When in early July 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.
Details of agreement
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.
County governments' costs
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.
Newspapers and internet
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.
Comprehensive medical cover
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.
This report was supported by the Africa Women Journalism Project (AWJP) in partnership with the International Centre for Journalists (ICFJ). [email protected]