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The wealth of a nation is directly linked to the health of its population and vice versa. The same also goes for households.

In rich countries, citizens have higher life expectancy at birth and after the age of 70 because they have in place health systems to eradicate respiratory and diarrheal diseases, the biggest killers of children from poor countries and households.

They have also invested in medical technologies that mitigate against preventable conditions that increase say, maternal mortality or death from trauma, such as road crashes.

In addition, they have invested considerable knowledge, systems and technologies that support medical care for senior citizens. 

The reverse is true in poor countries that still struggle with diseases such as malaria, which rich countries eradicated over 100 years ago.

Because of historical under-investment in healthcare, poor countries have been unable to control or eradicate diseases such as pneumonia, a leading cause of child mortality in Kenya.

It is common in public health institutions for underweight infants with pneumonia to share incubators with other preterm babies.

In poor countries, just as in poor households, a large proportion of gross income is consumed by food and medication- and not just for the nuclear family but also for dependents of bread winners.

And this is at the heart of the problems Kenya is currently facing with its doctors and nurses, who are on strike to demand higher pay, to be removed from the control of devolved governments and to belong to an independent institution that can take care of their welfare as a collective.

In poor countries, children are encouraged to work hard in school so that they can become doctors or lawyers- the dream professions among poor parents who believe these jobs are the surest tickets out of poverty.

As a result, children work hard and spend many years studying medicine, only to realise upon graduation they have won a pyrrhic victory.

Indeed, although doctors’ salaries are way above basic minimum wage, they are often not commensurate with the years of investment in knowledge accumulation.

This problem is further compounded by the fact that annual salary increments, especially in the public sector, are routinely below inflation.

If, for example, inflation rate is seven per cent and annual increment is five per cent, the increment is not sufficient to meet the higher cost of living.

This, again, is the leading cause of exponential growth in digital loans. Only last week, financial sector data indicated that banks have been going easy on these loans, first because default rates are rising and because borrowing has grown worryingly in the wake of reduced incomes arising from the shocks induced by Covid-19.

If a medical professional, who also happens to be the primary breadwinner in his family, falls sick, the income stops flowing; he stops paying his loans; and his family slides into poverty.

If, by God’s grace, he remains healthy, but a close relative falls sick, his household’s income and savings will be diverted to combat the illness, largely because health insurance remains dismally low in Kenya, with less than five per cent of the population having  any cover.

The challenges such a professional faces are made worse by the fact that income scales have been distorted by forces outside the money market.

In Kenya, for instance, legislators set their own salaries and allowances without considering how much revenue the country collects and what other productive sectors of the economy pay.

As a result, everyone else in the world of work feels compelled to demand higher pay to reduce the income inequalities.

Considering these two main factors, it is a no brainer that health sectors workers are using the pandemic as leverage to push for higher pay, regardless of what courts say about the legality of their actions.

The only downside is that by going on strike, they will be denying services to citizens at the bottom of the economic pyramid who cannot afford private healthcare and whose average income is less than Sh10,000 in towns and Sh3,000 in rural areas.

For such people, it is a conundrum that a doctor with an average salary of Sh250,000 can deny them services to demand higher pay.

— The writer is a partner and head of content at House of Romford      — [email protected]