Time to revisit thorny issues that undermine health sector

Doctors at Randburg Community Hospital in Nyando, Kisumu, treat patients on April 1, 2018. PHOTO | ONDARI OGEGA | NATION MEDIA GROUP

What you need to know:

  • There may be need for a bill designating regional referral hospitals and providing for their funding and operations.
  • Every health centre should have its own board and chief executive officer who will be accountable.

A momentous handshake took place between President Uhuru Kenyatta and Opposition leader Raila Odinga, which meant that the economy could breathe easy and the country could make progress on long pending issues like health.

The support of the Deputy President William Ruto showed the commitment of the leaders in moving the country forward.

This reminded us that while in the 11th Parliament, we had noted gaps in service delivery and often debated how to address them.

Unfortunately, during their term of office, MPs have many balls to juggle, particularly on the welfare of their constituents and so sometimes policy and legislative issues do not get addressed.

In an interesting turn of events, former legislators — spared of constituency welfare issues — can address policy gaps.

That is why we wish to make concrete proposals for solving and reforming health. The policy interventions include:

1. Reversing the health function back to the national government from county governments.

The Constitution, under Article 187, envisages and provides for the transfer of functions and powers between levels of government.

There is need to have a bill detailing the procedures for the reversal and who initiates the process.

It should also provide for a scenario where a county can voluntarily reverse a function or for citizens to trigger the process through a signature system.

2. Elevating the 11 level five hospitals into regional referral hospitals to be managed by the national government.

National referral health centres are a function of the national government.

At present, the country has two such hospitals; Kenyatta National and Moi Teaching and Referral.

All the referral hospitals in Nyeri, Thika, Machakos, Meru, Embu, Kakamega, Kisii, Garissa, Coast, Kisumu and Nakuru serve more than one county, hence the need to convert them to regional referral hospitals.

For regions not well served by the 11, a further four hospitals can be upgraded in areas like Kilifi, Wajir, Lodwar and Kitale.

There may be need for a bill designating regional referral hospitals and providing for their funding and operations.

For instance, the hospital boards can draw half of their membership from the host county and the other half from national and professional actors.

3. Provide for a conditional allocation to level five hospitals.

Why would conditional funds meant for level five hospitals be sent to county government accounts instead of the hospitals’ own accounts?

Such administrative changes on health financing would go a long way in enabling universal health coverage.

One quick and necessary change is to have the funds sent by the National Treasury directly to the hospitals, thus improving service delivery.

An accountability mechanism through a professional board and a chief executive officer can be created for the direct remittance.

4. Manage health centres the same way we do schools.

The funds sent to schools are remitted directly from the National Treasury and every school has its own board of management and the principal as the chief executive officer.

Every health centre should have its own board and chief executive officer who will be accountable.

This way the health centres should be allowed to spend the money they collect through cost sharing.

5. Ring-fencing and protecting health cash at the county level.

Health funds should not be used to support politically visible projects like roads.

All counties should allocate a minimum of 25 per cent of their funds to healthcare. Misuse of health funds should attract severe penalties.

6. Health professionals should have their commission established by Statute to deal with the many issues that precipitate strikes.

Such a commission would create a complaints tribunal funded by taxpayers to give the public a chance for complaints against misconduct.

The commission should be a one stop shop putting all health professionals under its ambit.

7. In Schedule Four of the Constitution, counties are allowed to deal with county health institutions.

A definition can be put in place to designate county health facilities as those ranging from level four or three downwards.

8. Promote uptake of NHIF.

As many adults as are registered voters 19.6 million; or as many adults as sim card holders (25 million) and ID card holders (26 million) should be NHIF members.

The NHIF can tailor covers for special categories like boda boda riders, farmers, green grocers, senior citizens and mother and baby (Linda Mama).

They could consider quarterly and half year payments with a discount incentive.

Such policy interventions would be reduced to bills that stakeholders can contribute in refining.

The bills would then be delivered to Parliament through petitions.

OPTIMISM

The health committee of the National Assembly could adopt the bills and move them or delegate the task to a private member conversant with the issues.

However, the proposals on resolving health issues would best be pursued in a bi-partisan approach.

That is why we believe the handshake provides a good opportunity and environment to resolve health issues.

Ms Nyokabi is the Boresha Maisha convenor and former Nyeri Woman Rep while Ms Kajuju is a former Meru Woman Rep.