It is collective suicide to devolve healthcare in Kenya

In the recent past, there has been heated argument for and against devolved healthcare in Kenya. The process has received support and condemnation in somewhat equal measure. While this process in anchored on the constitution of Kenya, it must be noted that there have been issues raised that need consideration.

The medical fraternity has come out to unequivocally fault the haphazard and hasty manner in which health care is being proposed. The constant unheeded caution by the deliverers of healthcare has resulted into the current standoff and imminent strike that will erode gains made so far in restoring the image of public health sector in Kenya.

What are the issues?

The Transition to County government act of 2012 stipulates that the most important aspect before devolution is presence of relevant law(s) to spell out roles, responsibilities, obligations, and processes. As we speak today. The Health Bill has not been passed. This is the bill that will govern healthcare and the relationship between national and county government in matters of healthcare. In the absence of this bill, devolved health will cause confusion, anarchy, endless tussles and politicization of health sector.

The bill speaks of regulation of training, standards, quality, recruitment and licensing of health care workers to guarantee Kenyans quality of care. The bill envisages reorganization of administration of health sector, proposes centralized recruitment, posting and development of healthcare workers to ensure that all the 47 counties are equitably served.

The rushed devolution portends to cause undue political interference at the county level. It must be noted that county governments have now officially entrenched tribalism going by the composition of officers serving at the County Public Service Boards. These boards are composed of tribe mates and cronies and as expected, there will be little objectivity in their judgments.

Immediate effects of devolution in absence of legal framework

The process will affect the entire spectrum of health care. Supervision of training at both undergraduate and postgraduate levels remains in jeopardy. Kenyans must be assured that the worker churned out are properly trained and equipped to attend to them. Equally important, those trained must be absorbed into the already strained system. In Kenya today, there are 4000 doctors serving a population of 42million Kenyans (1:10500); very few dentists and even fewer pharmacists. There is a deficit of 40,000 nurses in the Kenya. This will only be worse with expected resignations.  Training of consultants also remains uncertain. With a country pegging the Vision 2030 on a health workforce and improved health indicators, training of specialist must never be relegated. There must be a clear structure to determine training needs, numbers and streamline the processes

Healthcare is a highly technical aspect of development. Some quarters have termed it as essential service. There must be clear depoliticization of healthcare processes. With creation of small empires in the counties and impunity exhibited by the county authorities, it is clear that the sector is headed for total collapse unless urgent measures are put in place

What is the proposed course of action?

A well thought out strategy must be worked out to retain professionalism and quality regardless of devolution. Stakeholder participation on defining processes is very critical to ensure success; the relevant legal and policy mechanisms must be put in place to govern the devolution process. Structures must be developed to foster accountability in this highly sensitive sector. Thus a complete reversal of devolution of healthcare providers and their personal emoluments will ameliorate the situation at the law makers are urged to debate and pass the pending Health Bill. The bill must entrench a (central) Health Service Commission (HSC), a licensing Board, and an organ to check on Quality of care.

In conclusion, the policy makers should remember it is very difficult if not impossible to force a process onto people (implementers) whether backed by constitution clause of not. Let sanity and reason prevail.