THE TRAGEDY OF HURRIED DEVOLVED HEALTHCARE IN KENYA

It is argued that it is in the times of turmoil when people reason prompted by the need to restore order. This approach has a sadistic angle since some disorders are preventable. The intended devolution is ultimately a great thing but the care givers have faulted the process being followed in doing so.

In this article I discuss the top most expected problems with hurried and unstructured devolution of public health care in Kenya. It Is worth noting that should the anticipated challenges affect the health sector negatively, it’s the poor who will bear the brunt. Public health sector provides care to 87% of Kenyan population. The middle class who are decision makers receive care from elsewhere; the private sector and overseas facilities.

What is at stake with hurried devolution of healthcare?

It is envisioned in the constitution that healthcare being essential its devolution must be systematic and guided by clear structures. In addition, the Devolution to County Act of 2012 sets presence of relevant laws as foremost prerequisite in assessing if a function is to be devolved or not.

The proposed Health Bill was introduced by the previous government but did not see the light of the day owing to fundamental flaws therein. Overally, this bill proposes certain changes to ensure that the health sector remains professionally managed and preserves its essential nature in spite of prevailing political circumstances of the day. The functions below will be irreparably negatively affected by devolution devoid of relevant structures and policies.

Training of health personnel

Kenya is credited with provision of impeccable training if healthcare workers in all cadres in the region. As a matter of fact the neighboring countries have viewed Kenya as a role model in this aspect. There is standardization of training for nurses, clinical officers, medical, dental and pharmacy officers. This has been entrenched in the well defined centrally supervised training.

In absence of centrally structured supervisory bodies to inspect and accredit training, the quality training received will be eroded. Even in the developed nations like USA, there is one central body to ensure the quality of training is safeguarded.  As a direct consequence of hurried devolution, we are likely to see mushrooming of dubious training institutions. Due to the sensitivity of services the health professionals will provide to the public, this must never be allowed to happen.  There must be defined and supervised training of all cadres. This is effectively rendered impossible by the hurried devolution of health sector.

Registration of health care providers

The health Bill recommends formation of centralized registration body to ensure only those duly trained and qualified are registered to offer health services in Kenya and indeed other nations where Kenyan credentials are recognized. It has been practice to ensure that persons trained outside the country are tested and approved before they can practice in the country. This also helps in authenticating the certificate presented. This function must never be taken to the 47 ill-equipped counties since the repercussions will be costly. In the proposed and hurried devolution, there is no clear indication as to who registers health workers.

Supervision of Health care providers

Like any function, supervision is vital to ensure accountability by all healthcare providers. In the devolved healthcare, much as the county administration argues they are capable of supervising healthcare workers, this must be distanced from political patronage and interference. The delicate nature of healthcare requires clearly defined and unambiguous separation of functions. What may appear as supervision by politicians may eventually cripple operations in public health facilities.

Specialization and sub-specialization training

A weak economy as Kenya must take heed to invest in human capital development. The role played by specialists and subspecialist in the public sector cannot be overemphasized. The determination of priority areas of training and who is to be trained must be preserved. The rationalization for this must not be subjected to the political whims of county government. Some counties have argued that they don’t even need doctors in the first place. Incidentally the proponents of this thinking are not care seekers in these facilities.

Similarly, the trained consultants must be equitably distributed in all the 47 counties to ensure that some Kenyans are not starved of these services while other places are overstaffed. The current system of identification of trainees and redistribution of qualified specialist has been variously faulted. But this is better than no system at all. There is need to involve all stakeholder in crafting policies to achieve adequate and equitable coverage by consultants.  It is anticipate that the unplanned devolution being fronted and not backed by any policy or legal guidelines will irreparably dent the attempts of attaining better coverage as enshrined in the Kenya Vision 2030

Retention of workforce in the Public health sector

The jitters seen among the health workers owing to the anticipated political interferences, proposed reduction of pay and allowances is likely to push health workers out of employment. As it is, there a reports of resignations daily, stretching the already understaffed workforce in the lower units of healthcare system. It is worth noting that this may be viewed differently depending on which side one considers. To the Salaries and Remuneration Commission (SRC), they may laud this since they have constantly complained that the wage bill is bloated. But should they jubilate while an essential sector is crumbling? My opinion is no. To the employees, this is a very worrying development.  As with all other professions, it’s the hope of majority to have conducive and supportive environment to ensure services are discharged efficiently. A very thing workforce, de-motivated souls and poorly remunerated personnel inevitably affects their output. The public health sector is better improved through reduced exodus of staff to private sector, abroad and other unrelated engagements. The question is, does the devolved structure promote retention of staff in the public health sector? Simply no

What must be done to ensure smooth transition?

It is foolhardiness to presuppose that coercion and intimidation shall achieve results. If truly the relevance of devolution is to improve service provision, then dialogue must prevail. The Fourth Schedule of the constitution of Kenya has set the transitional period to three years to give room for adequate preparation before functions are handed over to the counties. But the usual practice of shifting goal posts has culminated to the standoff between the central government, the county governments on one hand and the healthcare providers of the other hand.

It must not be forgotten that no single group desires and longs for improved healthcare than the the healthcare providers themselves. The citizens must not allow other consideration but political class such as control of procurement, tendering and rewarding of cronies and sycophants to mar the process of devolved healthcare. Finally, in the event that the public health sector collapses, it is the poor citizens who will suffer and the elites continue enjoying uninterrupted services in private facilities and overseas institutions.