Effects of health crisis will be felt for a long time

For most of this year, public health facilities across the country have been practically closed.

The year opened with a continuing doctors’ strike that paralysed activities in most public hospitals and, after this was resolved, nurses and other health workers also started a series of work boycotts.

Nurses have been on strike for over three months, and most county health facilities remain deserted for lack of nursing services.

PATIENTS
At the height of the doctors’ strike earlier this year, a senior government official claimed that he was satisfied that the country can do without doctors because fewer patient deaths were reported in hospitals while the doctors were away.

Of course the official was glossing over or oblivious of the fact that few or no patients bothered to go to public hospitals during the strike because they knew they would not get the services they needed.

However, his statement unconsciously betrayed his attitude towards the health workforce in this country, and perhaps illuminated the content of health sector discussions behind closed doors.

DEVOLUTION
For a long time, the national government has viewed health as a burden that it is glad to dump on county administrations with the mischievous and cynical chant that “health is 100 per cent devolved”.

The county governments were initially excited to take on this heavy function, perhaps thinking that health services are cash cows that they would use to finance other sectors of their administrations.

They echoed the national government’s chant and insisted that they be given full control over this function.

MANAGEMENT
Four years later the health sector is in shambles due to mismanagement by both levels of government.

Our initial argument that firstly the function be transferred gradually based on ability of each county to manage it, and secondly that a national body be formed to manage the scarce human resources for health, was roundly condemned and rejected out of hand.

The function was quickly dumped on unwitting county governments, and the national government only retained the management of a few large hospitals as well as training and the formulation of national health policy.

CHALLENGES
Difficulties paying salaries, delays in procuring essential goods and services, and outright corruption have become the order of the day in the health sector, leading to continued industrial unrest and under-performance across the board.

It is, therefore, unsurprising to hear some governors and legislators arguing that perhaps it is time to create a national mechanism to manage human resources for health, leaving county governments to focus more on primary health care functions and the maintenance of county health facilities.

It is a fact that human resources for health present a complex mix of professionals and para-professionals, and it is very wasteful of this scarce resource to have 48 different authorities replicating the function that can be carried out by one representative institution managed at the national level.

SOLUTION
Politicians caucusing in Naivasha threw out the Health Service Commission from the final draft of the 2010 constitution just before it was presented for final passage by Parliament, despite the fact that it had appeared in all previous drafts.

This commission remains, in my view, the final and sustainable solution to the problem of industrial unrest in our health sector.

The fact that our politicians and other bigwigs can afford to ignore the ongoing crisis in the health sector is a clear indicator of the decline the sector has gone through.

INSURANCE

People are falling into extreme poverty every day due to the need to spend huge sums of money on the treatment of relatives who are suddenly diagnosed with catastrophic illnesses.

Private profiteers are ripping off our national health insurer because poor Kenyans are relying on it for treatment of common ailments at private hospitals of all shapes and descriptions.

The effects of the current crisis will be with us for generations to come.

Atwoli is Associate Professor and Dean, Moi University School of Medicine [email protected]