A Kenyan Redcross paramedic packs work equipment inside an ambulance while waiting to be dispatched to pick and transfer COVID-19 coronavirus patients from their homes to the hospitals, in Nairobi on June 3, 2020. (Photo by Simon MAINA / AFP)
To much fanfare, 100 Cuban doctors arrived in Nairobi in 2017.
They were part of an exchange programme between Cuba and Kenya. Cuban doctors were sent to fill some of the gaps in the Kenyan healthcare system and Kenyan doctors would get training in Cuba. Now, six years later, Kenyan health authorities have decided to cancel the arrangement.
Kenya’s healthcare system suffers from a mismatch between patient needs and the care that its diminishing and ill-equipped workforce can provide. A study in 2017 found that there were not enough chest specialists, physicians and emergency-care nurses in the country.
A 2018 assessment of health facilities reported that just 12% of all doctors in the country had the standard items needed to prevent infections, such as gloves, infectious waste storage and disinfectant.
Cuban doctors were billed as the answer to this malaise. The plan was for each Kenyan county to get at least two specialist Cuban doctors — including family physicians, oncologists and surgeons in plastic, orthopaedic, neuro and other specialities.
“Medical diplomacy” has been an essential component of Cuba’s foreign policy for close to 60 years. It routinely sends its health workforce to other countries and receives foreign workers to train.
To date, over 130 000 Cuban doctors have taken part in international missions in more than 100 countries.
In post-apartheid South Africa, following the flight of white doctors, an agreement was signed with Cuba that saw more than 450 Cuban doctors and medical lecturers deployed here between 1995 and 2005.
At the same time, more than 700 South African medical students were enrolled at Cuba’s Latin American Medical School.
Kenya sought to follow the same approach but it did not prove to be as quick a fix as intended. Soon after the announcement of the exchange programme, Samson Misango, a doctor working for the government, filed a lawsuit to bar the Cuban doctors.
He argued that the Kenyan government had lied about a shortage of specialised medical practitioners and that there were many unemployed Kenyan doctors available. The suit was eventually dismissed.
The programme also proved unpopular with Kenya’s doctors’ union, partly because Cuban doctors received double the salary of their Kenyan counterparts.
Then, in 2019, Dr Hamisi Ali Juma, a Kenyan doctor on the exchange programme to Cuba, was found dead in his hostel in Havana. This shone a spotlight on the poor living conditions of doctors sent to Cuba for specialist training.
Kenya’s medical union and parliamentarians called for the programme to be cancelled.
In October, the cabinet secretary for health Nakhumicha Wafula announced that the ministry would not renew the bilateral agreement with Cuba, saying “our very own healthcare professionals are committed to the cause”.
However, the sudden withdrawal of 100 specialist doctors from the health system is bound to have consequences.
When Brazilian strongman Jair Bolsonaro said during his presidency that Cuban doctors in his country could only stay if they took an exam to validate their medical credentials, Havana withdrew them.
Health experts said that millions of Brazilians, most of whom live in remote, vulnerable areas, were subsequently left without healthcare.
After Wafula’s announcement, Kisumu Governor Anyang Nyong’o asked the national government to rescind the decision. “Where will we find replacements for these doctors?”
It’s a good question but the exchange programme with Cuba might not be the right answer.
As of 2021, with 13 376 registered medical doctors, Kenya had 26 physicians for every 100 000 residents. The World Health Organisation recommends a ratio of 100 doctors per 100 000 people.
After six years, the exchange programme had added 100 doctors (for the price of at least 200 local ones) and sent 50 Kenyans for specialist training in Cuba — hardly denting the problem.
The union of Kenyan medics has suggested that the money for the exchange programme should instead be used for scholarships at local medical schools. This is probably a more sustainable solution.
Given that African doctors are leaving the continent in their tens of thousands to find better working conditions overseas, perhaps more needs to be done to keep domestic health workers happy.
This article first appeared in The Continent, the pan-African weekly newspaper produced in partnership with the Mail & Guardian. It is designed to be read and shared on WhatsApp. Download your free copy here.