At the just-ended Health Forum this past week, participants agreed that a mechanism needs to be found to improve the management of human resources for health. Among the shorter-term measures mooted is the need to ensure equitable access to highly specialised services by having most specialists based at county hospitals being detailed to serve a number of sub-county facilities in a particular region.
This improves efficiency in the system and reduces the load on county hospitals which will inevitably be inundated with all sorts of patients in the event that government announces nationwide roll-out of Universal Health Coverage.
In the long term, however, it is becoming increasingly obvious that the scattered management of human resources for health is not working in the best interests of our people. It is therefore gratifying to note that participants at the Forum appear unanimous that a national mechanism to manage the human resource function in health must be implemented sooner rather than later. This is in line with best practices elsewhere, and is the best way of ensuring uniformity in access to health services in the country.
Currently, we have practically left the health human resource function to ‘market forces’, while at the same time placing the moral burden of ensuring equitable access on individual health workers. Despite disparities in working environments across the counties, and huge differences in remuneration of health workers operating at the same level, Kenyans have insisted that all health workers must bear the responsibility of ensuring that the constitutional right to access to the best quality health services is achieved and maintained.
Unfortunately individual health workers have needs and desires just like anyone else, and the constitutional burden, constituting responsibility without any authority, has proved to be too heavy to bear. The result has been unending industrial unrest in the sector, with worsening service delivery and the entrenchment of a work ethos that is at odds with what one would expect in a professionally-run health service.
The proposed solution, which has been on the table since the promulgation of the Constitution in 2010, is the establishment of the Health Service Commission with the overall responsibility of registering, recruiting, distributing and disciplining health workers in the public sector. The original thinking when this Constitution was being written was that this Commission is key, and indeed it was included in all versions of the draft constitution up until the Parliamentary Committee retreated to Naivasha in early 2010 to come up with the referendum draft and deleted it.
There are those that have always held that it would necessarily take a referendum to right this historical wrong and entrench the Service Commission into the Constitution. Others have held that parliament has the power and authority to delegate some of the functions of the Public Service Commission, such as the management of the health human resource, to another specialized body of whatever name or description. Whatever we think, we now have the opportunity to operationalize our favourite option.
In any case, we can begin by delegating the health human resource management function to the Kenya Health Human Resource Advisory Council as established in the Health Act of 2017, and then take advantage of the referendum we have been assured is coming within the next year or so to entrench the Health Service Commission in the Constitution.
Lukoye Atwoli is Associate Professor of Psychiatry and former Dean, Moi University School of Medicine; [email protected]