Devolved health care is killing more people, not saving lives

Devolution can kill. That is the lesson from the country’s attempts to devolve health care. The best example of devolution killing is the current cholera outbreak. When was the last time you saw a three-digit death toll involving cholera?

Prisoners have died from the disease in institutions where the government controls the food and water supply. 

Had you ever  heard of so many people dying from the disease in water-rich Nakuru? Cholera used to be a concern for Nairobi and Mombasa because of their increasing populations and inadequate sanitation.

Nakuru is also doing a lot worse than other counties; 16 per cent of the patients developing cholera end up dead. This rate is 16 times greater than the WHO recommendation in handling the disease. 

The current outbreak has recorded more than 3,000 cases, almost 100 deaths, and involves 11 counties. It is an unacceptable situation and an indication of failed health care systems. Counties have failed the first major test of their health care systems.

A national outbreak requires a very strong government response. Cholera is transmitted mainly through contaminated drinking water. To get rid of it, you need infrastructure that offers people clean water and adequate sanitation. Cholera is highly contagious, and when people move to and from the affected counties, they could spread the infection.

To get rid of cholera, you might need to quarantine whole villages and take stool samples. It requires the government at its most muscular and jackbooted to inconvenience a few in order to protect  many. No governor who has an eye on re-election will dare order quarantines and stool tests required to stamp out cholera.

HEALHY BUSINESS

Cholera can be easily managed at the local level. However surveillance, targeting and sanitation are a national concern. All aspects of managin the outbreak only emphasise how inadequate counties are at managing contagious diseases.

During a cholera outbreak, only the central government can co-ordinate a proper response. The government has announced that it has spent half a billion shillings fighting the disease.

The reason counties can’t handle cholera is simple: public health is not sexy. It doesn’t have shiny new ambulances or brand new hospital theatres for governors to unveil. Sanitation doesn’t win votes, but it saves lives. This is why county governments are so inept at it. Their immediate goals of maximum publicity for re-election rather than what a county needs.

Thanks largely to our governors’ efforts, we have county health budgets being being misspent. We have ambulances in areas with no roads, teleconferencing facilities in hospitals with doctor shortages, hospital theatres in areas with no surgeons, and radiotherapy equipment with no technicians. In fact, one county has more ambulances that it would ever need, but as you know, sirens are a big hit with the voting public. 

The devolution of health care so far has threatened both the standards of service patients receive and the viability of the health care services in many counties. Putting doctors on county payrolls have worsened the sector’s chronic staffing and funding problems.

Last year, 800 doctors resigned from the public sector, according to the doctors’ union. The doctors who quit are going into private practice and, presumably, not going back to work for the government.

Rich counties top up their government allocation through revenue collection to attract the best doctors. The medical profession should also be criticised for this state of affairs. Most doctors prefer being posted to richer counties because it gives them a better chance to run their own clinics. Moonlighting in Mandera is hard while in Nairobi, every doctor seems to have a clinic. This is why you find that the busiest hospitals (which are in the richest counties) also have the worst absentee rates.

Some hospitals, like Coast General Hospital, were expected to subsist on money from Mombasa County while at the same time serving the surrounding counties. The result is that hospitals cannot deal with the current caseload and have been caught flat-footed by a spike in demand.  It was encouraging to read last week that the government is planning to take up level 5 hospitals under the national health care umbrella.

Disease control is a nationwide affair. There are economies of scale in fighting disease from the national level. There is pooling of resources and counties are unable to each recruit epidemiologists.

Devolution has been essential in national politics. The same isn’t true for health care. However, the move to devolve health care is beginning to look like an experiment whose failure will be measured in deaths. 

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How will CBK boss serve two masters?

I HAVE NO PROBLEM with the CBK governor’s marital status. However, I am very curious about his religious affiliation. It is good that, due to his beliefs, he refuses the trinkets and baubles of power. But I wonder whether that increases his suitability. Due to his membership of the Opus Dei, he lives a life sheltered from many economic realities. He does not, for example, engage with the economy like the rest of us since he gets a stipend for his needs.

I am curious about the strictures the Opus Dei places on its members. I think its beliefs should be scrutinised. The order does a lot of good work, but its past is linked with support for several right-wing dictatorships in Latin America. That is well known. In 2005, there was a bit of a brouhaha in the UK when Ruth Kelly, an MP affiliated to the religious order, was made equality minister. She shocked her party when she refused to answer the simple question, “Is homosexuality a sin?” I am not sure someone who is so openly committed to serving God should serve in the government. The practicalities of governing preclude rigid worldviews.  We have a manwho is very committed to serving God and at the Central bank, Mammon. What would happen if a conflict arose?

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Let’s stop buying stuff we can make 

THERE HAVE BEEN a lot of explanations about the shilling’s woes recently, except one of the most obvious: Kenyans’ tastes. They import too much but do not sell anything in return.  As I write, the shilling looks like it is set to hit 100 to the dollar.

Our current account situation keeps deteriorating. The answer should be, buy more Kenyan products, particularly where there are alternatives. I have seen Chinese toothpicks, German deodorants and Indian butter, all of which have local substitutes.

The government should ask more Kenyans to drink Kenyan wine rather than French, Chilean or South African wine. It should ask citizens to drink Kenyan beer rather than Dutch or American variants. It should tell coastal communities to stop eating fish that comes in from Pakistani trawlers and subsist on the smaller fish brought in by Kenyan fishermen. 

 Buy Kenyan, build Kenya. At the end of the day when the shilling tanks, we will be the ones to pay more at the pumps.

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FEEDBACK On why the NYS should be disbanded

Give sensible ideas

It is a misplaced call at a time when our youths require  attention  to help them overcome the many challenges they are facing. The school system’s discipline is not enough. Schools are busy dealing with the loaded curriculum. There’s even no time even for teaching of life skills.  Waga is reading politics instead of giving sensible ideas on how to make our youth participate in the country’s economic development.

Kosgei Yator

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Waga focused on negatives

I read Waga’s article with a mixture of sorrow and bitterness. Sorrow because I am not sure what his objective was, and bitterness because he focused only on the negative aspects.

The NYS has done what the previous governments failed to do. The international community has just given the Ministry of Devolution and Planning, under whose docket it falls, an award for improving the lives of the people living in slums and service delivery. Yet Waga sees no tangible benefit in the work it has so far done or in its potential? It would have been an interesting read if he had offered alternatives to the NYS.

Mike Muriithi

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NYS training is unmatched

I have always admired the deep insight offered by Waga Odongo, but on this one, I saw only shallowness. I have faced many great challenges, and it is the training and mentoring that I got at the NYS that helped me cope. The NYS is the only place where you can easily gain access to the best mentorship and training.

For Waga’s information, the NYS has the 5BEx (five body exercises) in the morning, followed by breakfast, then parade where cleanliness is inspected; then drills or academic training where counselling is given; then parade or fitness thorough cross-country programmes, then cleaning of the barracks and selbefore  you retire. The emphasis is on effort.

He should experience the NYS first-hand to know what really happens there. Let those who can benefit from it do so while wishing those who don’t well because they will have at least gained something useful.

Geoffrey

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NYS a dangerous project

Waga is right! The NYS is a political project, and a very dangerous one to the democratic nation we’re building. Napoleon in  The Animal Farm  had a similar project: he bred puppies which turned into ferocious dogs for attacking his opponents. The NYS project is a very clever project of the current ruling elite, who have a different view of the nation we’re building. The youths engage in civil works after training, so why put them through military drills and not courses like carpentry and motor vehicle repair? Why not engage them  in the various line ministries and county governments, if their work is manual?   

James Njau

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I like Waga’s radical but valid perspective of the NYS. However, it came at the wrong time, when questions are being raised about the minister in charge. This might be viewed by some critics as being instigated by political opponents for personal gain.

S.W. Thuita