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County bosses slowly presiding over collapse of the health sector

Saturday August 16 2014

Senator Godliver Omondi addresses public health workers from Mombasa County on August 11, 2014. Medical workers at the Coast General Hospital  threatened to go on strike over delay in salary payments. PHOTO | LABAN WALLOGA

Senator Godliver Omondi addresses public health workers from Mombasa County on August 11, 2014. One patient died in Mombasa as more doctors and nurses joined the ongoing strike over delayed salaries. PHOTO | LABAN WALLOGA | NATION MEDIA GROUP

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In a tiny village hundreds of miles from the capital city, far away beyond the reach of electricity, piped water or a tarmac road, a young teenage girl lies dying from a neck mass that is probably an undiagnosed cancer.

The cancer is both undiagnosed and untreated because the child’s parents do not have the financial means to access the technology needed for diagnosis and treatment of their daughter’s ailment.

Narratives such as this have been cropping up in Kenyan villages since independence. Sadly there is hardly a better metaphor for the Kenyan health care system more than one year after devolution of health services.

The process of devolving health services has now moved beyond the robust and passionate debate that preceded it. The end of active discourse on the matter should not lull potential consumers of public health into a slumber of satisfaction.

Direct evidence coming from the hospitals countrywide indicates that devolving all aspects of health might have opened a new chapter of challenges for a sector that was transferred on its knees from the national to county governments.

A curious scene recently ensued in a certain county hospital in the southern region of the former Rift Valley province that has raised the eyebrows of not just the health workers but other stakeholders that care about public health in Kenya.


On Wednesday morning, while the health workers were conducting a ward round, several Members of the County Assembly stormed the hospital. They were armed with cameras.

They hurled insults at the health workers while taking photos of patients as the workers performed medical procedures that are routinely carried out in confidence. The assailants then switched to the vernacular language probably explaining to the patients the purpose of their visit.


This despicable incident is only the latest in a long list of unnecessary and unethical cases of interference in medical practice at the counties.

The original objective in devolving health was for local leadership to mobilise resources and prioritise the construction of hospitals, equip, and stock them with sufficient drugs and medical supplies. However, there are currently few success stories from counties.

The local politicians armed with the singular weapon of supervision and motivated by short-term political goals have singled out the health worker as the prime enemy of the people.

In the quest to instantly satisfy the masses, local leaders are driving out workers and inviting an apocalyptic collapse of health services.

There have been incidents in parts of the former upper Eastern Province where local politicians have been ordering the medical superintendents to allow ambulances to pick up patients with minor illnesses from their homes and ferry them to hospital.

The working conditions for health workers under the counties are driving up resignations from public service. Health workers from several counties are downing their tools over delayed salaries.

From Kisumu to Kiambu, hospitals are shutting down as frustrated health workers battle conditions that are in shameful contravention of the Constitution and the labour laws of 2007.

Last month, more than half of the health workers countrywide received their salaries late. Many still await to be compensated for work done while others have had their salaries arbitrarily slashed by county health bosses.

The medical doctor interns are in their fifth month of working without compensation.


The well-meaning citizens of Kenya should not allow the willful destruction of the health sector. This is the time for the ministry of Labour, the Central Organisation of Trade Unions and the unions in the health sector to act.

They are the custodians of fair labour practices. The chain of command should be redefined to lock out political interference in the delivery of health services. MCAs cannot purport to be supervising health workers in a field they have no expertise.

It is the opinion of a majority of health experts that the management of human resources for health neither benefits from nor benefits devolution.

With chaos running into the second year, the counties should strongly consider handing over human resource management to a central body based at the ministry of Health. The counties can then be freed to concentrate on health infrastructure, drugs and medical supplies.

Dr Boniface Chitayi is a former secretary-general, Kenya Medical Practitioners, Pharmacists and Dentists Union. [email protected]