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Deployment of Cuban doctors to Kenya is facing headwinds after governors rejected the majority of those nominated in the second batch.

Although the Ministry of Health is putting on a brave face, the stalemate could scuttle a noble deal meant to increase the doctor-to-patient ratio. Governors are said to have demanded a specific cadre of doctors, leaving the agreement in the balance.

The county chiefs, through the Council of Governors, are said to have rejected the majority of doctors sent to Kenya by the Cuban government.

They are insisting on specialised doctors such as colon and rectal surgeons, critical caregivers, urologists, endocrinologists, neurologists, gastroenterologists, haematologists, geneticists and orthopaedics.

Cuba is said to be reluctant to release these specialists.

Week-long efforts to reach the chief executive officer of the CoG, Mary Mwiti, for comment did not yield any fruit.

List of demands

“It is true that the CoG presented to the Ministry of Health a list detailing the cadre of doctors that it required. What is the use of bringing a general practitioner all the way from Cuba when we have them around? The CEO will respond to all the concerns you have raised,” said the CoG’s communications director, Yvonne Ogwang. She said the CEO would get back to us later.

In the second phase of the agreement, Cuba was to dispatch 101 doctors, mostly primary healthcare specialists.

The contract of the first cohort of 100 elapsed in 2021.

Addressing journalists in September 2021, Health Cabinet Secretary Mutahi Kagwe said Kenya would bring in family medicine doctors to strengthen its primary healthcare system.

The initiative was part of a medical exchange between Nairobi and Havana, which saw about 50 Kenyan doctors sent to study in Cuba.

The 50 doctors returned to Kenya last year after a two-year study in the Caribbean island nation. They have already been distributed to various counties.

Health Chief Administrative Secretary Rashid Aman, who has been coordinating the arrangement, downplayed the stalemate, saying the government would address the concerns raised by governors.

“Most counties gave us new conditions, mostly on the cadre of specialists they prefer. We expect to have sorted out the problem in a few month,” Aman said.

He disclosed that Cuba has so far dispatched 74 doctors and that the Ministry has dispatched at least one doctor to each of the 47 counties.

An additional 17 doctors have been identified by the Cuban government following a request by Kenya on the specialists required.

Aman said the Cuban government has been reluctant to release some specialists owing to the Covid-19 pandemic, but that negotiations are progressing well.

“Cuba was forced to review deployment of its medical personnel to foreign countries due to Covid-19. Most countries are not able to release specialists like those dealing with critical care, cancer, pulmonologists, nephrologists and orthopaedic surgeons,” Aman says.

But other sources said most hospitals lack the equipment needed by such experts. Also, some of the specialists in the first batch ended up being under-utilised at Level 3 and 4 hospitals which lack basic facilities such as radiology, theatres, CT scanners, mammography and dialysis machines.

A case is cited of a county in Western Kenya that insisted on having a gastroenterologist who was eventually posted to a Level 4 hospital that did not have endoscope facilities such as gastroscope, colonoscope, side-viewing endoscope and enteroscopy.

Another county in North Eastern demanded an oncologist, whom it ended up posting to the only high level hospital in the area that lacked radiology, chemotherapy and biopsy tools.

A county in Eastern Kenya that sought an orthopaedic surgeon who was sent to a hospital with only one small theatre that was busy with obstetrician patients (mostly expectant mothers).

 Essential equipment

“Some demands by the counties are quite unnecessary unless they put in place the necessary infrastructure. We don’t understand why some counties that lack essential equipment are demanding for specialists,” said a member of the Kenya Medical Practitioners and Dentists Council.

Also, some counties have failed to meet their obligations such as provision of houses, security, transport and other basic facilities. A report compiled by the Ministry states that some doctors were staying in hotels against their wishes.

The report also faulted counties for underutilizing primary care doctors by not allowing them to carry out outreach programmes at the grassroots. Instead, some doctors were sent to Level 4 hospitals where their services were not essential.

Under the bilateral agreement, the foreign medics should be allocated furnished homes, air fare for holidays, paid utilities and transport, on top of their salaries. The national government caters for their Sh400,000 monthly salary, leave travel expenses and insurance cover, while the counties provide the other essentials.

Despite the challenges faced, Aman said the Cuban doctors played a key role in primary health care in rural areas shunned by Kenyan specialists.

“Most of our doctors, particularly specialists, prefer urban areas where they make good money,” said Aman.

He dismissed claims by some governors and KMPDU that some Cuban doctors were substandard.

“The government, in consultation with KMPDC and the CoG has a committee that flies to Cuba to identify the doctors required. And before those doctors are allowed to practice in Kenya, they are peer reviewed by experienced medics,” he affirmed.