Public-private partnerships key to healthcare devolution

By PASCHAL MANYURU

Many health workers in the civil service are questioning the government’s rationale to devolve health services. For instance, while health workers have opposed the move to transfer their salaries to the counties, the government insists that health being one of the devolved functions, must be handled at the county level.

This is just but one of the many challenges facing the devolution of healthcare. Others include the establishment of physical structures, recruitment of health workers, restructuring, quality, affordability and accessibility related issues as well as high disease burden, changing disease patterns, inefficiency and lack of accountability.

It is important to note that provision of effective healthcare is a specialised function that requires a multi-faceted approach. Therefore, some aspects such as quality control, pharmacovigilance and training would be better handled at the national level to benefit from economies of scale in the utilisation of the scarce resources. While all these fears exist, devolution presents an incredible opportunity to build a healthier Kenya. This potential can only be realised through Public Private Partnerships because no single organisation or governance structure can go the devolution journey alone.

Without responding to the constitutional changes through strategic partnerships, successful implementation of the devolved government structure will be a challenge. Engaging with the county governments is critical to the success of devolving health services. The Mission for Essential Drugs and Supplies (MEDS) has, for instance, chosen to partner with the 47 counties. This initiative creates an opportunity to enter into constructive dialogue with County Executive Committee Members for Health to jointly address priority areas in their respective counties. This is the most viable way to ensure that Kenyans have access to reliable, quality and affordable healthcare. Otherwise the devolution process would be derailed by endless wrangles.

More than 40 per cent of Kenyans access health care through non-government actors, with faith-based organisations forming the bulk of this sector. Through public private partnership, we will provide reliable and quality medicines and medical supplies efficiently and at affordable prices to all government health facilities in the 47 counties. Granted, MEDS serves over 1,800 health facilities across the country and another 22 in the larger East and Central African region.

It is impossible to devolve quality and accessible health services without sufficient skilled and evenly distributed health workers. Kenya is classified by the World Health Organisation (WHO) as having an absolute shortage of health workers. We are also struggling with the proliferation of quacks masquerading as professional medical practitioners. If this problem is not tackled, devolution might open up opportunities for such imposters to continue their practices.

To ensure health workers especially in rural areas have relevant skills to serve Kenyans, public private partnerships can offer quality capacity building programmes to those who lack access to continuous professional development. Since 1987, MEDS has trained over 18,000 health workers in diverse fields including medical, nursing and clinical officers. As private players, we can assist in capacity building, which will have a significant impact on health care provision in Kenya.

Counterfeit drugs continue to take a toll on the country’s health sector. Through partnerships, our WHO prequalified quality control laboratory will be accessible to all health facilities.

Each county should identify emerging health issues in their communities and tackle them by taking advantage of organisations with already established and tested systems. 

Successful devolution of health services demands public private partnerships between all key players in the health sector. Though we operate in a world of scarce resources, together we can achieve more with these fewer resources.

The writer is the Managing Director, Mission for Essential Drugs and Supplies