#Sickat50 was a Twitter campaign initiated during the health workers' strike in December 2013.
Though Twitter-based campaigns seek to highlight issues that affect a concern or the rights of workers, #Sickat50 became a conversation that went further than the immediate crisis of health workers on strike, with participants taking the opportunity to discuss what challenges, opportunities and decisions we were shaping as a nation while celebrating 50 years of independence.
In March 2014, Parliament demanded that the health role be stripped from county governments after the shocking resignation of 189 doctors across the health sector.
The House committee on Health recommended the creation of a special task force seeking to reverse the devolution of health services to county level, stating that it should be phased out for three years to avert the growing crisis.
During this confusion, there was no letting up on the name calling: doctors were consistently blamed for the crisis, and the public perception was always skewed in favour of the county governments.
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The common line was that the doctors wanted more money than was available and were therefore being greedy, despite the clear guidelines created by the national government on allocation of resources, funding and pay scales. By mid-2014, we still had a crisis in the healthcare sector, a lack of consistency in the hiring and remuneration of doctors across the counties and the devolution of clear ethnic bias added salt to the wound – doctors were unable to serve in areas where they are considered ethnically as “outsiders”.
In August last year, another round of industrial unrest over pay sent county governments reeling. By October, the Government pledged to form a unit to address health crises in counties, working with the Public Service Commission. The aim of the team was to address the perennial strikes by health workers and to smooth over relations with the protagonists.
The then Health Cabinet Secretary James Macharia, emphasised the need to improve relations between the Ministry and the county governments for the sake of the public.
“I would like to extend an arm of goodwill to other stakeholders. I know it appeared as if the Executive was fighting the Council of Governors but our desire is to promote adequate healthcare to the client,” he said then.
Nearly all counties are struggling to provide health care services to their constituents. In addition, members the workforce, which remains completely inadequate in numbers, are still expected to live as saints, never receiving their pay on time, never getting enough to live on and never complaining.
In fact, during the first few months after the devolution of health began, when resignations from doctors created a crisis so vast that it compelled the National Assembly to hold a special session in March 2014, there was a clear standoff, as doctors could not, in good conscience, continue working under the conditions that the county governments had created.
The challenge in healthcare provision at county level indicates that devolution is not simply a matter of enacting legal measures or implementing policies; it is also about bringing the different county governments into unity of purpose with the national government.
That will mean that whenever county governments take over a function, they do so to improve performance beyond what the national government has done; not just to ‘own’ the budget lines that go with the function.
And there is more that is wanting other than the health issue. It therefore means, it will take great effort from county governments to establish a relationship with national government to deliver on the expectations that the ordinary Kenyan has, from both levels of government; not only in the healthcare sector but in infrastructural provision, security, education and economic development.
County governments must resolve to place their client at the centre of everything.
This means they must tap into the experience of national government, which has been performing the functions they have taken over for the last 50 years; and accept to be guided as they input their own specialised focus on each service. It remains the core responsibility of the county governments to live up to the expectations of devolution; development that locals can see, and to commit to this, fully.
This must result in the building of infrastructure, sufficient human resources and creating paid work and tangible benefits for the people.
