By Samwel Doe Ouma
Shortage of qualified specialists and sub specialist doctors in the country is complicating government push to attain equitable and accessible health provision for all.
According to Paediatric Gastroenterologist Dr Polycarp Mandi there are seven paediatric gastroentologists in the country, five based in Nairobi and two others in Mombasa and Eldoret.
“Specialist units such as paediatrics, internal medicine, gynaecology, surgery, orthopaedics, ophthalmology, Ear Nose and Throat specialists (ENT), psychiatry, diabetes units and rehabilitation centres are majorly based in cities and towns making access to care a challenge to many patients.”
Geographic distribution and availability of human resource has been a challenge, with over 80 percent of the health work force working in urban and semi-urban areas, exposing rural Kenya to immense shortages.
Paediatric Gastroenterology, Mandi explains, is a branch of Paediatrics dealing with disorders of the digestive system from the mouth to the oesophagus, stomach, small intestines, large intestines and the anus. It also includes the liver and pancreas, he said.
He added that the area is broadly divided into three areas, Gastroenterology focusing on the digestive tract, Hepatology focusing on liver disorders and Nutrition dealing with nutrition related issues in children.
According to the World Bank, Kenya has an estimated population of 49.7million with an average population growth of one million per year, a median age of 19 and a high fertility rate of 4.4 children per woman.
The statistics point to the increasing need for paediatric gastroenterologists treating new-borns through to teen years.
According to Mandi, a paediatric gastroenterologist has specialised skills and ability to diagnose, treat, and manage digestive disorders in infants, children and teenagers.
He explained that as a subspecialty of paediatrics, gastroenterologist training is offered after completing specialist training in paediatrics. The fellowship training is a 2 year apprenticeship in a gastroenterology unit.
“Health challenges facing the country are diverse and ever changing. Training and up-skilling are needed urgently. Similarly, career planning for existing workforce at all levels needs to be relooked.”
Mandi points out that paediatric gastroenterologists training is not available locally forcing Kenyan graduates to travel overseas to pursue specialty training. Similarly, training in super specialties in both the public and private sector remains low.
He said common conditions and diseases treated by paediatric gastroenterologists vary in the digestive system and with age of the child.
“Common paediatric gastroentological problems are related to gut motility such as constipation and regurgitation. Chronic abdominal pain, most of it of unclear nature is also common. In infancy, liver related consults are more common,” he said.
Some of the risk factors and causes of digestive ailments are varied and age related. “So while infection related problems would be seen throughout childhood, metabolic disorders mostly manifest in infancy. Food allergies are also seen earlier in infancy when weaning begins,” he explained.
According to Mandi, the major challenge facing the country is the large doctor to patient ratio, making it difficult to cope with the referrals.
Currently, there are 2,204 active medical specialists out of 2,711 that are registered by the KMPDB to serve a population of 49.7 million.
Kenya has deficit of 40,332 doctors in view of the World Health Organization’s recommended 1:1000 doctor-patient ratio.
He says the medical equipment leasing plan meant to make specialized diagnostic equipment available in peripheral hospitals was not accompanied by appropriate capacity building, compounding situations where specialised equipment is available but no trained personnel to use them.
He said diagnostic capabilities have been unable to keep up with new advances in the field. This is especially so in the public sector.
“On many occasions laboratory samples have to be sent abroad for testing. We are still having to send patients abroad for further treatment due to lack of trained personnel.”
Mandi said devolution of healthcare was a good idea, as it was meant to bring health services closer to the people. If properly implemented he says it would help manage congestion and thus delays in the major referral hospitals.
In 2013, sub-Saharan Africa had a deficit of an estimated 1.8 million health workers, according to a WHO report—this deficit is projected to rise to 4.3 million by 2035. There are a number of reasons for the shortfall, including a lack of funding for education and training, international migration and career changes among health workers, illness, premature retirement, and even premature deaths.