In thinking about the optimum use of human resources in our country, it was natural to let our thoughts go to professional societies and to the role they play in this process. WAJIBU therefore talked with Mr. Job Kihumba, the Executive Director of APSEA (Association of Professional Societies in East Africa). We also interviewed Dr. James Nyikal, the then chairman of the Kenya Medical Association. You will find their thoughts below. (A few days after the interview took place Dr. Nyikal was appointed the Director of Medical Services in Kenya and resigned as chairman of KMA). The interviews were conducted by the Editor of WAJIBU.

WAJIBU. A professional society has two roles: one is the setting of standards, the other is to ensure compliance with those standards on the part of its members. We have two questions with respect to this. One, how do professional societies in Kenya see to it that their members measure up to international standards?

KIHUMBA. It is both our expectation and our concern that our members, the professional societies, should either be associated with or be members of larger bodies that set standards for the profession concerned. For example, the Institute of Certified Public Accountants in Kenya is a member of the International Federation of Accountants. In the year 2000 the Kenyan accountants adopted the international accounting standards. Another example: the Chartered Institute of Arbitrators is a branch of the Institute by that name in the UK, which, by the way, is the largest Institute of Arbitrators in the world. Generally, we expect our members to follow international standards. Often, these are Western standards–or if they are not, they are heavily influenced by Western standards. If our members are not associated with a larger professional body we would encourage them to do so in order to have access to world class standards.

The other question concerns the professional/ethical conduct of professional societies’ members. Given the not inconsiderable numbers of corrupt professionals in our nation, would you say that professional societies have not been playing their role with regard to this?

The unprofessional/unethical conduct of professionals must be seen in context. In my opinion, those who behave unprofessionally have always been a small minority. That they have seemed to be many is due to the political situation in which we have been living for many years: good professionals were ignored, bad ones were promoted.

For example, the fact that so many of our judges have been found to be corrupt was a simple result of the fact that some good magistrates and lawyers were simply passed over when it came to promotion. The reason was that they were not likely to go along with the many corrupt practices the government of the day was involved in. The professional societies also had few ways of enforcing good professional conduct. Take for example the case of the Legal Complaints Commission. Theoretically, it was an avenue for the public to have recourse against unscrupulous lawyers. However, the system did not encourage the lawyers to enforce their own disciplinary mechanism. The Legal Complaints Commission is based in the Attorney General’s office; that basically means that it is a government organ. It would be expected that the Commission would take prompt action against lawyers against whom complaints have been raised. This was never the case and thousands of complaints made by members of the public were left in abeyance for many years. On the other hand, if a lawyer misbehaved grossly and the Law Society of Kenya decided to de-register the particular lawyer, the immediate reaction would be a court injunction obtained from a compromised judge allowing him/her to continue practicing as usual. The whole system was poisoned in this way.

It was the same story for other professional bodies. Most of them have Boards that have the mandate to enforce professionalism by means of sanctions. But the government system that obtained in Kenya made it difficult for these Boards to operate. There was no enabling environment. This, however, does not mean that professional societies were completely disabled. There were a number of bodies, such as the Law Society of Kenya, which did not keep quiet and vigorously agitated for change.

Now that we, fortunately, have entered a new era politically, there is greater opportunity for professional societies to play their proper role in the enforcement of ethical standards. APSEA, for example, has recently created a Professional Integrity Task Force to enhance compliance with professional ethics and standards. This Task Force is composed of representatives of the public as well as of the private sector. The Government is supportive of this Task Force and had no trouble sending its representatives to sit on it.

As far as professional activity is concerned, one can observe a very great difference between one professional society and another; this is not necessarily dependent on the number of professionals in the society. What are the key factors to success in a professional society?

A key factor in a professional society’s success is its ability to lobby for change in their area of concern. Other factors are governing structures and, of course, leadership. I am thinking of a particular association in Kenya whose area of concern is a key industry. That industry has the capacity to generate more than 20 percent of Kenya’s GDP and to generate millions of jobs and wealth for the country, but the professional association has remained largely quiet as the industry has continued to weaken and wither away on account of bad policies and corruption. On the other hand, the Law Society of Kenya became a strong advocate of democratic change on account of its enlightened leadership.

What is the role of a professional society in assuring the optimum use of human resources? We are thinking of such things as professional brain drain, either by professionals leaving the country for greener pastures or by them not being used in the profession for which they were trained.

One has to pose the question: what are the factors that lead to brain drain? In 1999 APSEA instituted a programme called Rejuvenation and Revitalization of Professionalism. The Programme had three pillars: (1) Professional business opportunities (2) Professional knowledge and skills (3) Professional integrity and ethics. Let’s just talk about the first pillar: lack of business opportunities. This was the time that many doctors were migrating South for a number of reasons: they were offered better salaries there and felt they were not appreciated at home. The same thing holds true for the nurses: we have lost over1000 nurses, mainly to the UK, in the last few years alone. Kenya’s training facilities are good and our professional skills are widely recognized. However, our country itself is poor in recognizing and utilizing these skills. As a result, our institutions are sometimes lacking in key professional personnel. In addition, we lose the money we have spent educating so many people.

For obvious reasons the Programme we started in 1999 did not really take off. It was a public/private partnership but the Government was basically not interested. We did produce a lot of good documentation, though; the trouble was with the implementation. We now hope to give this Programme a new start and expect better results.

A key concern of WAJIBU is the promotion of social justice in our society. Given the fact that professionals have a greater role to play here than other Kenyans (“for unto whomsoever much is given, much will be required”) how do you see them scoring in this area?

I am afraid that our professionals do not score well here. Unfortunately, in our society the belief seems to have gained ground that the more you gather for yourself, the greater the gap between you and those who are dependent on you for a job, the greater your standing in society. Many of our professionals are elitist. For example, some doctors will charge exorbitant fees, even from people who can hardly afford it, just so they can drive an expensive car.

Why don’t we see that better income distribution would benefit the whole society? Just think what happens when one man earns something like half a million a month. What does he do with all this money? He is not likely to increase the number of eggs he eats a day. Instead, he probably uses his income for conspicuous consumption: a flashy car, a luxurious holiday overseas. This brings no benefit to our country, it only benefits people in other countries who are already well off. On the other hand, what if this money were used to increase the wages of 100 policemen? They would all eat better, spend more money on eggs and other food stuffs and the country as a whole would benefit.

Unfortunately, our new Parliament has also got off on the wrong footing in this respect. By voting themselves hefty increases the moment they got into office, our MPs sent the wrong message to the country: social justice would have been better served if they had started with increasing the salaries of policemen, teachers and other lowly paid public servants. However, these were told to wait.

Our last question concerns your Association. Could you tell us what are the gains that members get from being part of APSEA?

There are many advantages to membership in APSEA. First of all, as an umbrella body for professionals, we are able to do research on subjects and provide services that are crosscutting. The results of such research will benefit our members as a whole. The smaller societies benefit especially since they do not have the resources to provide a broad range of services to their members. Secondly, we can also represent and speak on behalf of members in larger forums. A good example is the fact that we represent the Kenyan professionals on the National Constitutional Conference. Finally, we run seminars for professionals. In such seminars, we may draw upon the strength of strong professional bodies to benefit all, including the small ones.

Interview with Dr. James Nyikal

WAJIBU. Dr. Nyikal, one takes for granted that doctors, having taken the Hippocratic oath, would be concerned about the welfare of their patients. Their mission, their vocation, is to heal. But do you see their responsibility, their concern go further than this to the prevention of disease? If, in the case of HIV/AIDS, for example, prevention is mostly a question of social and moral matters, do you feel responsible? To be specific, poverty is one of the main causes of the spread of AIDS, for example the fact that many people cannot make a living in the rural areas and have to come to the city to work, leaving their wives behind . It is also a factor in the progression of the disease. How does the KMA show concern about such matters?

DR. NYIKAL. As far as HIV/AIDS is concerned, the Kenya Medical Association is chiefly concerned with the effects of this pandemic on people’s health and on the delivery of health services. But we do support all efforts at prevention through our involvement in various workshops. For instance we have a Training Programme on the rational use of antiretrovirals together with the Ministry of Health. With respect to the social causes and effects of HIV/AIDS, we do not have special programmes, for example on migration as a cause of AIDS. However, we are involved at the policy level to develop guidelines for humane treatment. For example, we were involved in drafting the guidelines for employers with respect to the treatment of people living with HIV/AIDS.

Doctors cannot work well without auxiliary personnel, nurses and laboratory technicians. If there is a problem either with the training or with the working conditions of such personnel, does the KMA get involved?

Although we do not get directly involved in the internal affairs of nurses and laboratory technicians–this being outside our docket–we do interact and consult with them a lot. Whenever we draw up proposals concerning working conditions for doctors, we must include nurses and laboratory technicians as well since they are part of the medical establishment. We also want to investigate the reasons why so many nurses are leaving Kenya to work elsewhere and we are looking for funds to carry out this investigation.

People sometimes complain about fees charged by doctors. Are there any guidelines as to how much a doctor can reasonably charge?

We have actually prepared such guidelines and passed these on to the Medical Practitioners and Dentists Board. The reason is that we are a voluntary association and have no mechanisms for enforcement. The Board has published these guidelines, with very few modifications. Many people do not know about this but one can obtain these guidelines from the Board. What the public often does not realize is that doctors’ fees are generally a relatively small percentage of total medical costs.

What about a doctor’s social responsibility, his/her concern with the gap between the rich and the poor in our society, do you wish to say something about that?

In any social group you will find people who have a great concern for the disadvantaged and others who do not care at all or very little. Doctors are no exception to this. But it is my personal opinion that, as a group, doctors are not generally among the cream of society. It is true that, except for those who have recently graduated, doctors generally live in good areas and can afford to send their children to good schools. However, few of them are among the super rich.

Is there something else you would wish to say about the Kenya Medical Association?

Yes, I would wish to add that the way the KMA seeks to generally improve things in our country is through developing and influencing policy. The reason is that policies can have long-term effects on good practice. For instance, we have forwarded a Bill to Parliament to regulate the activities of H.M.O.s (Health Management Organizations). These are bodies that purport to take care of your health through the provision of complete health services. However, there is no legislation to regulate such organizations and we wish to see them regulated so that people do not lose their money when the organization collapses (as has happened in the past).

There are two other areas where we are seeking to influence policy. One is on the use of tobacco: we are working on a Bill for presentation to Parliament. The other is on the introduction of national social health insurance.

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