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This is truly a consequential Strike-A political analysis by Elesban Kihuba:

The purpose of this article is to examine the political landscape and the challenges associated with our industrial action. Health systems are organized nationally, but its trends are truly global. The Government and the Professional Organizations are some of the key stakeholders in the health sector. Their interactions, backstabbing and mistrust produce the forces that mould a countrys health system. KMPDU is set for a bruising second industrial action. This is a tell tale sign of a sector suffering from poor stewardship and may be inadequate leadership. We are well into our 2 nd week of our industrial action. The stakes are very high. Either we (KMPDU) win and restore dignity to our medical profession or we lose everything. Every man and woman who has fairly earned a degree in medicine/surgery/pharmacy is first and foremost a member of the medical profession and then a civil servant, an employee or a member of the private sector.

Administrative Structure:
The table below illustrates some of the key administrative organs that the union will deal with directly or indirectly:

Office Minister of Health

Function -Policy direction, monitoring implementation.

Authenticity of decisions taken during the Industrial action

Policy -Not transparent, the office has and restricted a lot of information on the true state of public hospitals in the country during the strike. -Principal assistant to the President (One of the -Medical licenses are issued to principal) in the day to qualified medical professionals by day running of the independent government agencies run Ministries. by the professionals. Its part of a selfregulatory mechanism in the medical profession. -Accounting Officer at the -Suspension of the doctors ministry advised and malicious. is ill

P.S

-Administration of Human -A fair disciplinary proceeding is yet to


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resources in the Ministry

be carried out and a court order is yet to be issued to warrant such an extreme measure.

P.S.C

-Responsible for _ appointment, promotion and discipline of civil servants, particularly those above JG L. _ Authority to determine a disciplinary case falls under the P.S.C.

Contentious Issue:
THIS WILL BE DISCUSSED BY THE SGC THIS THURSDAY.

Players:-Interests and Position:


We cannot take politics out of the Health system; health sector decisions are politically problematic. Politics is a dirty game and we (KMPDU) must be ready to get our hands dirty. While at face value the industrial action seems to pit the KMPDU against the Employer, the reality is that there are many political players in this game. The Union, among other demands is calling for a change in the way postgraduate training is conducted against a backdrop of resistance from the main actors (teaching hospitals and Employers) who are comfortable with the status quo. Some of the stakeholders that we might encounter in our journey include: Table: Showing the positions taken by the stakeholders: High Suppo rt Mediu m Suppo rt KMA. Senior Drs/Consulta nts. Low Support Non mobilized Low oppositi on Medium Oppositi on KNHDirector. MTRHHigh Oppositi on MinisterMOMS.

KMPD U.

Universities. AG office. President. COTU.

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Media. MinistryLabour. Citizens. Political Parties. Parliamenta ry CommitteeHealth. Consumer Organizatio ns. NGO.

Director. Head of Depts.

Key: Red=High Power, Green font=Low Power and Blue font= Medium Power.

The reaction of these players will depend on their interests and power. Some of the explanations for their position include: Office of the Minister of Medical Services -opposed to any tangible health sector reforms. As a result the Union has moved in to fill in the gap. A tinge of arrogance or poor understanding of the health system could also be at play. Technocrats -Not in touch with the current wave of change in the Kenyas Medical Profession. KMA- Largely ambivalent. Universities - Concerned that their College admission powers might be curtailed or fees might be slashed. KMPDU- will undergo a major transformation in its role (in the health sector) if it wins.

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KNH/MTRH- Not autonomous and powerless. They were unable to handle a local issue which has now grown out of proportion. Ministry of labour/Presidency institution/Political parties/Parliamentary Committee- their deafening silence is a clear sign of lack of political support.

Opportunities and Obstacles:


A quick analysis of the dispute indicates the following:

KMPDU-Has ample financial strength and membership to paralyze hospitals services in the country. They also have a clear vision on how to reform the health sector. The broad Health Sector actors- There are consensus that the health system needs improvement. Particularly the post graduate training which is only offered from the 2 national Hospitals. This has resulted in misdistribution of Medical doctors whereby more than 15% of the doctors working in the public sectors have been allocated to these 2 institutions. Universities are charged with production and distribution of knowledge. Higher number of students means better business and influence in the sector. Union leadership (may be membership) has been tagged as juveniles who are too impatient and egocentric. Presence of multiple factions in the union with differing (/conflicting) interests. A crowded in-tray (Union). Poor choice of political language.Implementation of RTWF/Musyimi report irrespective of its accuracy is vague and problematic for most stakeholders to grasp.

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Stagnation of the economy. The Country is preparing for an election. Lack of political support (any promises from the political offices (read ministrys officials) should be taken with a grain of salt). Political feasibility- is poor. Impudent misrepresentation of doctors issues/views by those in power(if the recent cabinet meeting is anything to go by) Impending evictions from the government/KNH houses and Salary stoppages.

Strategies that can be employed:


1. Make deals: With stakeholders who have shown low or medium support to strengthen their support. With those who are opposed to us to soften their position.

2. Threaten the withdrawal of hospital services in totality. 3. Improve access to the media. 4. Create a perception that the other party has refused to dialogue. 5. Play victim status (postgraduate training-80 hours without pay, they offer free service which is in turn charged exorbitantly by KNH/MTRH). 6. Demobilize neutral players 7. Engage the government directly- Get rid of any middlemen. 8. Create the perception that the solution is straight forward and cheap. (Disassociate registrars payment from self sponsored masters students tag- who are meant to cater for their upkeep). 9. Simplify our demands- and maybe get a slogan. 10. Get rid of the court process and refer the matter to Ministry of Labour.
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11. Get our hands dirty and occupy Afya house and organize for protests. 12. Display the real costs to tax payers/patients occasioned by government inaction. That the Ministrys decisions are unfair to the society and deny Kenyans the right to health. 13. KEEP THE TROOPS (ALL DRS IRRESPECTIVE OF AGE) UNITED.

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