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County Bias in Hiring of Diploma Holders Will Ruin The Health Sector

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Health professionals with degree qualifications in medicine, dental surgery, nursing, and pharmacy are set to miss out on employment opportunities in public hospitals if a recent trend by county governments to prefer diploma holders during hiring will persist.

A March 9th advertisement by the county government of Nyamira in the Daily Nation newspaper is the latest hiring by a devolved unit that appears to have sidelined degree holders in the field of health. Out of the 110 slots that were advertised, only three were allotted to medical officers representing 2.7% while clinical officers had 12 (10.9%) vacancies.

According to the advert, 5 (4.5%) Pharmaceutical technologists, 40 (36.4%) diploma nurses and 2 (1.8%) community oral health officers are set to be recruited in the Nyanza-based county. Their degree counterparts were not listed at all.

In the past 5 years, the counties of Uasin Gishu, Kajiado, Samburu, Elgeyo Marakwet, Narok, Bungoma, Kisii, and Nyamira have employed a paltry 41 doctors.

Consequently, rates of unemployment among university graduates in medical courses have shot up. A recent report by the Kenya Medical Practitioners and Dentists Union (KMPDU) indicated that about 4,000 doctors are jobless and there is no hope of securing employment soon as long as the skewed recruitment continues.

The only plausible explanation for this change of policy is the unhealthy desire for cheap labor which diploma holders are more than willing to offer because they are also being churned out massively by medical colleges in Kenya. Desperation for employment among these graduates has made it easier for counties to subject them to mean salaries and unconducive work environments.

In the clinical areas, these employees are often forced to perform responsibilities that are beyond their scope of practice due to an artificial shortage of doctors, dentists, pharmacists, and nurses. For instance, clinical officers have been reported to conduct cesarean sections in some health facilities, a function that is not included in their 2010 scheme of service. As a result, patients’ lives are put at risk or at the very least debilitating complications according to research.

Clinical officer-led cesarean sections have been found to be associated with an increased risk of wound infection and dehiscence which can significantly hamper the healing process according to a 2011 systematic review that collated research studies conducted in developing countries within the Sub-Saharan region.

Another article published in the Daily Nation newspaper on March 05, 2023, pointed out that hospitals blatantly ignore regulations “by allowing pharmacy technicians to do a job that does not fit their bill.” This can increase the risk of medical errors.

In the same article, findings from a study conducted by the Young Pharmacists Group (YPG) showed that dispensing of drugs in 70% of Level Five hospitals was being done by unqualified personnel.

Degree nurses who possess a wealth of knowledge in the care of patients and management have also largely been ignored despite undergoing rigorous training of five years inclusive of a one-year mandatory internship.

Substitution of top-level workers with mid-level workers not only compromises the quality of care but also contravenes standards of practice set out by various professional regulatory bodies.

Besides that, unemployment often leads to depression with some cases ending in suicide. It also fuels brain drain as disgruntled graduates seek better opportunities abroad denying Kenya the much-needed manpower to ameliorate the worsening health crisis.

Most importantly, county governments need to realize the critical nature of the health docket and the need for competent and adequate human resources. The citizenry deserves the best attainable care and that can be achieved when the right person performs a job they are licensed for.

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