Solve health sector impasse on devolution

NAIROBI: With the advent of devolution, the public health sector went into a spin following a protracted stand-off between the national and county governments and the industry players over the management of health services.

Notably, while other health functions have been devolved to the counties, the national government remains in charge of training, welfare and promotions, yet the major bone of contention has been remuneration, which doctors and nurses claim county governments are ill-equipped to handle. For the better part of last year, we witnessed a number of strikes by nurses and doctors, which compromised the quality of service. Across the country, striking doctors and nurses invariably complained of poor remuneration, delayed salaries, lack of medical supplies and poor working conditions.

According to the Kenya Medical Practitioners and Dentists Board, the Government's failure to address these concerns has seen at least 1,800 doctors quit Government service to date. For a country that boasts of only 3,300 doctors against an estimated population of 40 million people, this is worrying. However,  Health Cabinet Secretary James Macharia at one point tried to downplay the doctors' exodus, terming it a product of media exaggeration.

The National Assembly's Committee on Implementation of Resolutions has recommended devolved health functions revert back to the national government to facilitate the restoration of functions that are slowly grinding to a halt because of constant industrial action. While this recommendation resonates well with doctors, who have all along demanded that medical services be a function of the national government, governors, who have been calling for a total devolution of functions, will be opposed to this recommendation. The best way forward would be to have round table discussions with all the stakeholders.

The National Assembly's committee argues that over Sh3.7 billion allocated to counties for hiring health workers has been diverted to other uses by county governments and it is not hard to figure out where all the money ends because the Controller of Budget and the Commission for Revenue Allocation have indicted county governments for wasting resources on trips, allowances and recurrent expenditure.

We cannot deny the fact that medical services are in a crisis especially with the lack of adequate medical supplies and low doctor-patient ratios. More than 50 per cent of Kenyans live below the poverty line and cannot afford services from private clinics, hence over-reliance on Government hospitals.

The new rates recently announced by the National Health Insurance Fund seem geared towards forcing out unemployed Kenyans, who form the bulk of the population, by increasing monthly instalments to prohibitive levels that negate the Government's pledge to make medical care a priority and affordable to all Kenyans.

It is against this backdrop of gloom that the National Government must act with speed to stabilise the medical sector by addressing these very urgent concerns. In all their deliberations, stakeholders must put the interests of the country and poor Kenyans first. Hiring more doctors on favourable terms should be prioritised as the Government also ensures adequate medical supplies. A recent World Bank survey revealed 85 per cent of hospitals experience drug shortages. There have been cases of unnecessary red tape, delaying the supply of basic drugs to public hospitals.