By GATONYE GATHURA

Medical workers seem to have picked a hammer to kill a mosquito — threatening a national strike for the delayed July salaries even before the month had ended.

Previously, they have taken such drastic measures only while demanding loftier ideals such as better medical infrastructure and working conditions, more workers and better pay.

So why the rush for the hammer even before coming close to the bridge? Could it be that finally the reality of the new Constitution and indeed devolution, is sinking in for professionals who had left its baking in the hands of politicians and activists?

During the two-decade long Constitution-making, the better organised teachers unions made sure that the Teachers Service Commission (TSC) was entrenched in the document detailing that tutors recruitment, employment and deployment would remain within the National government, but it was not so for medical workers.

The final document was clear that medical workers and some other civil servants under the Public Service Commission are to be devolved into county government which will oversee their hiring, firing and remuneration.

Now that time has come to part with the former employer, the National government, the medical workers can clearly see a totally new landscape ahead of them and some want the clock turned back.

Dr Richard Mogeni, an official with the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), says the sector should be partially devolved with the central government handling personnel while counties can oversee infrastructure development.

The unions see a crisis in the health sector if indeed total devolution is done but they may be more worried over their very survival.

The government has already devolved more than Sh96 billion to the counties, part of which is for medical workers salaries but unions are questioning the urgency.

Arrangement

It is nearly obvious why a Jubilee government, just emerging from a bruising battle with teachers, cannot wait to hand over ‘strike-thirsty’ medical workers to the ‘nearest bidder’. By so-doing, the government will be killing several birds with the proverbial one stone — escape another strike battle, make governors who are baying for more money happier and ensure future criticism of the health sector is directed at governors.

The unions have good cause for worry, but it might be too late since the die has been cast. Nothing less than a national referendum to change the Constitution can turn back the clock.

As from Thursday, medical workers are employees of the counties and only paper work remains to formalise this arrangement. Today, there are 47 public medical employers in Kenya unless the various Constitution implementation commissions can delay the process.

While assuring the doctors that their July salaries will be paid in good time, the National government on Tuesday said it was paying last month’s salaries to some supposed county workers — including medical workers — on behalf of the counties. The county governments will later have to refund these monies to the national Treasury.

In June, Transition Authority Chairman Kinuthia Wamwangi had assured health workers their salaries will be paid by the central government for the next six months as counties put their houses in order.

But this reprieve is not guaranteed yet because governors want all functions of the health sector and related monies devolved urgently.

“Who said we are not ready? We are prepared to take over all health-related services, including paying medical workers their July salaries,” Governor Isaac Ruto told a local TV station in an  interview in June and dared anybody to prove otherwise.

To demonstrate how this devolution means to the future of collective industrial action by doctors and nurses; then envision a case where aggrieved health workers in Kajiado County are on strike but can hardly get more than just sympathy from their colleagues in neighbouring Narok.

For the medical workers, the train has already left the station but unfortunately for the Kenyan public and the health sector, it has left without the engine.

The engine, the Health Bill 2012, a roadmap for devolving the health sector and prepared by medical professionals and donors now lies dejectedly at Parliament.

Now that the politicians have hijacked the engineless train, KMPDU chairman Victor Ng’ani is angry arguing this is not how to devolve healthcare. He says medical professionals have been sidelined in the devolution process.

Dr Ng’ani says the devolution process is supposed to take about three years, “so what is this headlong rush?”

The Health Bill 2012 poses some serious questions. For example, it suggests for the National government to take over some 21 health facilities including all provincial hospitals and some high volume district units.

Such a proposal may not go down well with governors who would largely see this as a way of government bureaucrats encroaching on their territories.

However they have not worked out what happens say when a patient from Lamu County visits Cost Provincial General Hospital, which will be financed by the Mombasa County.

Retiring

Does such a ‘foreigner’ pay more to get services in a nation whose Constitution guarantees all citizens of healthcare anywhere in the country without discrimination?

Without discussing and passing the Health Bill 2012 or any such other law, the status of institutions such as Mathari Mental Hospital and the Spinal Injury Hospital, all in Nairobi County, still remain in a grey area. Do they belong to Nairobi County and her citizens or are they national institutions?

In their rush to take on the health workers indiscriminately, the governors could also be shooting themselves in the foot.

According to the Kenya Health Work Force Project of the Kenya and US governments, a quarter of the 43,970 registered nurses in the country were aged between 51 and 60 in 2009 most of who should be retiring this year. Such retiring workers must be apprehensive over their accrued benefits.

The Health Bill 2012 had proposed the creation of a Heath Service Commission along the lines of TSC, to recruit, employ and agitate for the welfare of health workers.

Outgoing Permanent Secretary in the defunct Ministry of Medical Services Mary Ngare was a strong supporter of such an institution. “It will be necessary to accommodate a Health Services Commission in the new arrangement, even though the Constitution does not call for such a commission,” she said.