By Verah Okeyo, NAIROBI Kenya
When in
early July Kenya Health Cabinet Secretary Mutahi Kagwe said 20 Cuban doctors from the
Henry Reeve Medical Brigade had been deployed to Kenya to help the country cope
with the Covid-19 pandemic, he did not give the finer details.
The doctors, after arriving at the
Jomo Kenyatta International Airport with minimal fanfare, joined the other set
of 100 Cuban doctors who have been working in Kenya for the past two years.
Ever since the Henry Reeve Medical
Brigade was constituted by late President Fidel Castro in 2005 to deal with
emergencies and serious epidemics, it has sent thousands of its members abroad
as part of its medical diplomacy – or what is known as “white coat army”.
While the arrival of the new Cuban
doctors once again raised questions about the impact of their 100 plus
compatriots, their terms were shrouded in secrecy.
Members of the more than 7,400
volunteer Cuban health professionals, seen as a positive aspect of the 1959
leftist revolution, are trained in medicine and infectious disease containment
and have been deployed to more than 27 countries, including Kenya.
And now, the Nation has
followed a trail of documents, emails and text messages, and can make public
for the first time, details of the bilateral agreement.
The deal that was signed between
Kenya and Cuba commits Kenyans to paying an estimated Sh1 million every month
for each of the 100 Cuban doctors. This is equivalent to the pay of five Kenyan
medical officers.
Cuba uses its doctors as a source
of hard currency and the Kenyan agreement is no exception.
At the time of signing the
agreement in October 2018, then-Health CS Sicily Kariuki refused to make public
the details of the agreement even though the importation of doctors was being
paid for by Kenyan taxpayers.
“This is a bilateral agreement
between the Government of Kenya and Cuba that cannot be wholly shared with the
public,” she told this reporter.
However, the Nation was
able to get a copy of the agreement, which shows that the government committed
to paying each of the doctors a monthly stipend of USD1,000 (Sh107,000 at
current exchange rates) while an extra USD4,000 goes to the Cuban government
for each of the doctors. This was equivalent to Sh396,000 as at June 2018 when
the contract commenced.
The amount at the current exchange
rate is Sh428,000. The money is paid into the Cuban government-held bank
account at the Banco Financiero Internacional S.A, Havana. Deposits are made in
euros based on the exchange rate at the time of payment.
The additional 20 doctors, who
arrived in July to offer clinical support against Covid-19 pandemic, will be
paid as their local counterparts, said CS Kagwe.
Under this agreement, the
government is responsible for providing accommodation, furniture, kitchen
appliances, kitchen utensils, electricity, water and cooking gas for each of
the doctors. These costs are borne by the county governments where the doctors
are deployed.
Dr Andrew Mulwa, the chair of
counties’ health executive caucus and health executive in Makueni, explained
that the county governments provide the Cuban doctors with furnished apartments
because they do not get house and commuter allowances.
“We give them furnished apartments
and facilities such as cookers, electricity, washing machines, water and
internet access, but we do not run their households, and they will leave
everything when their contracts end,” said Dr Mulwa.
In Kenya, entry-level doctors get,
among other allowances, Sh6,000 for commuter allowance and Sh15,000 as house
allowance. In July, the Salaries and Remuneration Commission also published its
revised salary guidelines for health workers in devolved units.
The money paid for the 100 Cuban
doctors in Kenya is at least Sh830,000, not counting the cost of living
expenses. Keeping one Cuban doctor in Kenya, therefore, costs close to Sh1
million, which translates to Sh1.2 billion for the 100 of them, for a year.
This amounts to Sh2.4 billion since 2018 when the doctors landed in Kenya.
Under the contract signed on March
20, 2018 between Ms Kariuki and the Cuban Minister for Public Health, Dr
Roberto Thimas Morales Ojeda, the government is required to provide the doctors
with newspapers and internet — as well as the costs of their attendance at
scientific events to encourage their “professional development”.
While the government also committed
to offering security to doctors deployed in insecure areas, two of the doctors
sent to Mandera — Assel Herera Correa and Landy Rodriguez — were kidnapped in
April last year by suspected al-Shabaab militia who demanded a $1.5 million
(Sh150 million) ransom.
The kidnapping led to the
withdrawal of Cuban doctors deployed to counties bordering Somalia such as
Wajir, Garissa, Tana River, Lamu, Isiolo and Taita-Taveta.
In other counties, the doctors have
opted to commute from the urban centre nearest to the hospital where they work.
For instance, doctors assigned to Msambweni hospital in Kwale commute daily
from Ukunda and have had their security enhanced.
While healthcare workers, including
specialist doctors, who work under county governments do not have health
insurance, the Cuban doctors are provided with a “comprehensive” medical cover
under the National Hospital Insurance Fund (NHIF).
The head of registration and
compliance, Mr Robert Otom, said the Cuban doctors are insured under the Public
Service Commission, and enjoy a comprehensive medical insurance cover. The
monthly premium for civil servants in Job Group S is Sh200,000, which is what
the government is paying for each of the doctors.
The insurance cover provides the
doctors’ access to more than 50 services broadly categorised as inpatient,
outpatient and laboratory services, including medical evacuation if required.
Outpatient costs are unlimited,
with a minimum threshold set at Sh100,000, while Sh300,000 is the minimum
threshold set for in-patient costs. The dental and optical cover is capped at
Sh50,000 and Sh40,000 respectively.
Health insurance has been a source
of contention and frequent industrial strikes, the most recent being this
August when health workers went on strike over delayed salaries, inadequate
personal protective equipment (PPE) for handling Covid-19 patients and lack of
medical insurance.
The NHIF claimed only 15 of the
county governments provided comprehensive medical insurance cover for their
medics.
Doctors—human and veterinary—are
the only county officers that are not insured; they constitute two-thirds of
the workers deployed to the county governments after these services were
devolved.
The government also pays for the
Cubans’ professional indemnity — the insurance cover taken by doctors to take
care of legal fees and penalties that may arise from medical malpractice claims
filed against them.
Dr Were Onyino, the chair of Kenya
Medical Association (KMA), said this is a legal requirement for any doctor who
wants to practise in Kenya. Dr Onyino said Kenyan doctors, including those
working in public hospitals, have to pay for this insurance and receive no
subsidy from the government.
The Nation could not ascertain how much the government pays for the
indemnity, but the rates from Britam, one of the insurance companies that offer
this cover, offers an insight on the minimum and maximum that Kenya pays.
Britam has three levels of
insurance cover for doctors including non-members of the Kenya Medical
Association, the national association of doctors and dentists which seeks to
promote the quality practice of medicine in Kenya.
Group A category is for specialists
such as surgeons, gynaecologists, anaesthetists, urologists and oncologists.
There are 47 specialist doctors from Cuba who fall in this category. The
monthly premium for non-KMA registered doctors ranges between Sh14,605 for the
minimum insurance cover of Sh1 million and up to Sh95,468 a month for
specialists who take the maximum indemnity cover of Sh60 million.
Paediatricians, dentists,
pathologists, radiologists and endocrinologists (specialists in glands and
hormones) are grouped in Category B and monthly premium payments range from
Sh8,277 for Sh1 million indemnity cover to Sh83,414 for the highest cover of Sh60
million. Out of the 100 Cuban doctors, four are radiologists. The 47 general
physicians and two dermatologists from Cuba fall in the low-risk category C.
Professional indemnity insurance
cover ranges between Sh1 million and Sh60 million and monthly premiums range
between Sh7,473 and Sh68,346 respectively.
Apart from medical insurance and
housing, the government is also paying for air tickets back home for holidays
or a one-way ticket home in case of disciplinary action against any of the
doctors.
Kenya agreed that the doctors would
only work 40 hours a week, from Monday to Friday (a maximum of eight hours a
day) and one 24-hour shift a week. Any doctor who works during days designated
as public holidays in Kenya and Cuba is compensated with an equivalent number
of days off.
In return, Cuba provided Kenya with
documents to certify the qualifications of their doctors and assured the
government of an “obedient” workforce.
