctors,
28:29when you can't go on leave, when your salaries cannot be paid,
28:33when such deductions like your loans, your pensions are not guaranteed,
28:37then you are worse than a slave in any hospital.
28:39It means you are a patient, because you'll be at work,
28:43and you're mentally worried whether your house will be locked by the landlord.
28:47You'll be at work, but maybe you can't even pay fee for your children.
28:51You'll be at work, and you have to borrow your cousins and your relatives
28:54to actually bring food on the table.
28:56So it means you are actually a patient.
28:58That's why we are united as doctors.
29:01That to say, whatever deal that you've worked for,
29:04whatever agreements that we have had,
29:06ought to be complied with.
29:07And if not, then we will always action the Article 41 of the Constitutions
29:13that give us the right to strike, the right to protest,
29:17and the right to begin, so that these things are honored.
29:20It's so interesting, as a doctor, a medical professional,
29:23you would imagine that your voice would really be within the medical field,
29:27and yet here you find yourself being a politician,
29:31tackling and butting heads with politicians,
29:33fighting for the rights of those who you represent.
29:36How do you balance that with your profession?
29:40You know, politics is an issue of interest,
29:45and most of the times when we have political conversations,
29:48it's a matter of sharing the limited, so say, economic thing,
29:54the economy, or the existence of interest.
29:57So, when we, but to be clear, we are not politicians.
30:03I am not a politician, neither am I a student of politics.
30:06But the reality is that the policies, the conversations,
30:11and the political class tend to take everything
30:14that otherwise the workers will have.
30:16You realize that the owners of these big industries, the hospitals,
30:20even the government, will ensure that they take all the taxes
30:23while the wages are not looked into.
30:26And that's why we come out and say, no, we must unite.
30:29And in our unity, we must get justice.
30:32That when government increases taxes,
30:34then the wages also must be increased,
30:36so that we are able to actually offer the services
30:39that gives these particular taxes.
30:41When, in private hospitals, when the employers there
30:46have increased benefits, they've made a million dollars
30:50or a hundred millions of shillings,
30:53then it is very important that the wages of these people
30:57who actually generate those profits are also considered.
31:00Yes.
31:00So, politics is a matter of interest,
31:03and therefore we have to come out there and advocate
31:05that our interest to ensure,
31:08and our primary interest to ensure that the patient
31:10who comes to the hospital goes home.
31:12So, our interest to ensure that patients go home
31:14is well facilitated by being paid the right way
31:18and by being supported by the right equipment
31:20in the right place of work.
31:21I understand that,
31:23but there's also a confliction of sorts, right?
31:27You have found yourself on the wrong end of protests.
31:31You found yourself under threat by unknown individuals
31:35based on what has happened when the doctors were striking.
31:39How do you handle that?
31:40Because, like you say, you're not a politician,
31:42but you have found yourself in the throes
31:45of a very politically heated environment.
31:49You know, for you to be elected as a union official
31:51and to represent the people,
31:52there's one thing that's fundamental,
31:55which is called sacrifice.
31:56You must be ready to sacrifice it all
31:58and must be ready to have courage.
32:01And courage means that you living
32:03should be secondary to the work you do.
32:05So, it means that as leaders in the union,
32:08you must be ready to die for this particular belief.
32:11Because I have seen this
32:13and I have a one-hand experience on it.
32:15When the government wanted to reduce the wages of interns,
32:20one thing was to see how to incapacitate the union.
32:24And for that, they will come with fear.
32:27When you're going for protests,
32:27they'll bring the police and try to stop us.
32:29Like, they warn us you cannot protest.
32:31Of course, there's doctors who have reported
32:33being physically threatened during protest times.
32:37Yeah.
32:38Personally, last year, I think I was even shot
32:40during this protest.
32:41But when they realize that these,
32:44the protests and the shootings
32:46and the action does not stop,
32:48then they say, oh, these threats don't work.
32:50Then they go to that aspect of firing all of you.
32:52You need to be fired from work.
32:54But they realize that that's what doesn't work.
32:56They now go to the point of bargaining.
32:58Then that also, they realize,
33:00in this bargaining, they must do what is right.
33:02That's when we get things done.
33:04So that's why I keep on saying that
33:05when we take these positions of leadership,
33:08the conviction of the right thing being done
33:10overweighs us, our personal benefits
33:13of living and of enjoying.
33:15It is that the conviction that the workers,
33:17the doctors, issues must be implemented.
33:19So the threats, the victimizations,
33:22all these other actions do not work.
33:24And that's why we end up having
33:26a progressive outcome for our bargains.
33:30And that's why I believe also in the constitution,
33:32the drafters of the constitution realized
33:34that to change the status quo of events,
33:38there's need of provision for people to unite,
33:40protest, and make it,
33:43make the public institutions
33:44to be responsible and accountable.
33:47And it's not as the politics,
33:50but that's what really drives us.
33:51And the unity.
33:52The doctors get so united.
33:53We may have doctors who don't agree with us sometimes
33:57and act like they are not in the same direction.
34:00But when it comes to the interest of the union,
34:03the interest of our membership,
34:05I will tell you that doctors unite
34:08in the entire country to take a united action.
34:11We will fight as one.
34:12And once we finish the war and gain what we need,
34:15then we can call you being enemies.
34:17So that's one of the fundamentals of our union.
34:20That when an issue is affecting interns,
34:21when an issue is affecting doctors like the one of Kiambu,
34:24which was just happening,
34:25when the issue is affecting the consultants,
34:28when an issue is affecting any one of us,
34:30we must stand all together
34:32so that we can actually protect.
34:34Because if we don't,
34:36then the next victim becomes the next category.
34:39You're really talking about then
34:40the need to restore trust
34:43between the public,
34:45between doctors,
34:46between government,
34:47getting all these people
34:49to believe in what Shah stands for.
34:55How would you encourage that trust to be built?
35:00I believe the current minister on Aden Douale
35:03has done much more
35:04than his predecessors have done
35:06in the short time he has been in the office.
35:09I think it came in in April,
35:11and now we are in the month of November.
35:14And you've not seen us issuing strike notices
35:17or doing protests.
35:18It's not because we can't do that.
35:21It's because there's been conversations
35:22and bargaining and discussions.
35:25It's because whatever we have sat down
35:27to agree with has been implemented.
35:30It's because the proposal that we put forth
35:32are actually being considered.
35:35As I told you,
35:35even in the Australian authority,
35:36we have been advocating for increased packages,
35:40and we are seeing changes in that.
35:41It means that it's a progress.
35:43We have issues of doctor interns.
35:45Last year, we were going on strike
35:46for them to be posted,
35:48and we paid the right wages.
35:50Every year before that,
35:51we were going on strikes and on demonstrations.
35:53But this year, 2025, in July,
35:57we did not have to go on demonstrations
35:58or on strike for 6,000 interns
36:01to be posted in the right wages.
36:03It means that all the actions
36:05that you've seen before
36:06is because of the provocation.
36:07This time, we have the issue
36:10of the doctor's arrears
36:11that were not paid in seven years
36:13that we went on strike for,
36:15being paid in September
36:16without us going on the street.
36:18And now again,
36:19the balance that we are having,
36:20they've called for meeting to discuss them.
36:23So the proactive nature of leadership
36:24in any of these health departments
36:28dictates the conversation with the unions.
36:31But then you see that there's a difference
36:32in the counties.
36:33We have a strike currently on going in Masabit.
36:35We just have a strike notice coming up in Imbu.
36:39We are planning to have action in Mombasa.
36:42We just finished a strike
36:43for 150 days in Kiambu.
36:46So it means, yes,
36:47that as much as the national government
36:50through the minister
36:51is doing what ought to be done
36:53to have good industrial relationship
36:55with the unions,
36:56the counties are not doing the same.
36:58And that disjointed action
36:59is what is causing those particular actions.
37:02Yes, the magnitude of action is different
37:04because now it is purchased
37:06in different counties.
37:07Well, from ministry,
37:09it will be nationally seen.
37:11That's the only difference.
37:12So yes,
37:12it plays a key role in health care,
37:15even in universal health care,
37:16even the WHO pillars of health care,
37:18that we must have good governance,
37:20we must have good leadership
37:21to realize universal health care.
37:24And you're seeing that.
37:25You, I can see that you have hope
37:28and belief in the actions
37:30that the current regime is taking
37:32in strengthening health care.
37:34I mean, they gambled,
37:35but the changes that are made
37:36in the Ministry of Health
37:37are having seeable or visible results.
37:41When we see the new minister,
37:43CS Health,
37:44and when we see the PS Medical Services,
37:49Dr. Omo Luga,
37:50who was my predecessor in the union,
37:52when you see the PS Mudoni,
37:54and when we see the appointments
37:56that they're putting up
37:56in the Social Aid Authority,
37:58the changes of the CEO,
38:01the changes of the claim management,
38:03the employment,
38:04in fact,
38:04the first time we're having
38:05the Social Aid Authority
38:06having many of the technical persons,
38:09the doctors in the authority,
38:11so that at the end of the day,
38:13we don't have the problem
38:15we used to have
38:15whereby the package is very limited.
38:17We want those packages
38:18to be looked into.
38:19And the doctors who are there,
38:20I believe they've been practicing
38:22and they know what it means
38:23to have an efficient package
38:25for patients to access care.
38:27So those are the improvements
38:28that we have seen.
38:29But then this requires an open mind
38:32for discussions with the stakeholders.
38:34They need to engage the unions.
38:36They need to engage the civil societies.
38:38They need to engage different bodies,
38:40even the patient bodies,
38:41so that at the end of the decision
38:42that it's arrived at
38:43is not unilateral
38:45to those who are only benefiting.
38:47It encompasses everybody
38:49that needs to access this care.
38:51There's a young man,
38:5315, 16,
38:54watching this interview of you
38:56and thinking,
38:57I want to be a doctor
38:59just like Mr. or Dr. Devji.
39:02How would you encourage them?
39:03What would you tell them?
39:06The reality is,
39:07I mean, for a long time,
39:08I think even now,
39:10many of the top performing students
39:13in high school
39:14dream of becoming doctors.
39:17And the reality is that
39:19it's a good profession
39:20because while many other professions
39:23have other ways of things,
39:26being a doctor in Isetati
39:28is a vocation.
39:29It's a call to sound.
39:31It's a call to see to,
39:32because every doctor
39:34in every hospital,
39:35their role in those hospitals
39:36is to see to it
39:37that this person
39:39who has come with so much pain
39:41that is suffering
39:41leaves the hospital
39:43walking and happy.
39:44It's the joy of every doctor.
39:46So yes,
39:47I would encourage anybody
39:48who feels
39:49and who believes
39:50that they have a call
39:52to help the humanity.
39:55Some people call it
39:56the doctor's second God.
39:58But in all these,
40:00I must also tell them
40:01when you come,
40:01for you to be called
40:03to offer these services,
40:04you must be well compensated.
40:06You must be well protected.
40:08And that's why,
40:09yes,
40:10it is important
40:11for people to train
40:13to be doctors,
40:13but it is also more important
40:15for government
40:16to see the need
40:16to actually employ doctors
40:19to offer services
40:20in the hospitals.
40:20It is the first time
40:21in the history of this country
40:22that we have doctors graduating
40:24and not getting employed
40:25while we have
40:26a bigger shortage
40:27like never before
40:28in the hospitals.
40:30They now make
40:32the countries,
40:35the developed countries,
40:36the Western countries,
40:38then have to employ
40:39most of the doctors
40:41and most of the nurses.
40:42It brings about
40:43the bigger brain drain.
40:44So when that happens
40:45in its entirety,
40:48it means we are going
40:49to have a country
40:50that needs more doctors
40:52who have been trained
40:52with taxpayers' money
40:53going out of the country.
40:54So yes,
40:55I want many young,
40:58intelligent,
41:00and bright boys and girls
41:02to graduate in high schools
41:05and join the medical professions
41:06and join the union
41:08so that together
41:09we can actually build the country.
41:10in reality,
41:12whatever any young person believes
41:14they want to achieve,
41:15they can achieve.
41:16And they want it to be achieved
41:17together with us
41:18in a country
41:19that we actually
41:20can define its future.
41:22I like that you highlight
41:24that the exportation
41:25of medical labor
41:27which has been ongoing
41:28for quite some time.
41:29You seem to not be
41:31keen on such provisions.
41:34There are two levels of it.
41:36I mean,
41:37when you have the G2G,
41:38the government-to-government
41:39agreement
41:40that is there
41:40between Kenya and UK
41:41regarding nurses,
41:44it has its benefits
41:45but also it has its demerits.
41:48The reality is that
41:49as a person who has graduated,
41:52as a healthcare worker,
41:53you don't need to be unemployed
41:54because you have skills
41:56that when you are unemployed,
41:58you lose.
41:59And therefore,
42:00getting a greener pasture
42:01that will offer you
42:02employment
42:03or practicing the skills
42:04you have anywhere in the world
42:06is a welcome idea for you
42:08because you are able
42:10to use your skills,
42:11you are able to earn
42:11and you are able to live.
42:13But it is not good
42:15for the country
42:15that is highly understaffed
42:18like the African countries
42:20like Kenya now.
42:22Because when we have
42:23the doctor-to-patient ratio
42:24of 1 to 17,000
42:25and we are producing
42:281,000 doctor every year,
42:30it means that we will get,
42:31it will take us 50 years
42:32when we employ every graduate
42:35to reach just the WHO recommendation.
42:38When you look at the countries
42:39like Australia
42:40where they have a ratio
42:41of 4 to 1,000
42:43or the countries like UK
42:46almost having the same,
42:47it's a different matrix with us
42:49because for us,
42:50it's very difficult
42:51to see that particular doctor.
42:52It's very difficult
42:53to get that service.
42:54So yes,
42:55for the country
42:56where there is a shortage,
42:57we need to have
42:58many doctors
42:59who have been educated
43:01by taxpayers
43:01many employed
43:02in the hospitals.
43:03And that's one of our agreements
43:04we had last year
43:05that we'll be having
43:062,000 employment
43:07of doctors every year.
43:08We actually try to push
43:09that with government
43:10because it has to be done.
43:12Because when you don't have
43:14doctors in the hospitals,
43:15we can't even have
43:16the universal health care.
43:17We can't even have
43:18the serial authority working.
43:20We can't have anything happening.
43:21And that's why we are headed
43:22to with counties
43:23because they don't employ.
43:24So the union is then pushing
43:25towards greater employment
43:27of doctors within Kenya,
43:29especially recruiting new staff.
43:32And it should not be only the union.
43:33It should be the media industry.
43:35It should be the unions.
43:36It should be the civil society.
43:37It should be the government.
43:39Because there's no conversation
43:40you can have
43:41about universal health care
43:42or health care service
43:43when you don't have
43:44the health care workers.
43:46And we have seen
43:46most of the counties
43:47doing the brick and mortar activities
43:49which people can see,
43:52but they can't get service.
43:52You'll see a level five hospital,
43:55level six,
43:55that are being now downgraded
43:56by this government
43:57or by the current ministry
44:00and the camp in DC
44:01because they have just been
44:03a shell of institutions.
44:05You've been called level six
44:06or level five or level four,
44:08but there's nothing operationalized
44:10in that facility
44:11that deserves that level.
44:12So downgrading it
44:13brings the reality
44:15that actually they have been
44:17woodwinking the public
44:18at the facilities.
44:20And that's the reality
44:20because governors
44:21do this politically.
44:23So there's need to employ
44:24health workers
44:25in these hospitals
44:26so that there can actually
44:28be health services
44:28in the facilities
44:29and also all other
44:30health care workers.
44:32And this also can happen
44:33if there's budgeting
44:34for annual recruitment
44:35that we're talking about
44:36just like for the teachers
44:37and for the military.
44:39Dr. Devji Yatella,
44:40I am so grateful
44:42for your time with us
44:43on this episode
44:44of Straight Talk
44:45and highlighting to us
44:46not to be hopeless
44:50in the implementation of Shah,
44:52that it is going
44:53in the correct direction
44:54with more implementation,
44:57more investment
44:59in the infrastructure
45:00and hiring
45:01within the medical field.
45:03And we hope to see
45:04that come to fruition
45:05in 2026.
45:07Thank you so much.
45:08Thank you so much, Yvonne.
45:09Thank you so much
45:11for watching Straight Talk.
45:13I'm your host, Yvonne Chekett.
45:14Join us again.