For many white South Africans, black demands for redistribution conjure up images of a new South Africa with no future; a country in which the state arbitrarily redistributes proceeds, assets and jobs. At the other extreme are many black South Africans who imagine redistribution to be the key to Utopia, to relief from misery and deprivation. Although there is no quick-fix solution, the status of the political and economic debate on redistribution as reflected in this book, reveals a convergence of views on a number of crucial issues in both the public and private sector, including employment, black empowerment, equal opportunity enhancement, structural constraints on change, contending policy positions and relevant African experience. The widely shared proposal of a mixed economy in a new South Africa is a prime example. (DÜI-Hff)
OBJECTIVE: To examine the availability of paediatricians in Kenya and plans for their development. DESIGN: Review of policies and data from multiple sources combined with local expert insight. SETTING: Kenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents. RESULTS: There are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged <19 years which in total numbers approximately 25 million. Only 94 are in public sector, non-tertiary county hospitals. There is either no paediatrician at all or only one paediatrician in 21/47 Kenyan counties that are home to over a quarter of a million under 19 years of age. Government policy is to achieve employment of 1416 paediatricians in the public sector by 2030, however this remains aspirational as there is no comprehensive training or financing plan to reach this target and health workforce recruitment, financing and management is now devolved to 47 counties. The vast majority of paediatric care is therefore provided by non-specialist healthcare workers. DISCUSSION: The scale of the paediatric workforce challenge seriously undermines the ability of the Kenyan health system to deliver on the emerging survive, thrive and transform agenda that encompasses more complex health needs. Addressing this challenge may require innovative workforce solutions such as task-sharing, these may in turn require the role of paediatricians to be redefined. Professional paediatric communities in countries like Kenya could play a leadership role in developing such solutions.
