Guard against sidelining counties on health

Sunday April 7 2013


A health system provides the means through which medical services are planned and delivered.

The Constitution envisages a health system whose management is devolved to the county level.

Devolved governments will own and manage county health centres, pharmacies and ambulance services.

They will also be responsible for providing the resources required for health services provision.

This means that the centre of power will move to the 47 independent county health management systems.

The national health system, on the other hand, is charged with providing tertiary services, formulating policies and providing technical assistance to counties.

The enactment of a new health law to align the health sector with the broad policy is at an advanced stage.

It recommends creation of numerous state agencies, which should report to an autonomous corporation. This has already elicited criticism from commissions responsible for protecting public interests during the transition period.

Should the national health system expand its administrative structure to cover a function that it is no longer directly involved in? Is the proposed administrative bureaucratic structure consistent with expectations for a ministry offering professional health services?

My view is that expanding the technostructure at the ministry of health would be wrong because it’s not consistent with devolution as contained in the Constitution.

The proposed health law provides for formation of an independent central health service authority with both executive and advisory functions while at the same time it declares that the ministry’s management structure will be based on functional directorates headed by the Director-General.

This introduces two unnecessary centres of power and two parallel lines of command all competing to remain relevant at the expense of the taxpayers.

It can also be read as a motive to introduce an autocratic policy process, which goes against the goal of establishing an open process where bureaucrats should play an impartial role in the policy process.

There is limited chance that a single authority can acquire adequate resources, namely time, money and adequate technical capacity to enable it take a leading role on all policy issues we will face in the future.

The Bill also fails to recognise the legitimacy and independence of the county government on matters of health and public health administration.

It goes without saying that if counties are responsible for economically supporting the health sector, then they can’t be pawns in this game.

The new normal is that Social policies (health services, sanitation, water, waste management, animal health) formulation is the reserve of the counties.

Based on the changes that have taken place in our governance fabric, the target should be to formulate a law that will create a democratic structure and promote an open policy process.

The proposed health authority should be transformed into an advisory body whose main responsibility should be to inform all stakeholders, including the public, on matters of health.

Counties should also be empowered to determine their priority health problems and decide on the means of overcoming them.

Dr Elesban Kihuba, is a Health Systems Researcher with Sircle. [email protected]