The Sustainable Development Goals (SDGs), officially known as ‘Transforming our world: the 2030 Agenda for Sustainable Development’ is a set of seventeen aspirational “Global Goals” spearheaded by the United Nations, through a deliberative process involving its 194 Member States [1]. In bringing to light it’s development agenda, the Government of Kenya in September 2016 launched the national implementation plan for the Sustainable Development Goals, and expressed commitment that ‘no one will be left behind’ in the economic and social prosperity of the country[2]. The SDGs consist of 17 goals, the third being “Good Health and Well-being – To ensure healthy lives and promote well-being for all at all ages”. The SDG of “Good health and well-being” makes a bold commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030. The aim is to achieve Universal Health Coverage (UHC), and provide access to safe and affordable medicines and vaccines for all. Supporting research and development for vaccines is an essential part of this process as well [3].

In August of 2016 during the closure of Universal Health Coverage in Africa forum held at the Kenyatta International Convention Centre (KICC) the Deputy President of Kenya William Ruto said that Kenya had stepped up efforts geared towards the attainment of universal health coverage in the country. He added that the government was to increase spending in the health sector, aiming to improve service delivery systems for primary, secondary and tertiary healthcare [4]. Such investments were hoped to continue to yield visible results including improved availability of quality healthcare services, enhanced equity in accessing and utilizing primary and specialized medical care, and affordability of services. Despite this, the DP admitted that notable progress towards UHC still meant more needs to be done. The government, he said, was determined to mobilize additional domestic resources to realize the target of at least 15 percent of Government spending.

UHC by definition is based on the principle that all individuals and communities should receive the quality health services they need without suffering financial hardship. Principally, it embodies three related objectives [5]:

i. Equity in access to health services – everyone who needs services should get them, not only those who can pay for them;

ii. The quality of health services should be good enough to improve the health of those receiving services; and

iii. People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm.

The World Health Assembly resolutions on UHC urges member states to continue as appropriate, to invest in and strengthen the health-delivery systems, in particular, primary health care and services; adequate human resources for health (HRH); and health information systems; in order to ensure that all citizens have equitable access to health care and services [6]. The seminal role of HRH in the attainment of health-related goals has long been recognized and was recently reaffirmed by the United Nations General Assembly, which identified the need for “an adequate, skilled, well-trained and motivated workforce” to accelerate progress towards UHC [7]. Any shortage of health workers can prevent good access to health services and is a barrier to universal coverage. When such shortages are accompanied by an unequal distribution of the workers, their impact can be even more dramatic.

Lack of access to health workers in rural and remote areas often leads to relatively high mortality rates in such areas. It also leads to rural residents seeking care at urban health facilities and thus to overcrowding – and increased costs – at urban hospitals. The relatively higher levels of staff in urban areas and facilities may lead to the underutilization of skilled personnel, who may then consider emigration. Low- and middle-income countries usually report a dearth of adequately trained and motivated doctors and nurses. ‘Brain drain’ situations prevail in developing countries and workers often migrate to high-income countries in search of better wages [8].

Various solutions to this problem have been discussed at high level meeting in the WHO forums, including financial incentives such as special geographical allowances, and other incentives related to job satisfaction such as multi-skill training, and task shifting. Findings from European sub regional workshops organised by WHO indicate that the recruitment of health workers to remote and rural areas and their retention in such areas has been promoted by a range of policies covering education, regulation and financial, professional and personal support [9]. As the health workforce is central to sustainable health systems, WHO recommends that countries should take effective measures to educate, retain and sustain a health workforce that is appropriate for the specific conditions of that country, including areas of greatest need, and is built upon an evidence-based health workforce plan. It also recommends that countries should strive to meet their health personnel needs with their own human resources for health, as far as possible.

During the first Kenya Medical Practitioners’ Pharmacists and Dentists Union (KMPDU) industrial action of December 2011 a committee was formed and chaired by the then Minister for Finance (now President), Uhuru Kenyatta. Concessions on both sides led to a return-to-work formula that promised further discussions between various Government sectors to work out a long-term plan that would address the problematic HRH issues, particularly those affecting doctors. It is from these subsequent discussions that the KMPDU Collective Bargaining Agreement (CBA) was born [10].

The KMPDU CBA is an agreement that was negotiated between the Ministry of Health (MoH) and the KMPDU. It regulates the terms and conditions of doctors in the Public Healthcare sector, their duties and that of their employer. This agreement was signed on the 26th of June and was to be effective from the 1st of July 2013 [11]. The CBA addresses the needs of HRH in Kenya in the following ways [12]:

1) Shortage of doctors: The MoH shall employ at least 1200 doctor per year for the next 4 years to reduce the current understaffing in public health facilities;

2) Skilled and well-trained workforce: All doctors employed by the government shall be eligible to sponsorships for postgraduate training and bonded in government service in accordance with the provisions of prevailing training policies;

3) Motivated workforce: a consensus proposal for a salary was agreed upon with higher allowances given to doctors working in hardship areas;

4) Equally distributed workforce: The union recognized the MoH’s right and duty as an employer to deploy officers to all corners of the country as needed;

5) Professional and Personal support: Every doctor shall have a right to present their grievances free from interference, coercion, restraint, discrimination or reprisal.

Concerning the welfare of medical personnel, it is the position of the Cabinet Secretary (CS) of the MoH of Kenya, Dr. Cleopa Mailu that “The welfare of medical personel is critical and the single most important ingredient for provision of health services.” He further added the need to insure the ability to train, sustain and maintain key personnel in the country. This function, he said, cannot be left to the Counties alone. While further addressing the issue of ‘brain drain’ of health workers, he added that better working conditions is the ultimate solution [13].

It is very unfortunate that months into a national doctors strike, in light of all of the deliberations to solve the problem of HRH with a very clear proposal on CBA implementation by the Union, there is little commitment from Government to implement it. Implementation of the CBA is an action that would help both doctors and members of the public who have remained victims of a dysfunctional health system finally get to realise the vision of good health and well-being for everyone [14].

Dr. Hassan, Ahmad Mkuche

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REFERENCES
[1] United Nations official document 11 Oct 2016

[2] UNDP in Kenya Press release 2016 ‘Leave no one behind’.

[3] Goal 3: Good health and well-being, UNDP, retrieved 28 September 2015

[4] The Star News article 28th August 2016 “State on right path towards universal health coverage

[5] WHO Health Financing UHC Definition

[6] WHO Sustainable health financing structures and universal coverage

[7] WHO HRH coverage: from evidence to policy and action.

[8] Early implementation of WHO recommendations for the retention of health workers in remote and rural areas

[9] WHO/World Bank Ministerial-level Meeting on Universal Health Coverage 18-19 February 2013 WHO Headquarters, Geneva, Switzerland

{10} Dr. Wafula Nalwa- KMPDU member

{11} Dr. Steve Nigel- KMPDU member

[12] KMPDU CBA 2013

[13] Expert from MoH policy manual

{14} Dr. Ouma Oluga- KMPDU Secretary General