Report exposes rising inefficiency in counties as healthcare deteriorates

Striking nurses in Mombasa stand in soliderity outside the Coast General Hospital. They ended the five day strike on Monday following a court order. [PHOTO/GIDEON MAUNDU/STANDARD].
Two years into devolution, health institutions are ailing. From drugs shortage and expired ones to delayed salaries, hospitals countrywide are grappling as Kenyans, especially the poor, suffer.

The Ministry of Health says most dispensaries and health centres hardly stocked recommended medicines. A health sector performance report for 2013 and 2014, says only a third of dispensaries had the required medicines in stock.

“This indicates a major challenge for dispensaries since all recommended commodities must be available in all facilities at all times for efficient delivery of quality services,” reads the report in part.

The report indicates high rates of expired drugs in dispensaries and health centres of up to three times higher than allowed levels indicating poor planning and high wastage of public resources in the counties.

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The analysis concludes that while there has been a rush to improve infrastructure including buying of equipment the quality of health care deteriorated during the first two years of devolution.

“I urge all health stakeholders to read the report and ensure the recommendations are implemented,” says Director of Medical Services Nicholas Muraguri, in a forward.

Because of the deterioration of quality of healthcare there was an increase of deaths due to ill-health during the said period.

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Twenty five counties led by Garissa registered a hike in the number of deaths while Bungoma had the highest reduction of deaths.

The ministry blames country governments for putting too much emphasis on infrastructure at the expense of quality health care and welfare of health workers.

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Enumerating success of devolution in a documentary aired during the opening of the Kisumu conference, governors displayed ambulances and medical facilities they have bought to improve health care.

The National Government has also leased Sh38 billion medical equipment to be distributed in all counties. The lion's share of the funds will go towards cancer diagnostic equipment while Kenyatta National Hospital remains the only public health facility offering radiology services.

“Data suggests that the health sector was able to increase the number of functional health facilities by about 20 per cent during the study period. The largest increase was reported in Nyeri, Kirinyaga, Kajiado and Kiambu counties,” reads the report.

The government says quality of service may have been affected by disruptive deployment of health workers to the counties which may have reduced productivity.

“The worst affected countries were those that reduced the pay of health workers while there was less work disruption in counties which did not reduce workers allowances and other earnings.”

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“These kinds of disruptions lead to some very unfortunate consequences and they are far from over with the national government playing poker with doctors,” says Ouma Oluga, Secretary General of the Kenya Medical Practitioners Pharmacists and Dentists Union.

The union has threatened that its members may go on strike unless they are given a Sh300 per cent salary increment citing a 2013 Collective Bargaining Agreement.

“We hope the two tiers of government carefully read this report because so long as important workers issues remain on the shelves lives will continue being lost regardless of how much equipment is bought,” says Dr Oluga.

The demand for higher pay on the other hand, the ministry says could lead to the hiring of lower level cadres which could further compromise the quality of care.

The Ministry is yet to take the Health Bill 2014 to Parliament which has been at the Commission on Implementation of the Constitution since July last year. The Health Bill has been at the centre of health workers demands arguing it would legally spell out their terms of engagement.

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While the counties have been calling for more health funds the report shows high levels of inefficiency and improper utilisation of funds. The report says if the funds are reduced in more than half of the counties they would still achieve the same results they got in the last two years and advices them to utilise resources efficiently for better results.

Isiolo, Lamu and Vihiga counties are reported to have used resources efficiently while the least efficient counties were Nairobi, Kiambu, Kilifi and Homa Bay. Nairobi and Lamu counties however, appear to be investing more than they may require in infrastructure.

The Ministry concludes that even with the current level of funding the 44 inefficient counties in health delivery can improve their output by 47 per cent which could save lives.

“Counties are utilising health resources with levels of efficiency that are staggeringly different.”

The Ministry however, calls for more health funds to counties in the Northern Arid Lands. The current levels of investments, the report says are grossly inequitable when compared to the other counties.

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ministry of healthdevolutionhealthcarehealth workers