Adhere to devolution master plan to stop chaos in heath sector

Nurses are on strike yet again. Clinical officers are most likely next in line, having issued a similar notice like the nurses’, complaining that their collective bargaining agreement has not been honoured, months later. Doctors could soon follow suit, paralysing the health sector.

The 2010 Constitution devolved almost the entire healthcare to the 47 counties. Kenya Gazette Supplement No. 116 of August 9, 2013 outlined the transfer of functions, including health, from the national to the county governments through the Transition Authority (TA).

FUNDING

The principle behind the transfers was simple: Costing was to be done so that equivalent funding would be provided for from the Exchequer for efficient and proper service delivery.

Counties were to ensure that healthcare is given priority by allocating enough resources to procure drugs, non-pharmaceuticals, medical equipment and promotion primary healthcare.

This is where TA failed in its mandate to shepherd devolution of health to achieve the desired results. In Trans-Nzoia County, for example, in the 2013/14 financial year, an allocation of Sh110 million was budgeted for provision of drugs, non-pharmaceuticals and other reagents against an estimated Sh300 million costing by the technical team. The county could not sufficiently provide public hospitals with medical supplies due to lack of funds.

This has been the trend.

The national and county governments should explore funding options and allocate more resources to health.

The 2001 Abuja Declaration, which is binding on Kenya as other African states, recommended that healthcare receive at least 15 percent of gross domestic product (GDP). Kenya operates way below that.

TA also failed by not coming up with a human resource manual (HRM) to provide a policy guideline to health workers. For example, the challenge then had been the fate of officers deployed on a transfer from other counties. They are stuck to-date.

In addition, there has been constant delay in payment of salaries not just to the health workers but the entire workforce in the counties. Several meetings with Ministry of Health officials to have disbursement of salaries exempted from the rigorous requisition of funds through the Controller of Budget’s office have not borne fruit.

DEMOTIVATED

Also, in most cases, health workers are exposed to poor working conditions. At times, they have little or no protective gear — such as gloves, gumboots and dustcoats. This exposes them to the risk of contracting dangerous diseases.

There is also generally a lack of enough equipment in most hospitals. There are few laboratories, which are poorly equipped. Patients are referred to private clinics for X-ray, laboratory services, CT scans and MRI to name but a few. Ironically, some of these facilities are owned by doctors in government employ.

This makes it hard for committed health workers to perform their duties. It has resulted in unhappy, dissatisfied, demotivated and frustrated workers with low productivity.

Some patients have been angry with the health workers, even attacking them for being referred to buy drugs at costly rates in private health facilities.

Corruption and theft of funds have also undermined provision of healthcare. Add to this nepotism and tribalism, where competent health officers who are not politically correct have been hounded out of office in favour of unskilled officers are put in charge of selective sensitive departments.

Besides government watchdogs eradicating corruption, counties must cut expenditure such as travel costs by leaders, who ought to show the way by seeking services in public hospitals.

Lastly, the Health Bill 2015 must be quickly passed into law to address all the ills that bedevil the health sector.

Mr Simiyu is a former CEC Health, Trans-Nzoia County. [email protected]